Golfer’s elbow is a descriptive term for pain on the inside of the elbow that is typically aggravated by gripping or lifting when the palm is facing upwards, or hitting a golf ball. One of the most common diagnoses for golfer’s elbow is tendinopathy of the common flexor tendons of the wrist, which is typically an overuse injury. The muscles that bend the wrist forwards attach onto a bony point on the inside of the elbow (medial epicondyle) via a common tendon. This tendon can become painful following increases in activities such as gripping, pushing and golf.
--What causes golfer’s elbow?
Golfer’s elbow is typically caused by an increase in activities that load the tendon. A common story heard by physiotherapists is, ‘I wanted to get ready for a golf trip, so I went to the range and hit 200 balls. The next day my elbow was so sore.’ The tendon responds to this increase in activity by becoming swollen, and begins a process of trying to make itself stronger, so that it can perform the task in the future. However, this process does not always work perfectly and, in some people, the tendon gradually becomes painful, often days after the increase in loading. If left untreated, your pain symptoms can increase, resulting in weakness and making daily activities increasingly difficult.
Another common trigger is a direct impact to the inside of the elbow.
--How do I know if I have golfers elbow?
The diagnosis of golfer’s elbow is made by a combination of symptoms and signs. The symptoms include pain on the inside of the elbow, and are aggravated by gripping or pushing with the palm turned upwards. In more chronic cases, the elbow may become stiff after periods of rest, such as first thing in the morning. Pain with gripping (like a handshake) and tenderness on the bony point on the inside of the elbow may be a sign that you have golfer’s elbow.
Other conditions, such as ulnar nerve entrapment, can give symptoms similar to golfer’s elbow, and your physiotherapist can assess whether this is the case. There are also times when your neck or upper back may be the source of your golfer’s elbow.
--How can physiotherapy help with golfer’s elbow?
Accurate diagnosis is crucial in the selection of the best treatment for golfer’s elbow. Your physiotherapist will be able to accurately assess and differentiate the source of your elbow pain. Once your physiotherapist has established the source of your pain, they will discuss the best management of your condition and a plan to return you to being pain-free.
Part of your physiotherapy management may include some hands-on treatment. They will teach you how to do this yourself and may also use modalities, such as pulsed ultrasound or ice.
Another treatment that your physiotherapist will use is exercises with weights, which will help relieve the pain, increase the ability of the tendon to cope with load and increase the strength of your forearm muscles. This will be something that your physiotherapist will progress as you get stronger. You will probably need to do this for 12 weeks.
Your physiotherapist may fit you with an elbow brace or use strapping to relieve the pain in the short term, but this will not be the solution to your problem and is not a substitute for exercise.
Finally, your physiotherapist will discuss some of the treatment options you can talk about with your doctor, such as the use of injections or topical medications.
--How effective is physiotherapy for golfer’s elbow?
While there is very little high-quality research published on golfer’s elbow, the anatomy of golfer’s elbow is similar to the painful Achilles tendon, which research has demonstrated improves with muscle-lengthening (eccentric) exercise and, in many cases, is pain-free within 12 weeks of treatment commencing. Your physiotherapist will be able customise your management to give you an optimal treatment program.
There are short-term pain-relieving benefits of massage and ice.
--What can I do at home?
There are many things that you can do at home to help reduce the pain of golfer’s elbow.
- Ice can be an extremely valuable tool. Generally, an ice pack is applied for 8–10 minutes, until the skin goes numb to touch. It’s important to have a damp towel or something similar between your skin and the ice pack to avoid an ice burn and to remove the ice if you feel like your skin is burning. There is no rule as to how often you might use an ice pack, but 3–4 times a day is a good place to start. People with medical conditions that effect their circulation or those who are hypersensitive to cold should seek professional advice as to whether ice is safe to apply.
- Modifying your activity is also a great way to reduce your pain. Try picking things up with the palm facing down towards the ground. Swap hands for gripping tasks as much as you can, or if possible eliminate them entirely.
- You can try a tennis elbow brace from the pharmacy as a pain-reliever.
- Your golf swing or grip may be overloading your elbow and be contributing to your golfer’s elbow. Book some time with a coach or a golf pro and see if they can suggest some modifications that may help.
- Finally, massaging your forearm muscles can help relieve some of the pain and tightness.
As with all injuries, accurate diagnosis is a crucial part of best management.
--How long until I feel better?
Targeted physiotherapy management of golfer’s elbow typically begins to give people short-term relief immediately. With an eccentric strengthening program, there can be an increase in pain initially, but people usually find improved function within 2–3 weeks, and in many cases, complete resolution within 12–16 weeks.
