What is Medial Epicondylitis (Golfers Elbow)?
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.
Signs and Symptoms of golfer’s elbow
- Pain on the inside of the elbow. This pain can travel down the forearm into the belly of the muscle and sometimes even into the hand.
- Pain is commonly 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)
- Tenderness on the bony point on the inside of the 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.
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. This can cause direct changes to the tendon and muscle and affect it’s ability to cope under load.
Treatment for 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:
- Hands-on treatment. This will address any imbalances in muscle or tendon which can be a common contributing factor to this condition
- Activity modification. An initial change to your exercise regime or daily activities may be needed to avoid the condition getting worse
- Ice. to ease pain and swelling. Do it for 20-30 minutes every 3 to 4 hours for 2 to 3 days, or until the pain is gone.
- Anti-inflammatory. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, naproxen, or aspirin, will help with pain and swelling as per GP instructions.
- Strengthening exercises. This may be with weights or resistance bands 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.
- Taping/bracing. 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.
In the past cortisone injection therapy was often recommended, however new research has indicated that corticosteroid injections result in worse long-term outcomes compared to physiotherapy or placebo injections.