Now that the sun has poked through the rain clouds everybody has Spring- Fever and is excited to get on with their beloved summer activities. Along with the enthusiasm there’s been an increase in over-use injuries, especially among golfers. Golfer’s elbow is a condition known as medial epicondylitis, or inflammation of the medial condyle of the elbow. It is commonly seen in golfers, and tennis players who put a lot of top spin on their shots, and people performing repetitive activities of wrist flexion and forearm rotation. It is usually the result of over activity of the flexors and pronator teres muscles in the forearm.
Repetitive movements, trauma or excessive load to the muscles causes microtears of the flexor or pronator tendon in the forearm, close to its attachment on the medial epicondyle. Initially there is bleeding and inflammation associated with the microtears in the tendon. Instead of healing with muscle tissue, scar tissue is laid down which is not as strong or extensible as normal muscle tissue.
The ulnar nerve lies very close to the flexor and pronator teres tendon and often becomes entrapped in scar tissue, becoming over stimulated and pathological.
Signs and Symptoms
Initially pain is experienced after an aggravating activity, such as lifting and carrying with the palm facing up, but will subside with rest. If the condition worsens, the pain will occur during activities which stress the forearm flexors or the pronator teres muscle. As the condition deteriorates, pain is experienced more often, eventually becoming constant. The result is weak muscles, poor biomechanics, +/- nerve pathology. If the ulnar nerve is involved, it may cause pain in the forearm, progressing to pins & needles or numbness in the last two fingers in the hand.
Treatment
A physiotherapist will assess the neck, wrist and shoulder to determine if they are contributing to, or causing the elbow problem. This is often the case when both elbows are involved.
For simplicity sake, we will assume it is truly just an elbow problem. Golfer’s elbow is slow to heal and resolve due to their chronic nature. Initially the pain and inflammation must be controlled. This requires ice and rest from the aggravating activities. Acupuncture is often useful in controlling the pain, releasing tight muscles and settling down the nerve.
Therapeutic modalities such as ultrasound, laser and heat encourage healing of the muscle and tendon.
Soft tissue therapy is performed at the lesion site and to tight or thickened tissues. Transverse frictions and myofascial release of pronator teres and the forearm flexors assist in breaking down scar tissue, lengthening of short muscles and promote healing of the muscle and tendon.
Stretching and strengthening of the affected muscles is necessary to prevent recurrence of golfer’s elbow. As soon as pain permits, isometric, concentric, and finally eccentric strengthening exercises should be performed pain free.
The ulnar nerve is treated by Active Release Therapy, nerve mobilizations and scar tissue release surrounding the area of entrapment.
A graduated return to activities is recommended, with a careful biomechanical assessment of techniques to ensure the flexors and pronator teres are not being stressed excessively.
If your golf game is suffering this summer and you are blaming it on your elbow, or you are experiencing elbow pain, give us a call.
Bragg Creek Physiotherapy
949-4008.
Carole Damnjanovic B.Sc.P.T.
Lisa Le Poole B.Sc.P.T.
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