Physiotherapy Treatment of Golfer’s Elbow
Golfer’s elbow is also known as medial epicondylitis and is the less common sister condition of tennis elbow, both conditions sharing the tendon degenerative nature without inflammation. They are referred to as tendinopathies due to the pathological changes which occur inside the tendon without an inflammatory process. Not just occurring in golfers, golfer’s elbow also appears in racquet sports, cricket bowling, weightlifting and archery.
The muscles which flex and rotate the forearm originate over the medial epicondyle, the bony prominence on the inside of the elbow, with the tendon anchored into the bone by the tendinous insertion. The pain occurs close to this and may be due to a degenerative process occurring in the tendon, as little inflammation has been noted in these cases.
High stresses occur in the cocking phase of a throw and during the subsequent acceleration, and in the golf swing from high backswing down to near the ball strike. Golfers are more likely to have their dominant hand affected and tennis players who use heavy topspin in their forehands are also more at risk.
Tennis elbow is more common but golfer’s elbow remains the most reported pain problem over the inner elbow. Men are more likely to be sufferers than women in a 2:1 proportion, with most people affected in their early adult or middle years. The dominant hand is typically affected in two-thirds of cases, a third report a sudden pain onset with pain coming on slowly over time in the rest.
Typical symptoms are an ache or pain over the front of the inner elbow which is worsened by repeated wrist bending and improved by rest. Hand, forearm, elbow and shoulder pain may be reported, with grip weakness in the hand. If the ulnar nerve is involved this can also contribute to the weakness and give pins and needles in the forearm. The physio palpates the muscles and their tendinous insertions, the elbow joints and the groove behind the elbow where the ulnar nerve lies. To exclude other significant diagnoses the physiotherapist will perform a neurological examination.
Most golfer’s elbow treatment is conservative, not surgical. Treatment involves activity modification, forearm or wrist splinting, anti-inflammatory drugs, steroid injections and physiotherapy. Modification of the use of the arm is vital to prevent ongoing stimulation of the condition, so altering the mechanics of swinging the golf club or other sporting equipment is essential. Patient education continues with the identification of aggravating activities and postures and the patient is taught to avoid them.
Cryotherapy (cold therapy), gentle stretching, ultrasound, frictions and anti-inflammatory drugs are the main treatments for acute golfer’s elbow. Once it has settled down into the sub acute condition then the aim is to increase flexibility by stretches, improve the strength of the muscles and go back to normal daily jobs. Bracing can be used either to rest the musculature (wrist brace) or to realign the forces through the tendons (counterforce bracing). In the case of chronic golfer’s elbow the treatment can be the above plus gradual weaning out of the splint and paced return to sport.
Doctors inject corticosteroid medication into the sites of chronic golfer’s elbow but this treatment appears to be more useful in the earlier, acute cases. Other therapies, such as shockwave or laser, have been used but do not seem to be effective. Once physio has been attempted for some time without improvement then a surgical approach may be considered, cutting out the abnormal tissue from the tendon. The ulnar nerve can be transposed around to the front of the joint from its position in the groove posteriorly.
Advice from a professional instructor is well worthwhile as they can instruct on technique of the golf swing, aerobic fitness, muscle strength work and flexibility. Warming up prior to activity and stretching afterwards, with good sporting technique and sound choice of equipment are the basic requirements. Monitoring of patients by the physiotherapist, especially if they are sports people, may be essential to avoid overdoing and training or performing through pain.
November 22 2008 03:10 am | Health
