Golfer's Elbow

Many racquet sports players and golfers develop pain on the inner side of the elbow. This condition is a type of tendinitis called medial epicondylitis or "golfer’s elbow." Medial epicondylitis is caused by using a repetitive strong grip while swinging a golf club or racquet or by using the wrist too much during these motions. The condition is an overuse injury of the wrist flexor tendons that attach to the lower end of the arm bone (humerus) in the elbow area.

The flexor muscles of the forearm that flex the wrist toward the palm of the hand originate at the medial epicondyle of the humerus. Strong use of these muscles can cause injury at the point of maximum stress where the tendons attach to the bone on the inner side of the forearm.

Contributing Factors

Weak muscles

Overuse – excessive and repetitive forceful gripping while flexing and twisting the wrist

Improper equipment – incorrect grip size or over-tightened strings

Poor playing technique – improper wrist action, poor ball contact

Treatment

Rest: You may have to temporarily stop the aggravating activity. A period of rest is most important to allow the injury a chance to heal. You will make the condition worse by continuing the activity that causes the injury, especially if you experience pain. Avoid heavy lifting or carrying, opening doors or handshaking repeatedly.

Ice: Apply cold to your elbow three times a day for 20 to 30 minutes at a time in the early painful stage and for 20 minutes after active use of your arm. Protect your skin by putting a towel between your elbow and the ice bag.

Stretching: Stretching will help prevent stiffness by making the muscles more flexible and by breaking down scar tissue.

Physical Therapy: Exercises to strengthen the forearm muscles can begin as soon as the pain subsides. Building strength will help protect the injured tendon and prevent the injury from happening again.

Medication: Sometimes anti-inflammatory medication helps reduce the pain. If you do not have a problem with this type of medication, you may take Aleve, one or two tablets twice a day with meals. Or, you may take Advil or aspirin. Anti-inflammatory medication is appropriate provided they do not cause stomach upset.

Brace: A counter-force brace which is an elastic strap that is worn one to two inches below the elbow. This type of brace gives compression to the forearm muscles and helps lessen the force that the muscle transmits to the tendon. At first, the brace may be worn at all times but as the pain subsides, the brace is necessary only for protection during activities that stress the injured arm.

Surgery: Surgery is rarely required but is sometimes useful to correct chronic or recurrent tendinitis.

Returning to Sports

Warm Up: Always warm up before you play. Complete a full range of motion of all major joints and work up a "sweat" prior to stepping on the tennis court or golf course. Follow this by slowly performing the motions that you use in your sport. In tennis, do easy strokes next, and then slowly increase your intensity until you are sweating again. The forearm muscles should be stretched well after the warm up.

Your Racquet: Use a lighter weight racquet and move your hand up a bit on the grip. Change to a racquet that has greater spring. Reduce the string tension. Grip size can also be an important factor. If possible, discuss equipment with your local pro.

Your Stroke: In tennis, the forehand stroke, the serve or the overhead can cause medial epicondylitis especially if a lot of spin is applied. Avoid the shots that aggravate the problem. Reduce wrist motion to a minimum. Lessons may be necessary to alter your strokes.

Your Game: When you go return to your sport, start back slowly. In tennis, warm up first and rally for only short periods of time, avoiding problem shots. Play less time each day or play doubles. Avoid playing competitive games until your elbow is healed. In golf start with only putting and chip shots. Slowly work up from a few holes to a complete game.

After the Game: Stretch the muscle after you are through playing. Apply ice to the elbow for 20 minutes.