Elbow Pain

Golfer’s Elbow

Golfer’s Elbow

Golfer’s Elbow, aka Medial Epicondylitis, is a niggly condition that affects not only the everyday golfer taking a swing, but those involved in racquet sports, (e.g tennis/squash), throwing, and activities that involve gripping (e.g driving). This may be due to repetitive stress or excessive loading which can build up around the tendons and muscles on the inside of the elbow and forearm.

For some people, you may not see this coming. Over time, what may begin as a low level irritation can soon turn into a pattern of pain and discomfort from the stressed structures, which can lead to pain with grip, weakness in grip and sensitivity to touch. If this is your dominant arm then this can be quite limiting in day to day activities.

med Epicondylitis

But alas! All is not lost! It may just be that your grip technique is off, and this in turn has put low level undue stress to the inside elbow. For example, a lot of amateur golfers can have poor swing mechanics at impact, which can lead to excessive load on the forearm muscles. Simple swing modifications may be all that you need to become pain free. For sports that require a lot of throwing (e.g Cricket or baseball), technique needs to address the power exerted from the ground up through the body. Rest from your aggravating activity, and icing around the elbow may be advised in the first instance to allow any inflammation to settle and structures affected to begin their repair process. A graded and progressive strength programme for the muscles of the shoulder, arm and forearm may also be required.

elbow

Tennis Elbow

Tennis Elbow or Lateral Epicondylitis

Background Information

  • Affects 1-3% of our population.
  • Risk Factors include:
    • Smoking
    • Obesity
    • Aged between 45 and 54
    • Repetitive movements for at least 2 hours daily
    • Managing physical loads over 20 kg

What is Lateral Epicondylitis?

Tennis Elbow

Tennis Elbow

  • Your Lateral Epicondyle is a bony point on the outside of your elbow.
  • Your wrist extensor muscles attach at this point. These muscles enable you to lift your wrist and assist with grip.
  • Lateral Epicondylitis is inflammation of this area when these muscles are repetitively overused.

What can cause lateral Epicondylitis?

  • Repetitive or explosive demand on the muscle-tendon is the main cause of lateral epicondylitis.
  • Performing strenuous or exaggerated movements with a known degenerative tendon.
  • Repetitive motions in which the wrist frequently deviates from a neutral position (ie not held straight).
  • The regular handling of loads over 20 kg.
  • Non conditioning or weakness of the muscles/tendons to be able to perform all of the above tasks

Treatment

  • Initially relative rest and avoidance of all aggravating activities with guided graded return of these activities when appropriate.
  • Use of Taping/support brace to offload the tendon.
Support Brace

Support Brace

  • Physiotherapy led specific strengthening exercises.
  •  Use of Non-steroidal anti-inflammatories or Gels if not contraindicated
  • Using ice wrapped in a light cloth over the painful area – 10 minutes on, 5 minutes off, 10minutes on.
  • Soft tissue release and friction massage of the wrist extensor muscles and tendon.
  • Dry needling or western medical acupuncture to aid muscle release and pain relief.
  • Joint mobilisation
  • If your symptoms persist or are significantly impeding your function/ability to work a corticosteroid injection or PRP treatment may be beneficial.
    Elbow Injection

    Elbow Injection

  • Very occasionally a surgical referral may be required if severe pain/functional restrictions continue for six months or longer despite compliance with physiotherapy.

Prognosis

  • Over 90 % of cases of epicondylitis can be managed non-operatively.
  • On average if left untreated, symptoms associated with Epicondylitis persist between 6 months and 2 years
  • With treatment symptoms usually improve within 6-12 weeks.
  • In some cases rehabilitation may take 3-6 months.
  • Longer rehabilitation is more likely with high physical strain at work, dominant side involvement, concurrent neck pain, duration of symptoms for greater than 3 months, and severe pain.