Golfer’s Elbow (Medial Epicondylitis)
The rapid arm and wrist movement required in many jobs and sports can lead to sprains, strains or persistent tendonitis in the elbow area. Most of the muscles that create hand or wrist movement originate in our forearm. Muscles that close our wrist and hand (flexion) are located on the inner portion of our forearm (see figure 1). These muscles are collectively known as our forearm flexors. The attachment point of most of these muscles is on the inside of our elbow at a bony prominence known as the medial epicondyle. Many common actions can cause trauma to the tendons of these muscles at their attachment point, causing a pain usually referred to as golfer’s elbow or Medial Epicondylitis (M.E.).
While a golf swing can cause this sort of trauma, the majority of persons experiencing this condition are not golfers. Severe to moderate trauma can happen from sports such as tennis, golf or baseball. Similar injuries can occur from common work activities such as hammering or chopping wood. As well, mild but persistent, cumulative trauma often develops in the workplace as a result of muscles that are asked to remain in a contracted state without adequate rest cycles.
The most common symptom of M.E. is pain felt on the inside of the elbow. This pain is made worse: when palpated (pressed on), when flexing the wrist (especially under load), when grasping objects, when lifting heavy objects, or when stretching the forearm flexor muscles. Initially the pain is felt at the elbow but as the condition progresses pain can radiate into the forearm.
Treatment of this condition will depend on how you developed the problem and should usually involve a soft tissue specialist. Treatment of M.E. caused by trauma will be different than if the onset was gradual. However there will be treatment similarities no matter how you developed the condition. What follows is a range of approaches used to treat golfer’s elbow. Most of these modalities are offered in our clinic. The rest you can do on your own.
Rest – Initially the body needs time to repair the area. Ideally the aggravating activity should be stopped or minimized. If work exacerbates the pain then you may need to look at ergonomic assessment of your tasks and work station. You may also need to look at light duty or job rotation.
Cold Treatment – A Cold pack should be used after any exertion or deep massage, or when experiencing pain in the elbow. Use a wet towel so that ice does not make direct contact with the bone. Do not leave the cold on for longer than ten minutes. If the pain continues, then you can do several cycles of cold for ten minutes on, followed by ten minutes off.
Ultrasound – A series of ultrasound treatments will speed up tissue healing. This is particularly with any form of tendonitis when combined with manual therapy such as Soft Tissue Release
Soft Tissue Work- which includes trigger point massage, deep muscle stripping, friction massage of the tendons and Soft Tissue Release will speed up healing.
Stretching – Once healing has begun, you can begin stretching the forearm muscles. Stretching is always done with a straight elbow. Figure 2 shows one method of stretching both forearm flexors. To stretch only the affected arm, use your good arm to grasp the fingers of the other arm and pull back till you feel a stretch along the forearm. This can be done seated or standing and is performed with a straight elbow on the affected arm.
Elbow Braces – This is an area of disagreement among physical therapists, but the general consensus is the braces can be effective if used during the aggravating activity, and not used at other times (i.e. not all day). These are available at many drug stores and sports stores.
Acupuncture – Acupuncture has also been shown to be helpful in the management of elbow pain.
Ergonomic Factors – Typically there are ergonomic factors contributing to any repetitive strain injury such as Medial Epicondylitis. Ergonomics not only refers to your setup at work, but also how you perform any activity at home or at play. For some basic ergonomics education check out my articles on Repetitive Strain Injury and Workstation Ergonomics. In our consultations here with you at Brian Fulton RMT, we can go over these issues to minimize the impact of any given activity on your body.
Anti Inflammatory Medications – This is outside of my realm of expertise, but there are natural anti-inflammatory products on the market as well as the prescription and non-prescription drugs. Ask your doctor, pharmacist, or naturopath about these options. Anecdotally I have spoken to a few people who have had good responses from some of the joint medications containing natural anti-inflammatory compounds.
Strengthening – Once the area has healed you can begin strengthening the muscles and tendons involved. The stronger an area of the body is the less likely it is to be injured again. Figure 3 shows a resistance exercise that targets the structures involved in M.E. The wrist is flexed against mild resistance. Over time the resistance is then increased.
Overall body conditioning is also important to consider. Poor body conditioning can lead to fatigue and improper body mechanics as the course of any activity prolongs. As well, a healthy body simply resists the stresses of mechanical insults better and bounces back quicker than a poorly conditioned body.
All forms of tendonitis can be stubborn to manage if the aggravating activity is not stopped. Like any condition, it will respond best if you get at the root cause of the problem. For more information, see a massage therapist for a treatment and rehabilitation program specific to your own situation.