Golfer’s Elbow
One of the next most common injuries seen in golf is aptly named “Golfer’s Elbow.” This is pain at the inside of the elbow. This most commonly occurs in the trail arm of the golfer. It can also occur in any racket or throwing sport, especially any with an emphasis on top spin.
While it used to be thought that it was an inflammation issue of the tendon that attaches to the inside of the elbow, it has been discovered that it seems to be more commonly a tendinopathy which is degeneration of that tendon. A tendinopathy comes from repetitive overload with a disorganized healing pattern. The most vulnerable time for that tissue is from the top of the backswing to impact. Many elbow injuries occur when a golfer “chunks it” or catches the ground with their swing. This puts a rapid stretching on that tissue and can damage it.
Golfer’s elbow can be a very persistent condition that seems to hang around. The highest success rates come from a combination approach of activity reduction or modification, rehabilitative exercises, soft tissue work and proper mechanics. On the rehabilitative front, the first goal is to load the tendon in an uncompressed position. This load is of a long duration, but light. This can come in the form of flexing the wrist with the arm straight out and supported and holding a weight (maybe a couple pounds) for 45 seconds. Take a break and repeat for 3 to 5 sets. This is incredibly effective for a couple reasons. First is that tendons speak the language of load. They don’t know what we are trying to do with them, all they know is that they were loaded or not. This kind of exercise causes an extreme amount of load. However with it being an isometric exercise (aka no movement) it has a very low inflammatory component. All exercise has an inflammatory component, and we want to reduce that as much as possible when rehabilitating an injury. Holding a position also promotes what is called interfascicular sliding, which is basically allowing the healthy portions of the tendon to slide past each other and expose the degenerated portions to load. This load then forces the degenerate portions to remodel in an organized fashion and heal the injury. Once these isometric exercises can be easily done, then the athlete can move to a similar set up but now they slowly lower the weight from a wrist flexed position into a wrist extended position. This slow lowering is called an eccentric load and again increases the load on the tendon forcing it to adapt.
Various soft tissue techniques can be used to also promote the mobility and flexibility of the tissues in the forearm. To date, no one specific type has proved to be significantly better than others and seems to be more about athlete tolerance and preference.
Some individuals will opt to wear a compression band on their forearm. This shifts the point the muscles pull on from the damaged tendon onto the band. This change in pull point can help off load the tendon and allow it to heal while the individual is able to keep functioning.
Elbow injuries have a tendency to be stubborn and hang around. The most important part to remember in taking care of them is to be consistent with rehabilitation and give it time to remodel and heal.
