Golfer’s Elbow – Medial Epicondylitis: Symptoms, Causes, Prevention, Healing Cycle & Treatment

What is Golfer’s Elbow?

Golfer’s elbow also called medial epicondylitis is a common painful condition that is caused by damage to the tendons that connect the forearm muscles to the internal bones of the elbow. Pain associated with a golfer’s elbow can spread to the forearm and wrist because the pain is intense on the medial side of the bony structures of the elbow and the medial muscles due to which the medical term for golfer’s elbow is medial epicondylitis [1].

Symptoms of Golfer’s Elbow

1. Pain and tenderness are often felt on the medial side of the elbow. However, this pain can spread to the inside of the forearm towards the wrist. The pain is often worsened with certain movements.
2. Stiffness or weakness in the elbows and wrist due to the injured tendon in the elbow.
3. Pain or difficulty in shaking hands, turning a doorknob, holding a cup, gripping something, and raising arms [2].

Causes of Golfer’s Elbow

1. Golfer’s elbow is caused by damage to the muscles and tendons that control the wrist and fingers. Injuries are often associated with excessive or repetitive stress. This is especially true for vigorous wrist and finger movements, improper lifting, throwing, or striking including insufficient warm-up or poor physical condition can cause a golfer to injure his elbow. In addition to golf, many activities and movements also lead to golfer’s elbow, including:
2. Playing racket sports with improper or biomechanically wrong tennis technique can cause Golfer’s elbow, especially the backhand stroke, using too much topspin, and using a racquet that is too heavy or too small can cause injury in the tendon [3].
3. Sports that include throwing can also be a cause of a golfer’s elbow because the improper technique of throwing the baseball or softball, soccer, archery, and javelin throw can cause a golfer’s elbow [2].
4. Weight lifting without proper training can result in lifting weights using incorrect techniques, such as flexing the wrists during bicep exercises. It can cause excessive strain on the elbow muscles and tendons resulting in the golfer’s elbow [2].
5. Repetitive, forceful, and occupational movements can also cause a tear in the elbow tendon. Examples of these occupations include construction, carpentry, and plumbing.

Normal Healing Cycle of Golfer’s Elbow

In a normal healing cycle, a cascade of three events is involved to repair the damaged tendon which includes inflammation, proliferation, and maturation. Inflammation refers to the increased temperature, swelling, redness, and soreness in the affected area. The proliferation phase of healing is started with the scar tissue formation at the injured site helping it to be healed up, and reducing inflammation. The scar tissue is a connective and stretchable tissue that is specifically formed in the site where the blood cells detect any inflamed area in the body and send the signal to the white blood cells to form scar tissue. At the trigger point, the scar tissue formation is stopped and the superficial and deep layers of fascia are formed at the injured site so that the maturation stage could be reached. In the maturation stage, the scar tissue and fascia are released so that the injured site can function normally [4].

Chronic Healing Cycle

In a chronic healing cycle, the inflammation and proliferation stage is remained continued because the damage or tear in the tendon is continuous resulting in the prolonged redness and swelling at the elbow tendon hence the inflammation and proliferation stages go in a cyclic manner and the maturation stage does not reach [5].

Not Effective Treatments for Golfer’s Elbow

Common treatments of Golfer’s elbow that are not effective for stopping pain are:

1. Heating and Icing are not effective because these are the only temporary solution to pain.
2. Foam roller provides a soothing effect to the injured tendon and when the equipment is switched off, the pain is reversed.
3. Electronic stimulation (Estim) can be effective to reduce pain for a few hours as it reduces inflammation in the tendon but the continuous chronic healing cycle causes the pain back in the forearm.
4. Massage at the elbow to reduce pain is not effective in the case of a golfer’s elbow because it increases the temperature and swelling in the damaged tendon due to which the inflammation is increased.
5. Stretching and strength exercises are not effective for the golfer’s elbow because excessive or repetitive movements can worsen the pain [4].

Effective Treatment of Golfer’s Elbow

炎症階段

1. Rest is necessary to heal the injured tendon and to prevent repetitive movement of the elbow.
2. MagnaHeal is a wearable device that has incorporated a magnet in it to utilize a magnetic field to reduce inflammation.
3. An anti-inflammatory diet can play an effective role in reducing the inflammation in the Golfer’s elbow.
4. Restoring certain deficiencies of vitamins and minerals is essential to prevent tears and damage to the tendons [5].

增殖階段

1. To release the accumulated scar tissue at the inflamed tendon, an instrument of A3 and A5 is specifically designed to apply pressure at the injured site that releases the scar tissue both superficially and deeply.
2. To release the fascia layers at the superficial layers, an A1 instrument is used to apply pressure. For deeper layers of fascia i.e. epimysium, perimysium, and endomysium, A5 has been used that help in the release of fascia layers at the tendon in the elbow [6].

Preventive Measures of Golfer’s Elbow

1. Avoid the trigger of the golfer’s elbow by reducing the repetitive motion of the elbow or wrist. Especially when a person is a professional carpenter, plumber, or constructor.
2. If the pain is in the inflammation stage, then use Magna Heal, an anti-inflammatory diet, and restore the deficiencies.
3. If the pain is in the proliferation stage, then opt for the medicines or therapies that release scar tissue, trigger points, and fascia restrictions [[5, 6].

參考 

1. Ciccotti MC, Schwartz MA, Ciccotti MG. Diagnosis and treatment of medial epicondylitis of the elbow. Clinics in sports medicine. 2004 Oct 1;23(4):693-705.
2. Nabil BA, Ameer MA, Abdelmohsen AM, Hanafy AF, Yamani AS, Elhafez NM, Elhafez SM. The Impact of Tennis and Golfer’s Elbow on Shoulder External Rotators and Abductors’ Peak Torque. Journal of sport rehabilitation. 2019 Nov 26;29(4):469-75.
3. Amin NH, Kumar NS, Schickendantz MS. Medial epicondylitis: evaluation and management. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2015 Jun 1;23(6):348-55.
4. Hoogvliet P, Randsdorp MS, Dingemanse R, Koes BW, Huisstede BM. Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review. British journal of sports medicine. 2013 Nov 1;47(17):1112-9.
5. Shiri R, Viikari-Juntura E. Lateral and medial epicondylitis: role of occupational factors. Best practice & research Clinical rheumatology. 2011 Feb 1;25(1):43-57.
6. Pitzer ME, Seidenberg PH, Bader DA. Elbow tendinopathy. Medical Clinics. 2014 Jul 1;98(4):833-49.