Dr. Christie discusses how Golfer's Elbow is treated at Health Fit Chiropractic

What is golfer's elbow?
The elbow serves as a link between the shoulder and the wrist, and because of this, elbow injuries can occur.

When they do, they often involve an overuse mechanism.  One injury to the elbow is known as golfer’s elbow, and although it is often associated with the sport, golfer’s elbow can occur with numerous repetitive activities.

The medical term for golfer’s elbow is medial epicondylitis, and it can occur after non-sporting activities just as frequently as with sports.  The key characteristic of this condition is pain at the elbow's inner bony part: in particular, the flexor-pronator tendinous origin.

The medical term for golfer’s elbow is medial epicondylitis.
It can occur after non-sporting activities just as frequently as with sports.

The key characteristic of this condition is pain at the elbow's inner bony part: in particular, the flexor-pronator tendinous origin.

One common example of an activity causing medial epicondylitis includes using a hammer or a screwdriver for an extended period. Suppose you ever had to put together furniture by hand, and you couldn’t use a power tool to make the process go faster. In that case, you may have noticed your elbow hurts after wielding a miniature screwdriver or using a hammer to get those wooden dowels in just the right way.

Ultimately, any activity involving extended wrist flexion and pronation, such as golfing, rock climbing, swimming, or throwing, may result in medial epicondylitis. This condition is also seen in work occupations that require repetitive hand, wrist, and forearm motions.

Here’s a quick link on WebMD about golfer’s elbow: https://www.webmd.com/fitness-exercise/golfers-elbow-basics#1

 

What Classifies Golfer's Elbow
What does medial epicondylitis, or golfer’s elbow, feel like? How is a person to know when they have this painful elbow condition?

Symptoms experienced during golfer’s elbow include:

  • Tenderness: A person will often experience tenderness on the inner part of their elbow. There is a specific bony protuberance known as the medial epicondyle, where the pain is characterized. This bony bump on the inside of the elbow is where the tendons of the forearm muscles attach, and if those muscles are irritated or inflamed, the pain will travel long the tendons to this bony site.
  • Location of pain: Although usually along the elbow's inner bony part, sometimes the pain can also be experienced along the forearm's inner side and is generally worse with certain movements.
  • Stiffness: The elbow may also feel stiff to the point where making a fist can cause pain.
  • Weakness: Because of the forearm muscles' involvement, a person may experience weakness in their hands or wrists.
  • Nerve involvement and paresthesia: Weakness of the forearm muscles can also involve the nerves of the forearm, resulting in numbness or tingling into the fingers. People with golfers elbow often complain of tingling sensations that extend into the ring and pinky finger of the affected forearm.

Golfer’s elbow can come on suddenly or gradually, although it is almost always associated with repetitive activity. This repetition creates a breakdown of muscle fibers and collagen in the associated tendon, resulting in tendinopathy.  Multi-level tendinopathy sets the painful and cumbersome process of golfer’s elbow in motion.

Here is a link to read more about tendinopathy: https://www.healthline.com/health/tendinopathy#vs-tendinitis

 

Involved musculature of the forearm

There are several muscles involved at the elbow that become implicated with golfer’s elbow.

Some muscles directly attach and become inflamed at the elbow’s inner bony plateau (the medial epicondyle). Others become involved because of muscle recruitment patterns with golfing, throwing, poor conditioning, improper lifting technique, using a hammer, or twisting a screwdriver.

The forearm muscles associated with the flexor-pronator complex are pronator teres, flexor muscles of the forearm, including flexor carpi radialis and flexor carpi ulnaris, flexor digitorum superficialis, and palmaris longus.

Because the muscles can run along the length of the forearm, wrist pain is also often associated with golfer’s elbow. Rarely is a visit to the hospital or orthopedist needed for this condition.

Because many injuries of the elbow are from overuse, such as golfer’s elbow, other associated conditions such as sprains, strains, and tendonitis/tendinopathies can occur.

Who is at risk of developing Golfer's Elbow

You could be at higher risk of developing golfer’s elbow. Some activities have an inherent bigger risk. These include:

  • Weightlifting;
  • Sports that involve throwing or “winding back” motions of the arm and shoulder;  
  • Forceful, repetitive movement seen in different occupations such as construction and carpentry;
  • Any activity typically related to excess or repeated stress;
  • Forceful wrist and finger motions;
  • Sports activities with repetitive valgus stress, flexion, and pronation, such as golf, baseball, tennis, fencing, and swimming.

Even individuals who do not engage in higher-risk activities may still develop golfer’s elbow if they have poor conditioning or not enough warm-up prior to exercise or play.  Other risk factors include being age 40 or older, obesity, and smoking.

Is imaging necessary for Golfer’s Elbow?

Often not, but sometimes a patient’s condition may warrant further investigation.

X-rays can sometimes show deposits of calcifications near the medial epicondyle.

If there is nerve involvement, such as extensive weakness and tingling or numbness into the ring and pinky finger, a nerve conduction test may be done to evaluate the ulnar nerve for neuropathy.

How do you manage Golfer’s Elbow?

Because the nature of this injury is repetitive, which means it occurs in sequence over time, addressing the repetition and making changes to movement becomes a crucial part of an effective treatment plan.

This isn’t to say a person with golfer’s elbow has to stop their daily routine, sporting activities, or stop doing their job.  Management of golfer’s elbow will depend on whether the condition is acute (sudden onset) or chronic (repeatedly occurring over time).

Treatment approaches may include isometric exercises, specific stretches for muscles and tendons of the forearm, ice and rest, myofascial release (targeted soft tissue work into the muscles and fascia), splinting the wrist or using a specific elbow brace, making ergonomic changes at work or home, and more.

Golfer’s elbow is just one condition that we are successful in treating, and we have many methods of successfully implementing treatment.

How we treat Golfer’s Elbow

In our Boca Raton Sports Chiropractic practice, we take a detailed history of your injury, followed by a functional movement assessment and examination. Our goal is to not only provide you with the correct diagnosis of your injury – after all, what if your elbow pain is not Golfer’s Elbow? – but also determine the underlying root cause of your injury.

For instance, there are many examples of muscle compensation patterns that place undue stress on specific aspects of the body, including the elbow.  To best address these muscle compensation patterns, we must identify what they are and how they are potentially affecting you.

Proper treatment begins with a thorough and experienced assessment and exam to determine the exact condition and cause.  After this, we have many tools in our toolbox for effective treatment. 

We may analyze your daily ergonomics and habits to determine if lifestyle or activity modifications are necessary and what those may include.  We also prescribe sports rehab exercises, utilize soft tissue approaches, including myofascial release work, and have other therapeutic modalities to safely and compassionately treat your elbow pain.

Your treatment plan is unique to you and your condition.  We may use some approaches to help your elbow pain consist of sports rehabilitation exercises, Active Release Techniques (Muscle Work), chiropractic, Graston Technique®, and deep tissue laser therapy.

Frequently Asked Questions

Why a chiropractor over medication or surgery?

Chiropractors are trained to treat musculoskeletal injuries, from strains/sprains to repetitive use injuries, and the elbow is part of this system.  A chiropractor is a healthcare professional well-versed in conservative forms of treatment – that is, approaches to treatment that avoids steroid injections or anti-inflammatory drugs. 

Medications can have unpleasant side effects.  For example, a muscle relaxer may have drowsiness as a warning on the label, making it difficult to take this medication during the day.  And surgery can require downtime from work or activities of daily living, which not everyone can afford.

A conservative approach often has fewer side effects. It allows a person to continue doing what they love, help slow or prevent injuries before they occur, and return to their daily living activities more quickly. 

Are chiropractors trained to take care of elbow injuries?

Absolutely.  Chiropractors are known for working on spinal complaints, but their training includes extremity work on the arms and legs.  A chiropractor can treat the initial injury, aid with soft tissue healing, help with rehabilitation, and help the patient with activity modifications to restore proper movement and function.  May patients report feeling better after seeing a chiropractor, some even performing at a higher level than before the injury!  Therefore, a treatment plan needs to relieve pain and help stretch and strengthen the elbow effectively.

Additionally, treating an elbow injury alone may not be enough if the patient unknowingly continues doing whatever caused the injury in the first place.  Part of a comprehensive evaluation and treatment includes education, and our doctors are trained to provide.  Helping you understand your body and how it moves is an important piece to preventing future injury.  Here are some other articles to read regarding treating golfer’s elbow:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322013

https://www.mayoclinic.org/diseases-conditions/golfers-elbow/diagnosis-treatment/drc-20372872

When should I see a chiropractor for my elbow pain?

A chiropractor can be the first and best line of defense in the conservative management of your injury. The chiropractor goes through a screening process to see if they are the best fit for you and your road to recovery or if you need to be referred to another specialist, such as an orthopedist or sports medicine doctor.

If rest, ice, and activity changes have not helped your elbow pain, give our office a call. 

It’s okay to give it time, too; many people will often use a “wait and see” approach to see if their pain will go away.  However, we often hear, “Why didn’t I come in sooner?” when people realize they didn’t need to live with the pain.

You can also see a chiropractor before you get hurt.  A chiropractor can establish a baseline functional movement assessment to determine how your body moves and functions in time and space and if something needs to change before an injury happens.

If you are dealing with elbow pain, do not let it linger on without resolution. If you want a same-day examination and treatment for your sports injury, call our Boca Raton or Miami chiropractic and sports injury office at 561-997-8898 or schedule online