Rob Hobkinson, a physiotherapist who works on the DP World and PGA Tours, explains what golfers elbow is and how to treat it.
Golfers elbow, or medial epicondylitis, is a common condition that affects not only golfers but anyone engaged in repetitive arm and wrist motions. In this article, we delve into the causes and symptoms of golfers elbow, as well as an expert insight on effective treatment options to alleviate pain and get you back playing golf.
The expert insight throughout this article is provided by Rob Hobkinson, who has specialised in golf for more than 25 years, beginning his career as a PGA Professional and now travelling the world supporting elite professional golfers on the PGA and DP World Tour. Through Peak Golf Performance he brings together the 3 disciplines of strength and conditioning, physiotherapy and golf, to deliver completely bespoke and highly supportive programmes.
Golfers Rob has worked with include – Jordan Smith, Nicolai and Rasmus Hojgaard, Yannik Paul, Eddie Pepperell, Marcus Armitage and Matt Wallace.
Golf can be a pain in the…elbow!
Elbow pain in recreational golfers can be debilitating. Googling to self-diagnose elbow pain is common and frequently in-accurate.
So, before we clarify some of the basics, we must first acknowledge that there are many conditions that can affect the elbow, forearm, wrist and hand. Therefore, a full understanding of the problem you have can only be reached through appropriate individual assessment from a registered health professional such as a physiotherapist -preferably one that regularly works with sports people.
Some of the basics – golfers and tennis elbow
Golfers elbow can be described as a pain felt on the inner area of the elbow, especially when moving the palm of the hand at the wrist joint downwards towards the inner part of the elbow.
Tennis elbow (often mis-labelled as golfers elbow) is pain felt on the outer part of the elbow and often painful when attempting to raise the middle finger towards the back of the hand.
The bony landmarks on the outer and inner aspects of the elbow can be painful to touch. Some people may report numbness in the hand as the nerve that supplies feeling to that area runs across the elbow joint.
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These conditions can affect grip strength significantly and impact the smallest of tasks such as opening a door or picking up a glass or cup.
Therefore, when a golfer is experiencing this, it can be frustrating due to the impact on enjoyment of practice and play and in the worst cases, rendering golf impossible.
Golfers and tennis elbow can be conditions that last for months but also can be years before fully resolved if not addressed appropriately.
What can be the cause of the problem?
As with many conditions, golfers and tennis elbow risk can be elevated with age and health status.
However, the most common trigger in golf can be a sudden increase in activity. This may not be caused specifically from golf-related activity but is often triggered by a repetitive movement that at the time may seem innocuous, such as some un-planned gardening or DIY task in the house.
The result can be an acute trauma causing a sudden muscle contraction, creating micro-tears within the tendon of the muscle near where it attaches to the bone.
Common treatment approaches
Hoping that this issue will resolve itself quickly is unlikely but stopping aggravating activities in the short term is important to ease the pain. However, an appropriate treatment plan is important if you are aiming to return to golf with a reduced risk of an exacerbation.
There are three recognised approaches to treat these elbow conditions.
1 – Conservative management
This is the most common treatment approach and is normally overseen by a physiotherapist and will include:
Activity management: Initially the problem can be helped by stopping the offending activity, but returning to full use of the elbow needs to be managed carefully as using it with ever increasing effort can improve the issue in the long-term.
Pain management: whilst not resolving the problem, consuming non-steroidal anti-inflammatories and pain killers may aid in the acute phase or whilst working gradually on returning to the offending activity.
Bracing and taping techniques can help reduce the perception of pain when returning to activity.
Focused rehabilitation using resistance-based exercise helps the affected tendon to return to a healthier, less painful state, ultimately a pain free state which is totally possible.
2 – Complementary treatment approach
Corticosteroid injections carried out by an experienced health professional can provide respite, but long-term benefits are questionable and therefore must play a part of an overall treatment approach.
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Other approaches include shockwave therapy, massage, and electrical muscular stimulation, all of which may help with symptoms but should form part of a broader treatment plan.
3 – Surgery
Surgical intervention may be considered if there has not been an improvement following a diligent conservative approach. Long-term considerations are essential as there will be follow-up rehabilitation which would reflect a similar approach if you had not elected surgery in the first place.
Therefore, it is often recommended to address this issue conservatively prior to choosing invasive procedures.
Take home message
The classic golfers elbow is a problem that can be fully resolved but it can take significantly longer than people appreciate and therefore managing expectations plays an important role.
Remember, there are strategies available that can help you get through this, but you must play a proactive role to resolve the problem to help you get back playing pain free.
