Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physical Therapist.

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Golfers Elbow Physical Therapy Guide

What Is Golfers Elbow?

Golfers elbow or “medial epicondylytis” is a painful condition that most commonly occurs as a result of overusing the wrist flexor tendons of the forearm and elbow joint (a tendon is a structure which connects a muscle to the bone). The tendons most commonly affected are that of the Pronator Teres or the Flexor Carpi Radialis. As the name suggests, golfers elbow can often be caused by playing golf and other swing related sports, but it is mainly the result of a number of  other physical activities that involve repetitive gripping and wrist movement.  As a result, it is often a condition which affects those who complete manual work.

Golfers elbow is less common that its counterpart “Tennis Elbow” which  affects around 2 – 3% of the population every year, golfers elbow affects approximately 20% of this. In the United Kingdom this means that there are 200,000 new cases of golfers elbow every year!

What Is Really Happening In There?

The forearm flexor tendons are repeatedly damaged by overuse movements such as manual labour, repetitive gripping or racquet sports. This causes “micro trauma” to the tendon whereby minute tears disrupt the integrity and strength of the structure. To add insult to injury, the blood supply is diminished around the site of injury, and as such it struggles to heal on its own. This is when an acute injury becomes a chronic one, and action needs to be taken.

What Causes It?

Golfers elbow is a chronic overuse injury. The injury itself has normally been developing over the course of months or years of disuse, and pain commences when the tendon simply can’t take any more! As a result, there isn’t typically a single episode of trauma; most people report a pain coming on over the course of a few weeks, unable to distinguish an exact time.

It is common in sports / occupations that involve repeated gripping of objects (whereby you squeeze something between your hand and fingers). In golf, the tendon is often damaged during a players swing if they have poor technique and in tennis it can be brought on by players who apply a lot of topspin on their forehands. In the workplace, it can be something as simple as gripping a pen for long periods of the day. This is because during tasks that require wrist stabilisation (such as gripping), or wrist flexion movements, a considerable load may be placed on the tendons over a long period of time. The highest amount of stress occurs when the elbow is extended and the forearm supinated.

What Are The Symptoms?

Medial elbow pain is typically presented as pain on the inside of your upper forearm, just below your elbow – the pain may also travel down your forearm towards your wrist in more severe cases. The peak incidence is between the ages of 40 and 50 years old; however, the condition can affect any age group.

The most common symptoms are:

  • Pain when lifting objects or simply bending your arm.
  • Pain when writing or gripping small objects, for example, when holding a pen or clicking a mouse
  • Pain when twisting your forearm or wrist – for example, when turning a door handle or opening a jar
  • Pain and stiffness when fully extending your arm
  • Grip strength decreased
  • Reaction times decreased

What Are My Treatment Options?

There are many treatment options available to people who suffer with Golfers elbow!

Rest & Time

It is imperative that you stop doing the thing(s) that caused the elbow pain to begin with and avoid activities that agitate it further. This can be a wide variety of things from tennis, twisting open jars or even typing on a keyboard. There are no specific activities to avoid, as it is completely subjective; everyone is different. Throughout your rehabilitation programme you must make note of what to avoid via trial and error. Any time that you feel something is causing the pain to flare up, or if you feel your elbow getting “hot” you must take care of the injury site and stop the activity. Perhaps the worst thing you can do for this type of injury is to “work through the pain”, tendons do not heal in this way and it will only set you back more time if you do.

Taping And Straping

There are some advantages to strapping up the elbow. Rest is an important part of the recovery process and slightly immobilising the elbow with a strap is certainly an advantage to allow better healing times.

When performing any activities that put the elbow at risk, a strap could be seen to help avoid re-injury by giving proprioceptive feedback to your tendon. Check out our favourite tape here!

Rest And Time

It is imperative that you stop doing the thing(s) that caused the elbow pain to begin with and avoid activities which agitate it further. This can be a wide variety of things from golf, twisting open jars or even writing with a narrow pen. There are no specific activities to avoid as it is completely subjective; everyone is different. Throughout your rehabilitation programme you must make note of what things to avoid via trial and error. Any time that you feel something is causing the pain to flare up, or if you feel your elbow getting “hot” you must take care of the injury site and stop the activity immediately. Perhaps the worst thing you can do for this type of injury is to “work through the pain”, tendons do not heal in this way and it will only set you back more time if you do.

Take note of the small, subtle movements that you perform on a daily basis. For example, pain can be brought on by opening jars with your affected arm/hand. Sleeping on your affected arm can also cause you to wake up in the morning with discomfort and pain.

Physical Therapy

Although rest is a vital component of the recovery process, it doesn’t mean the affected limb has to be completely immobilised. In fact, tendons need to be placed under tensile loads to grow and stay healthy. The difficult part is finding the specific movements in which you place the tendons under load, and strengthen the wrist flexor muscles in your forearm.

Exercises

Exercise is the most important component for your recovery and one that must not be avoided. Tensile load needs to be placed through the affected muscle to enable it to grow!

These exercises should be done daily; they will take approximately 20 minutes, but will greatly improve your pain, prognosis and recovery time.

Golfers Elbow Exercises

1) Eccentric Wrist Curl

This is the number one exercise prescribed by Physical Therapists and health care professionals in the health industry. It places a tensile load through the affected tendons whilst slightly stretching them, causing them to break down scar tissue, encouraging an inflammatory response to the area. The position of your arm can be modified to make the exercise easier or harder. To make the exercise harder you simply straighten your elbow further.

How to do it:

  • Place your affected arm on a steady surface with your hand and wrist hanging over the edge, palm facing the ceiling
  • Hold a small weight, or place some form of resistance through the hand (holding a can of beans)
  • Slowly let your wrist bend towards the floor (the slower the better)
  • Once you reach the bottom, use your good arm to lift the weight back up.

Repeat for 10 reps, 3 sets. Try to do this 3 times per day.

2) Reverse Tyler Twists

The Tyler Twist exercise is the latest evidence based exercise in the treatment of medial elbow tendonopathies. It requires the use of a Theraband Flexbar, which can be purchased here!

It works upon the same principles as before, the extensor tendons are stretched whilst a tensile load is slowly placed through them.

How to do it:

  • Lift the elbow of your un-injured side upward and rotate your forearm so your palm faces away from you
  • Grasp the other end of the FlexBar with the un-injured hand facing away from you and pointing downward
  • Twist the FlexBar with the hand on the un-injured side as you stabilize with the injured-side hand
  • Hold both wrists steady as you extend both elbows in front of you. The wrist on your injured side should be flexed toward you and the other wrist extended
  • Slowly release the FlexBar with your injured side while maintaining tension with the uninjured side

Repeat 10 reps, 3 sets, try to do this 3 times per day.

3) Supination / Pronation

Your forearms also contain the muscles that are responsible for pronating and supinating your wrist (the movement you would use to turn a door knob back and forth). These muscles can become weak in patients with golfers elbow and so it is a good idea to strengthen when possible.

How to do it:

  • Begin with your affected arms elbow resting on your thigh with your thumb pointing towards the ceiling
  • Hold a small weight in your hand
  • Slowly rotate your palm up and then down so that your palm faces the ceiling, and then the floor

Repeat 10 reps, 3 sets. Try to do this 3 times per day.

4) Isometric Flexions

Once you can feel your pain improving and you are better able to complete tasks that you weren’t previously able to do, then you can progress to isometric exercises of the wrist. Isometric exercises are used in strength training but differ from eccentric. During isometrics the joint and muscle length do not change during contraction. Examples of this are poses in body building or pushing against an immoveable object such as a wall.

How to do it:

  • Rest your injured forearm and hand on a steady surface
  • Keep your forearm steady in a palm up position.
  • Use your opposite hand to push against an upward movement of your hand at the wrist

Repeat 10 reps, 3 sets. Try to do this 3 times per day.

5) Ulnar Nerve Flossing

Due to its close proximity to the medial epicondyle, the ulnar nerve may become irritated or trapped under scar tissue caused by golfers elbow. This should be treated with neural mobilisation using the technique demonstrated below. The goal is to create tension in your Ulnar nerve and mobilise it in different directions to reduce pain. There are many different ways to complete this exercise but this is the most common.

  • Raise your shoulder and elbow to 90 degrees and have your palm facing away from you
  • Use your uninjured arm to push your fingers down so that you are able to place your palm on your ear
  • Once in this position pain free. Move your neck to the opposite side and hold for 10 seconds

Repeat 3 reps, 3 times per day. If it aggravates your pain or send neurological symptoms into your hands, stop the exercise and rest.

6) Wrist Flexor Stretch

As mentioned previously, golfers elbow is a repetitive strain or overuse injury. Therefore stretching can seem counter intuitive, however it is important that you lengthen the tendon to realign the muscle fibres during the healing phase. Complete this exercise like the rest, however never try to stretch through pain!

  • Extend your affected arm in front of you with your palm down
  • Bend your wrist, pointing your hand and fingers toward the ceiling
  • With your other hand, gently bend your wrist further until you feel a mild to moderate stretch in your forearm
  • Hold each stretch for 10-15 seconds, repeat 3 times.

Deep Transverse Frictions

Deep transverse frictions are a weapon against tendon injuries like golfers elbow which is used by Physical Therapists, but can be performed by the subject themselves. The purpose of deep friction massage is to maintain the mobility within the soft tissue structures of the tendons and prevent adherent scars from forming. The massage is deep and must be applied transversely to the specific tissue involved.  The movement encourages realignment and lengthening of these wrist flexor muscle fibres and will improve your recovery rate.

To find the specific tissue we require (the flexor tendons) see the image below. Place your fingers of your massage hand on this site. Make a fist with your injured arm, If you feel the muscles move under your fingers and bulge outwards, you are in the right place.

We also use foam rollers, or a cricket/lacrosse ball which can be found here! The same rules apply, you want to press deep into the tendon to realign the muscle fibres and prevent scar tissue from forming.

Prognosis

Untreated golfers elbows can last anywhere between 6 months and 2 years, with high chances of the condition returning in the near future. Medical research suggests that Physical Therapy and exercise are the most effective way of treating the condition, most patients show significant improvement after 6 weeks of treatment however it can take up to a year to show full improvement.

To reduce your chances of getting golfers elbow again, you must continue to strengthen and stretch your forearm muscles. Taking breaks from activities that involve long periods of tendon loading will also prevent tendon micro-trauma and if you feel some pain coming on, you must try cease that activity immediately.

2017-09-01T23:52:58+00:00