Chiropractor Chandler AZ

Golfer’s Elbow Treatment Chandler & Sun Lakes

If you are experiencing pain on the inside of your elbow that gets worse when you are swinging a golf club, throwing, playing tennis or lifting weights, the cause may be golfer’s elbow or medial epicondylitis. Pain on the inside of the elbow isn’t as common as tennis elbow (aka lateral epicondylitis), but it can be an aggravating and chronic problem. Early treatment prevents the condition from causing permanent damage to the flexor tendons in the forearm, which might need to be corrected surgically.

What is Golfer’s Elbow

Golfer’s elbow, also known as medial epicondylitis, is a repetitive stress or overuse injury that affects the flexor and pronator muscles and tendons of the forearm. The medial epicondyle is the bony protrusion on the inside of the elbow: the site where you typically experience the most pain.

Golfers may develop pain on the inside of the elbow from incorrect form (“hitting from the top”). Medial epicondylitis also affects bowlers, pitchers, javelin throwers, racquet sports players and football players. It is also associated with certain occupations such as carpentry and plumbing.

bicep muscle insertion labeled

Although the condition is most often caused by overuse or improper form, it can also result from a direct hit to the area or sudden, extreme, eccentric contraction: something that might happen if you try to lift too much weight doing a biceps curl (the eccentric movement is the lowering of the weight).

Early on, you might notice some swelling in the area. This may subside with time, even if the condition persists (e.g. pain). Because these tendons are located near the ulnar nerve, you may also experience tingling in the arm or numbness.

Over time, the condition may also affect the medial collateral ligament that stabilizes your elbow during movement. Some pitchers also develop calcification and/or bone spurs in the area.

Symptoms of Golfer’s Elbow

If you are experiencing any of the following symptoms, it’s time to contact your chiropractor and/or physical therapist about golfer’s elbow:

  • Pain on the inside of the elbow that becomes worse with movement. The pain may radiate down the inside of the forearm. Although the pain may subside with rest, it resumes with the movements that caused the injury.
  • Numbness or tingling in the little fingers due to compression of the ulnar nerve.
  • Swelling and tenderness in the area.
  • Weakness in the hands or wrists, especially when flexing the muscles that control them.
  • Over time, the condition can limit range of motion, especially for pitchers.

Video: Medial Epicondylitis & Lateral Epicondylitis

Who is at Risk for Golfer’s Elbow?

Golfer’s elbow affects men and women equally; prevalence is highest in the fourth and fifth decades of life. Younger athletes who compete at the elite and semi-elite levels may also be affected. Risk factors include:

  • Participating in sports including golf, tennis, bowling, weight lifting, pitching and javelin throwing.
  • Improperly fitted sports equipment, particularly grip size for golf clubs and tennis racquets.
  • Certain types of manual labor including carpentry and plumbing.
  • Obesity
  • Smoking
  • Making bad decisions based on activity levels 20 years ago, you know who you are.

Home Treatment for Golfer’s Elbow

The first thing you need to do if you develop golfer’s elbow is to stop the activity that led to the injury. We know this is tough for those who love getting out on the links during the Fall, Winter and Spring seasons in southern Arizona, but if you continue to play, you will continue to hurt.

Ice is your best friend. Apply an ice pack to the area at least 3-4 times per day. The people who ice the most often are the ones who get better the fastest. Decreasing the muscle flexor tendon pain and inflammation is very important in treatment, and enhances recovery.

Wearing braces during activity to reduce daily irritation, especially when continuing to participate in sports or exercise. Tennis elbow and lateral epicondylitis braces are usually interchangeable and work well, and Mueller provides a very durable support that works for most people. I usually recommend people purchase two. One to get sweaty and stinky, and one to wear during the day. Most people won’t wear the sweaty one during daily activities.

Your primary care physician may recommend anti-inflammatory medications such as Advil, aspirin, Aleve or Tylenol for 10-14 days to reduce swelling in the area. He or she may also recommend a night splint if you have a tendency to sleep on your arms and aggravate the forearm muscles.

Your primary care physician may recommend anti-inflammatory medications such as Advil, aspirin, Aleve or Tylenol for 10-14 days to reduce swelling in the area. He or she may also recommend a night splint if you have a tendency to sleep on your arms and aggravate the forearm muscles.

Kinesio or rock tape can be helpful to decrease pain during activity. The tape can be applied frequently during the week and worn for a day or two.

Office Treatments

If home treatments don’t resolve the problem, the next step is active treatments including physiotherapy. The physical therapist may use ultrasound, class IV low level laser, or interferential (electric) therapy to decrease pain in the area.

Counterforce bracing can help you to complete activities of daily living without making the symptoms worse. Rigid athletic taping can also help.

Establishing full, painless range of motion is the first goal, before beginning exercises to strengthen the area. At the same time, it’s important to continue with general condition exercises that target the core, muscles of the middle back and chest, to make sure that weaknesses in these areas aren’t causing you to improperly use your forearm muscles.

Your physical therapist should evaluate your form if you became injured while playing a sport. Form errors include “throwing” from the apex of the backswing when playing golf, incorrect serving and forehand stroke for tennis players. Professional pitchers can develop muscle imbalances such as hypertrophy of the flexor forearm muscles that alter the valgus angle of the elbow and lead to medial epicondylitis.

Active Treatments

Once the swelling and pain in the area has subsided and range of motion is restored, the next step is to strengthen weak muscles and correct muscle imbalances that may have led to the injury.

This is a case in which some is good, but more is not necessarily better. Start low and go slow when beginning to strengthen the injured muscles. Exercises may include rows, flies, curls, reverse curls, kickbacks, supination and pronation of the forearm, as well as lat raises (side and forward) and core exercises on the stability ball such as planks, glute bridging and mountain climbers to address any weakness in the hips, abdominal, lower and middle back muscles.

If you are a racquet sports player, exercises that develop agility in side-to-side motion are important so that you don’t constantly over-reach to return balls. Along similar lines, golfers should concentrate on twisting exercises that help to maintain proper form during the golf swing.

An inexpensive exercise tool is the flexbar. It is commonly used to strengthen flexor and extensor muscles through eccentric and concentric contraction. It is excellent for slowly increasing dynamic forces into the wrist flexor muscles with movement and shaking (specific exercises and video links are included in the exercise packet).

If your pain persists for several weeks or more, more advanced and aggressive treatments might be required. A successful treatment to break up scar tissue and promote healing is the Graston Technique & Shockwave Therapy.

Graston Technique for Golfer’s Elbow

graston technique elbow pain

Graston technique is one of the best ways to break up scar tissue that develops in chronic injuries to reduce pain and speed up healing. Graston technique utilizes stainless steel tools designed to break up the scar tissue by sheer force. When the tools slide along the skin they pull one layer of tissue past the other. The scar tissue is pulled apart, triggering the body’s healing mechanisms to repair the fibers.

Shockwave for Golfer's Elbow

shockwave therapy

Extracorporeal shockwave therapy uses a percussive instrument to break up fascial adhesions and scar tissue in the injured area. It is an effective way to enhance range of motion and decrease pain. Graston utilizes an instrument to slide along the tissue and break scar tissue with shear force. Shockwave therapy breaks up the adhesions with compressive forces, and can be more comfortable for the patient. We often utilize the treatments together or on alternating days.

Video: Shockwave Therapy for Tendon & Ligament Injuries

Cold Laser Technique for Tendon Repair

cold laser elbow treatment

Class IV cold laser or low level laser therapy is an excellent modality for decreasing pain and inflammation from golfer’s elbow. Specific wavelengths and frequencies shut off the inflammatory cells, to decrease inflammation in the area. Different wavelengths and frequencies help to turn on repair and healing processes inside the cells. These wavelengths speed up the delivery of adenosine triphosphate (ATP), which is “fuel” for the cells created from the blood sugar your body makes from food.The repairing cells use this energy to lay down healthy fibers more quickly, reducing pain and speeding up the healing process.

Hand and Wrist Exercises

Many individuals with golfer’s elbow develop weakness in the hands and wrists because of tendonosis of the flexor muscles. Hand and wrist exercises will help to strengthen these muscles and resolve muscle imbalances that may have developed between the flexor, extensor, pronator and supinator muscles in the forearm, hand or wrist.

Many of these exercises are easy to do at home with minimal equipment. For more information refer to our section on hand and wrist exercises.

Medical Treatments

If your pain and swelling doesn’t respond to over-the-counter anti-inflammatory medications, your primary care provider may recommend a corticosteroid injection. The injection will decrease pain and inflammation and may help you to begin range of motion exercises earlier.

If your symptoms don’t resolve after six months or more with conservative therapy, your primary care physician may suggest referral to a hand specialist to evaluate other options.

Our Chandler Chiropractic and Physical Therapy clinic treats patients with a variety of muscle, tendon, joint and ligament injuries. The clinic provides treatment for endurance athletes and weekend warriors in addition to common headache, neck and back patients traditionally seen in Chiropractic, Physical Therapy, Massage Therapy clinics. We work with all ages and abilities of the residents of Ahwatukee, Phoenix, Tempe, Gilbert, Mesa and Chandler AZ.