Non-golfer with golfer’s elbow
Golfer’s elbow refers to a painful condition of the inner side of the elbow. Cause of the pain is usually overuse of the forearm muscles attached to the elbow. These muscles work to bend the wrist and rotate the forearm. Despite the name, it also afflicts non-golfers.
Any repetitive wrist flexion activity (bending towards the palm side your hand) can lead to the development of Golfer’s elbow; activities such as golf, tennis, badminton, or games that involve repetitive throwing such as cricket and netball.
The main symptom for Golfer’s elbow is pain at the inside of the elbow. In addition,
- The pain is felt either on or around the bony part, and sometimes spreads down the forearm.
- The pain is usually worse with wrist bending or grasping/lifting activities. Sometimes fully straightening the elbow is difficult because of pain.
- There may be tingling sensation, or numbness on the inside of the forearm and the last 2 fingers, and is usually worse with or after activities.
- Over time, grip strength weakens.
The management of Golfer’s elbow starts with pain control, followed by soft tissue therapy, and conditioning of the affected muscles and followed by the correction of technical faults.
Pain control & soft tissue therapy
This is the first stage. Before we proceed with the other stages of treatment, the pain needs to be under control. Initial pain and inflammation control is usually achieved by rest, icing, and use of anti-inflammatory medication (see RICER). This happens within the first 1-2 weeks. Physiotherapy treatments such as ultrasound, myofacial release & taping are helpful too.
Conditioning of the affected muscles
When pain and inflammation is under control, the stiff muscles need to be released by heat treatment, massage, and stretching exercises. (pictures) Strengthening exercises should start with pain-free movements. Important movements are gripping, bending of the wrist, and turning of the forearm. Good posture of the body and shoulders is important during exercises. For those who experience tingling or numbness of the forearm and fingers, it is because the nerve passing through the affected muscles is irritated, either by direct compression of the muscles or by the chemicals released from the inflammation of the muscles. In this case, it is necessary to gently mobilize the nerve to assist with better healing (see picture).
Technical fault in movements varies depending on the different requirements of the individuals. For example, those who play racquet sports, good wrist control during strokes are crucial to prevent overuse injury. A good technique is one in which the wrist stays neutral (bent neither to the palm nor the opposite) during strokes. Return to sports should be paced to the tolerance of the muscles, and improvement of techniques and fitness.