Golfer's Elbow (medial epicondylitis)
Inflammation of this kind occurs as a result of physical overload, such as heavy work or strenuous sport, though it can occasionally also occur with rheumatic disease. The suffix –itis means inflammation: a process in the body marked by heat, swelling, redness, pain and loss of function. When inflammation occurs without infection playing a role, it typically produces rheumatic-type symptoms such as pain and stiffness.
Anyone can develop this kind of inflammation if too much pressure or force is placed on a particular spot, especially if the area isn't well conditioned. A sudden exertion of force – lifting something heavy, for example – can cause an injury. These inflammatory reactions most commonly occur in people over 30. Most adults have, at some point, experienced pain around a joint as a result of overload. The pain can sometimes be severe enough that you'd rather not move the affected body part at all. It can also occur at night, when lying on the affected area. The pain can also show up elsewhere, known as ‘referred’ pain: pain from an inflammation is often felt across a much larger area of skin than the inflamed site itself. One example is pain felt in the middle of the upper arm due to inflammation in the shoulder. Another is radiating pain down the arm, sometimes as far as the hand and fingers.
What is golfer's elbow?
Golfer's elbow is an inflammation on the inner (medial) side of the elbow. Many muscles, and especially tendons, run through the forearm, allowing you to flex and extend the wrist and fingers. The extensor muscles/tendons attach to the outer bony point of the elbow, and the flexor muscles to the inner bony point. The outer point is involved in tennis elbow, the inner one in golfer's elbow. Key forearm flexor muscles, which run all the way to the fingers, pull relatively hard on their point of attachment, leading to a nagging, chronic complaint at the tendon or muscle belly. This is usually brought on by prolonged overload of these forearm muscles relative to the other muscle groups in the forearm. The condition is called golfer's elbow, but that doesn't mean it only occurs from playing golf. It's also regularly seen in tennis players, pitchers (baseball and softball) and climbers, and it can occur in everyday life too – among tilers, for example.
Symptoms
- Pain on the inner side of the elbow.
- The pain is often quite intense.
- Sometimes radiating pain into the forearm, wrist and hand.
- Rarely radiating into the upper arm and shoulder.
- Loss of strength and possibly impaired coordination.
- The forearm can feel hard and swollen, even at rest.
- Symptoms are provoked by bending the fingers while simultaneously moving the wrist towards the palm. Picking something up with an underhand grip tends to provoke symptoms.
Causes
The most common cause of golfer's elbow is overload. Any activity that places repeated, prolonged strain on the forearm muscles, combined with inadequate rest, can lead to overload of these muscles. This can involve heavy lifting or incorrect wrist movements.
What you can do yourself
Avoid or reduce the activities that originally caused the complaint. The best way to prevent new flare-ups of pain is to follow the advice of your doctor and physiotherapist. It's worth following that advice, since it helps rebuild muscle strength and fitness, increasing the load capacity of the musculoskeletal system – the only way to prevent future problems. As ever, prevention is better than cure. This means athletes who use their forearms very intensively should train their arm muscles specifically so they're loaded symmetrically and evenly. Prolonged, repetitive training should be properly alternated with exercises that release tension. Here too it comes down to the right balance between maximum effort on one hand and recovery on the other. If you perform certain actions every day, whether at work or in your free time, in a way that invites overload, the muscles involved get too little time to recover – and recovery is essential for staying in good shape.
If avoiding or reducing these activities isn't possible because of your work, an elbow brace can be used to help protect the elbow during that particular load.
Physiotherapy treatment
Treatment focuses first on unloading the muscles involved, as well as improving local blood flow – with ice therapy in the acute phase if needed.
Physiotherapy treatment will focus on reducing pain, keeping the joints mobile and maintaining muscle length. Improving muscle strength is also very important, since it makes the tissue more resilient, making golfer's elbow less likely to recur in future. Exercise therapy strengthens weaker muscles, lengthens shortened muscles, and improves the necessary balance between specific muscle groups. The physiotherapist can also try to improve local blood flow through deep transverse friction massage, dry needling and, where appropriate, related techniques such as periosteal pecking. Kinesiology taping can also help well in the acute phase.