Archive | June, 2012

Golfers Elbow

21 Jun
I have hit that stage in life where my friends and I have started to drift away from team sports, but are still in need of that competitive aspect of their lives. Some have taken to running, or triathlons, but by far the majority have picked up a set of clubs and have found themselves on a golf course. Now, the other 3 members of my infrequent 4 Ball will happily testify that I rank up there with the very worst golfers you will ever see. Thats not to say I dont enjoy an occasional round, but my grip is what one friend described as an ‘afront to the game’. High praise indeed. The standard right handed golf grip is left hand over right but, for whatever reason, I play right hand over left – essentially a left handed grip for a right handed swing. It sounds ugly (it is), but eat my 2 pars on the Ryder Cup Course!!
I digress.
As the above has made clear, I am far from a golf expert, so I will not spend too much time discussing the finer intracacies of where your middle finger is gripping the club, or whether you should be able to see 2 or 3 knuckles, I am merely going to break down what happens when people start feeling symptoms of what is commonly known as Golfers Elbow (GE). Medial Epicondylitis, to give GE its proper terminology, could be considered the little brother of Tennis Elbow (lateral epicondylitis), and is much more rare that Tennis Elbow. So how to differentiate? As is often the  case with anatomy, the answer is in the name.
Medial = midline, referring to the body
Epicondyle = a rounded boney prominence (imagine a cartoon bone. The epicondyle would be the bum shape at the end!)
 itis = inflammation
So essentially, inflammation of the inside edge of the elbow.

General area of pain

So what happens?
GE is at its root, an over use injury. Many muscles attach through tendons to the Epicondyle, and due to the hugely repetitive nature of swinging a golf club, these muscles pull and strain which can lead to inflammation and/or damage to the tendons, causing huge pain in the inner elbow area. The damage to the tendons is classified as Tendinitis (inflammation of the tendon), or Tendinosis (degrading of the tendon), and a qualified therapist will be able to differentiate. Symptoms? Pain! The inner edge of the elbow area will be painful, and the pain may increase on movement. Movement of the wrist – for example gripping – may exacerbate the pain. There may be some visible swelling, and in some cases loss of strength in the affected arm and wrist. The inflammation of the muscles and tendons can also compress the ulnar nerve leading to numbness further down the hand and toward the fingers.
Self Help
The first thing to do with any inflammation injury is to get rid of that swelling, so we need to get some ice on the painful area as soon as symptoms appear. Never place the ice directly on the skin, instead wrap your ice pack in a tea towel. Do this for 10 minute periods 3-5 times for a couple of days. Anti-inflammatory drugs can also be taken, or alternatively an anti-inflammatory gel can be used (for example, Voltarol). A simple stretch that you can do at home to start with is to turn your palm away from your body, and lay the palm down onto a flat surface (see picture).
As with a lot of injuries, treatment is 2 fold; primarily we need to stop the pain. To do this we need to look at exactly which of the soft tissues in the forearm are the guilty suspects. Using various active release techniques, we can start to loosen any excessively tight areas, and ease the load of overworked muscles (see for more information)  Secondly, we need to correct any potential  biomechanical issue creating a problem, which can often include a strengthening programme. This correction period can be aided by the use of Kinesio Tape (see for more information).
In extreme cases, a GP may administer a cortisone injection to reduce the swelling, but this can usually be avoided when treated early.
N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work. For more information please visit