Golfers Elbow Treatment By Osteopaths

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Golfers elbow is also known as medial epicondylitis and is the less common sister condition of tennis elbow, both conditions sharing the tendon degenerative nature without inflammation. They are referred to as tendinopathies due to the pathological changes which occur inside the tendon without an inflammatory process. Not just occurring in golfers, golfers elbow also appears in racquet sports, cricket bowling, weightlifting and archery.

The muscles which flex and rotate the forearm originate over the medial epicondyle, the bony prominence on the inside of the elbow, with the tendon anchored into the bone by the tendinous insertion. The pain occurs close to this and may be due to a degenerative process occurring in the tendon, as little inflammation has been noted in these cases.

The flexor tendons are put under stress by activities which force the forearm outwards away from the body and these stresses occur as the wrist is cocked prior to throwing, in the early acceleration of the throw and in the golf swing from high backswing to just before the ball is hit. The dominant hand is affected in golfers and in tennis players those who impart a heavy topspin to the ball are more likely to suffer.Golfers elbow is not as common as tennis elbow but is the commonest cause of medial elbow pain with about half as many women affected as men. The third to fifth decades of life are the commonest periods for pain onset and 60% of golfers elbow occurs in the dominant hand. An acute onset of pain is reported in a third of patients, with the other two-thirds developing over a period of time.

Pain and ache over the front of the medial epicondyle is the typical symptom, worse with repeated flexion of the wrist and improved with resting. Shoulder, elbow, forearm or hand pain can occur, with weakness or pins and needles in the lower arm. Osteopathy examination includes the bony tendon insertions, the elbow joints and the muscles, with palpation of the funny bone area behind the elbow where the ulnar nerve lies. Nerve involvement can give weakness in the forearm muscles and sensory symptoms, so an exclusion neurological examination is performed by the osteo.

Conservative, non-surgical, treatment is the mainstay of management. This includes osteopathy, anti-inflammatory drugs, wrist splints and steroid injections. Patient education is important and activity modification is the first line of treatment, reducing the frequency of aggravating episodes. Altering the mechanics of the golf swing or other activity is vital if the area is to be allowed to settle. The patient avoids certain activities with the affected muscles and avoids leaning on the elbow.

Cryotherapy (cold therapy), gentle stretching, ultrasound, frictions and anti-inflammatory drugs are the main treatments for acute golfers elbow. Once it has settled down into the sub acute condition then the aim is to increase flexibility by stretches, improve the strength of the muscles and go back to normal daily jobs. Bracing can be used either to rest the musculature (wrist brace) or to realign the forces through the tendons (counterforce bracing). In the case of chronic golfers elbow the treatment can be the above plus gradual weaning out of the splint and paced return to sport.

Doctors inject corticosteroid medication into the sites of chronic golfers elbow but this treatment appears to be more useful in the earlier, acute cases. Other therapies, such as shockwave or laser, have been used but do not seem to be effective. Once osteo has been attempted for some time without improvement then a surgical approach may be considered, cutting out the abnormal tissue from the tendon. The ulnar nerve can be transposed around to the front of the joint from its position in the groove posteriorly.

A professional instructor will allow correction of golf swing technique. Overall fitness including strengthening exercises, aerobic work and stretching is another aim of treatment. Proper sporting technique and equipment usage is vital in athletes, with a good warm up prior to performance and good stretching afterwards. Patients may need to be strictly monitored and treated by the osteopath as many sports people ignore pain during activity, worsening or prolonging their symptoms.

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