Golfer’s elbow – Swing into freedom from pain

1. Symptoms of Golfer’s Elbow

A doctor may use the medical terms medial epicondylitis or epicondylitis humeri ulnaris, but this condition has two leading indicators: discomfort on the inside of the elbow and restricted movement.

• Early on, only activities that strain the affected area trigger the pain. Often, these indicators subside quickly if care is taken.
  
• Eventually, the bony protrusions on the inside of the elbow react become painfully tender and overheat, redden or swell.
• The elbow begins to hurt when resting or when under slight strain. Regular movement is no longer possible, and the pain can radiate into the whole limb (carpal tunnel syndrome, wrist pain).
• Sufferers find it hard to grip firmly. The fist can only be closed to a limited extent.
• Patients often try to relieve the pain by keeping the elbow permanently flexed.((Müller, A.M., Müller, S.A., Stelzenbach, C., Tennis- und Golfer-Ellenbogen. In: Schweizerische Zeitschrift für Sportmedizin und Sporttraumatologie; 2015, 64 (4), p. 28)), ((Heinrichs, G. et al., Ellenbogenüberlastungssyndrome. In: Trauma und Berufskrankheit; 2014, 16 (4), p. 411))

Self-Test

If you have several of the indicators, you likely have this condition. Try a self-test to be sure:

Sit down in at a table and place the affected limb on it with the palm facing upwards. Ask someone to hold your wrist. Then try to raise your palm by bending your wrist. If you notice pain inside your elbow, it is possibly medial epicondylitis.

The following chapters offer important answers about the causes of this condition.

2. Causes of Golfer’s Elbow

2.1 Occurence and Risk Groups

Typical symptoms occur in the fourth and fifth decade of life, so sometimes a doctor will refer to medial epicondylitis as “midlife crisis of the tendon.” This health condition occurs more frequently when people have regular professional activity and are climbing the career ladder, suggesting a connection between the demands of modern working environments and pain in the elbow joint.((Müller, A.M., Müller, S.A., Stelzenbach, C., Tennis- und Golfer-Ellenbogen. In: Schweizerische Zeitschrift für Sportmedizin und Sporttraumatologie; 2015, 64 (4), p. 25))

The main risk groups for this health condition are those:

• Who repeatedly perform screwing movements,

• Lift heavy loads or,

• Bend the limb often over long periods.((Müller, A.M., Müller, S.A., Stelzenbach, C., Tennis- und Golfer-Ellenbogen. In: Schweizerische Zeitschrift für Sportmedizin und Sporttraumatologie; 2015, 64 (4), p. 25))

This health condition can certainly be caused by spending a lot of time on the golf course or by being an athletics ace; however, most patients have never held a club or a javelin. Chopping wood, painting, hammering, repairing cars, cutting and peeling food all day as a cook – or sitting in front of a PC for 40 hours a week typing – can all contribute.

2.2 Anatomy of the Elbow

Your elbow is a “hinge” joint made up of three partial joints. Three bones are involved – the humerus, the radius, and the ulna. The forearm’s flexors and pronators are the primary muscles involved; they are responsible for the flexion and inward rotation of the forearms, hands, and fingers.

📌 Golf or tennis elbow?

Tennis elbow occurs much more frequently and starts at the outside of the elbow where the muscles that stretch the forearms, hands, and fingers start. The muscle attachments of the extensors are therefore affected.

2.3 How Golf Elbow Is Caused

Your finger and hand flexors have a common tendon attachment located at your elbow’s inner bony protrusion. This is the source of your pain.

This health condition happens when the tendon attachment at the elbow is consistently irritated. Permanent overloading, mostly due to one-sided flexing, causes this.

Extended periods at your computer – typing and using your mouse – mean you keep bending your palm towards your wrist. For optimal muscle function, you should take care to move your joint in all possible directions, but this doesn’t happen if you are frequently at a 90-degree angle to your desk. Flexors shorten, and fasciae (the connective tissue around the muscle) become tangled. Simultaneously, the extensor is compensating for the position.

This increases the force with which the tendon pulls on the bone. Eventually, the load exceeds your body’s repair capacity. Then the smallest injuries (micro-trauma) occur at the bone transitions. The periosteum can become detached and cause inflammation. This might cause a “mouse arm” (or more commonly, repetitive strain injury syndrome) due to the one-sided overload of constant mouse clicking at work.

Sources of Pain

It is not inflammation that causes your pain – that is just the body’s reaction and an attempt to repair what happens when you pull the bone too hard. It’s actually overloading the muscles and fasciae that causes the discomfort as, in addition to the response to overstrain, there is also signal pain. This is your body warning you that the tensile stress in a certain area is too great, and there is a risk of severe damage. To prevent this, your brain tells you where the threat is – the inside of your elbow. Read more about signal pain and our theory of pain development here.

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3. Treatment of Golf Elbow

We recommend treating this health condition without delay – even if the discomfort is bearable. Not intervening at an early stage risks partially or completely tearing your tendon. Additionally, calcium deposits or ossification might occur and may require lengthy therapies.((Heinrichs, G. et al., Ellenbogenüberlastungssyndrome. In: Trauma und Berufskrankheit; 2014, 16 (4), p. 411))

Watch and wait?

In most cases, even without medical treatment, spontaneous healing occurs within one to two years. A doctor will often recommend a “watch-and-wait” method.((Heinrichs, G. et al., Ellenbogenüberlastungssyndrome. In: Trauma und Berufskrankheit; 2014, 16 (4), S. 413)) But you don’t have to keep suffering; by exercising, you can become pain-free.

Our stretches are specially designed to relieve this health condition. We know it is a different complaint from tennis elbow and accommodate its specific therapeutic requirements.

3.1 The Liebscher & Bracht Approach

Our goal is to make you pain-free. We don’t just want to relieve your symptoms, we want to provide treatment for the cause – the muscular-fascial tension in the flexors.

Pain therapy from Liebscher & Bracht supports you in many ways. You can find all the information about our concept – osteopressure, light osteopressure, stretching, and fascial roll massages – on our therapy page.

Our therapy helps to compensate for one-sided movement patterns or incorrect posture by stretching your arms. The pulling force on the muscle tendon at the inner elbow is reduced, and the musculofascial network can start to repair. Your brain can stop the signal pain, and inflammation gradually subsides.

3.2 Conventional Measures

A conventional health care treatment may include anti-inflammatory medicine, painkillers, and cortisone injections. In the short term, this can help with discomfort, but in the long term, continued use of medicine may have serious side effects. As well as weight gain, skin damage, and suppression of the immune system, “numbing” the pain with medicine can lead to further injury as the body’s warning system is impacted.

📌 Our therapy differs from almost all common medical approaches as osteopressure, fascial roll massage, and exercising treat the cause, not just the symptoms. Success can be permanent:

• No side effects, complications, or risks.
• Exercising is free. Do it at home or in your office.
• Reduce your sick days and move normally.

A combination of stretching and foam rolling reduces the tension on the elbow, relieves the tendon, promotes blood circulation, and stimulates repair processes.

4. Exercises to Combat Golfer’s Elbow

Our treatments are tailored to treat medial epicondylitis with care. The fascial roll massages and the stretching are designed to normalize muscular tension in the whole limb.

Read our checklist if you are new to exercising and start with confidence.

We assume that the tensions are located on your left side. If your problem is on the right, do the movements for the other side first. We recommend you always practice on both sides to prevent new imbalances developing.

Exercises in Brief – Stretching the Forearm

• Step 1: Put the affected limb in front of you and turn it outwards until the fingertips are pointing towards the knee. Now slide back with your knees and keep the elbow stretched.

• Step 2: Turn the limb of the affected side with the palm upwards, make a fist, bend the fist, turn it inwards, and lay it down on the floor, palm slightly raised.

Stretching Exercises in Detail

Liebscher & Bracht's Five Pillars of Practice