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  • Dr. Brian Abelson, Dr. Evangelos Mylonas

Resolving Golfers & Tennis Elbow

Updated: Nov 19


Golfer’s Elbow (Medial Epicondylitis) refers to the pain and inflammation that occurs at the inside point of the elbow (medial epicondyle). Golfers Elbow often involves three structures: the common flexor tendon, the carpi radialis muscle, and the pronator teres muscle. (1)


Tennis Elbow (Lateral Epicondylitis) refers to pain and inflammation that occurs at the outside of the elbow (lateral epicondyle). The lateral or outside of the elbow is affected 4 to 10 times more than the inside side (medial elbow). (5) Tennis Elbow often involves the origin of the common extensors and the muscles involved in supination. This includes a muscle called the carpi extensor radialis brevis, the point at which the most tenderness is usually felt.


IT'S A REPETITIVE STRAIN INJURY


Golfer’s Elbow and Tennis Elbow can be caused by any activity (not just golf or tennis) that requires forceful and repeated bending of the elbow, wrist, and fingers (causing valgus/varus stresses during elbow flexion/extension). (1) Both these injuries are often referred to as repetitive strain injuries or RSI. With RSI injuries repeated actions stress the muscles (soft-tissue), causing micro-tearing of the flexor/extensor tendons, and increasing inflammation or irritation of the surrounding soft tissues.


RSI injuries often occur when muscles and tendons continue to be re-injured while the small tears are still in the process of healing. These injuries cause the body to lay down additional adhesive tissue between the muscle layers in an attempt to stabilize and heal the affected soft tissues. This tissue can form attachments to adjacent layers of tissue and structures, and inhibits the normal movement or translation of these soft-tissue structures. This lack of smooth movement can cause friction and generate an ongoing cycle of friction and possible inflammation.

Want to learn more about elbow anatomy? Check out our video “Anatomy of the Elbow”. In this anatomy review we discuss the bones, joints, and muscles of the elbow. This is one of the key videos we recommend viewing before attending our Motion Specific Release courses.





UNDERSTANDING THE KINETIC CHAIN OF GOLFER’S & TENNIS ELBOW


The game of golf (and tennis) emphasizes one-sided activity of the body; you are either a right-handed golfer or a left-handed golfer. This unilateral focus is the cause of numerous injuries as golfers tend to develop muscle imbalances which cause a wide array of myofascial restrictions.


Golf, in its ideal form, is all about efficiently storing and releasing energy from your core, out into your extremities. The classic golf swing engages the entire kinetic chain from your feet – which form a solid stance – up through your hips and core, to finally release energy through your shoulders and arms right into the club head. This is much like a coiled spring, storing energy, then suddenly releasing it. (6)


Unfortunately, for most golfers, this “coiled spring” is either broken, or functions only minimally. Many golfers find that in the game of golf, much of their energy and focus is spent on learning how to compensate for muscle imbalances, poor posture, and the multitude of myofascial restrictions that have developed over time.


Many patients who come to our clinic suffering from Golfer’s Elbow, also show the following common problems:

  • Rounded shoulders (anterior posture).

  • Restriction in the neck and low back.

  • Tight restricted hips which are causing abnormal motion patterns and poor balance

Fortunately, we are able to effectively treat and resolve Golfer’s (or Tennis) Elbow within a relatively short period of time. We do this by looking at the entire kinetic chain for each injury, and do not restrict ourselves to just the elbow.


Essentially, we look at the body as a single functional unit, rather than focusing our treatment on just the site of pain. We do this by:

  • Conducting a complete biomechanical analysis in order to identify specific areas of restriction, weakness, and imbalance.

  • We then apply an integrated treatment approach which combines various soft-tissues techniques that break down restrictions and promote healing.

  • Throughout this process, we incorporate specific functional exercises to restore strength, muscle balance and flexibility in order to prevent re-injury.


ULNAR AND RADIAL NERVE ENTRAPMENT


In addition to the surrounding tendons and muscles of the medial elbow, many patients can also suffer from the consequences of a common nerve compression. In the medial elbow this compressive nerve syndrome is known as Cubital Tunnel Syndrome. (2) This syndrome refers to as a compression of the ulnar nerve within the cubital tunnel of the medial elbow. This syndrome is the second most common type of nerve compression syndrome of the upper extremity, after Carpal Tunnel Syndrome. (4; 7)


Approximately 60% of the patients who have Golfer’s Elbow also suffer from compression of the Ulnar Nerve. (3) These patients will often experience an altered sensation or numbness and tingling of the 4th and 5th fingers. That being said, it is also extremely important for the practitioner to rule out that the patients numbness is not coming from the neck (cervical radiculopathy).


In the case of injuries to the lateral elbow (Tennis Elbow), patients could also be suffering from radial nerve compression, also known as “Radial Tunnel Syndrome.” Many patients that have initially been diagnosed with Tennis Elbow may actually have a Radial Nerve Entrapment syndrome. (6) For both ulnar and radial nerve entrapment, it is important to perform a comprehensive physical examination to ensure that the condition is not misdiagnosed.



MANUAL THERAPY FOR GOLFER’S AND TENNIS ELBOW


The following videos demonstrate some of the MSR procedures that we often use when treating our patients with Golfer’s Elbow (or Tennis Elbow). We use a combination of both soft-tissue procedures and osseous manipulation. As mentioned, we do not just limit our treatment to the elbow, but when needed address a larger kinetic chain.


Treating Golfer’s Elbow - Motion Specific Release

When treating Golfer’s or Tennis Elbow (or any elbow issue) it is important to treat the larger Kinetic Chain, and not just the symptomatic area.





5-Point Shoulder Joint Mobilization - Part 1

In this video I demonstrate the Motion Specific Release "5 Point Shoulder Joint Mobilization" protocol. Many people think of the shoulder, as being just one joint. In reality, we must consider five different joints. Understanding and working with the inter‐relationships between the structures in these five joints is critical for successfully resolving shoulder, elbow, and even wrist and hand injuries.


MSR - Ulnar Nerve Release

As mentioned earlier, up to 60% of patients with Golfer’s Elbow also suffer from Ulnar Nerve Compression. (3) Patients with ulnar nerve compression often complain about sensory changes in the fourth and fifth fingers. They may also complain of trouble when opening jars, or turning doorknobs, or experience weakness when performing work that requires repetitive motion. In this video, we focus on releasing the ulnar nerve by using Motion Specific Release (MSR) procedures.


MSR - Radial Nerve Release

Radial nerve compression may occur at any point along the anatomic path of the nerve. The most common site of compression is in the proximal forearm (area of the supinator muscle) involving the posterior interosseous branch of the radial nerve. In this video we focus on releasing the radial nerve using Motion Specific Release (MSR) procedures.


EXERCISES FOR GOLFER’S & TENNIS ELBOW


The following videos demonstrate some of the exercises we often prescribe to our patients who suffer from elbow pain. These are just a small sample of the exercises we could prescribe, and are provided for demonstration purposes only. These videos are strictly for increasing mobility; other strengthening exercises are prescribed when appropriate.


Pin & Stretch For Golfer's & Tennis Elbow

This video shows you how to release your elbows by using both pin-and-stretch techniques and cross-friction massage. These are great exercises, especially when combined this with self-myofascial release of the elbows by using a lacrosse ball.



Five Great Daily Shoulder Mobilization Exercises

Elbow problems often involve restrictions in the shoulder. For best results, you can perform these exercises throughout your day. These exercises can make a huge difference in your posture, especially when you have been sitting for a long periods of time.



Ulnar Nerve Flossing Exercises

If you have an Ulnar Nerve Entrapment Syndrome, then you can use the exercises in this video to floss, mobilize, and release this nerve from its surrounding tissues.






Radial Nerve flossing Exercises

If you have Radial Nerve Entrapment Syndrome, use these exercises to floss, mobilize, and release this nerve from its surrounding tissues.







CONCLUSION


Golfer’s and Tennis Elbow can be resolved by using a structured, logical, evidence-based treatment methodology along with an exercise rehabilitation program. Often for a full resolution, the practitioner must address the needs of a larger kinetic chain, one which involves more structures than just the elbow itself! In addition, any problems caused by nerve compression must also be addressed.



If you have Golfer’s or Tennis Elbow make an appointment with our incredible team at Kinetic Health in NW Calgary. Just scan the QR code with your phones camera and click the link, or call Kinetic Health at 403-241-3772 to make an appointment today!






Bibliography


  1. Overuse and traumatic injuries of the elbow. Hayter CL, Giuffre BM. s.l. : Magn Reson Imaging Clin N Am, 2009, Vols. 17(4):617–638.

  2. Peripheral nerve entrapment and injury in the upper extremity. Neal SL, Fields KB. s.l. : Am Fam Physician, 2010, Vols. 81(2):147–155.

  3. Nerve injuries about the elbow. Hariri S, McAdams TR. s.l. : Clin Sports Med. , 2010, Vols. 29(4):655–675.

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