Hello and welcombe back once again to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy and health related. In today's blog we will look at a topic and problem that is close to my heart (and arm!) as I have had several episodes of it over the years. I can hear people saying "You are a physio! You should be able to fix yourself!" Well if only it was that easy, there are unfortunately some conditions out there that are very difficult to treat and have a large tendency to come back. In this case we are going to look at the evil little brother of tennis elbow: golfer's elbow.

 What is Golfer's Elbow?

A good starting place when thinking about Golfer's Elbow is firstly:  "what is golfer's elbow" and "why is it called golfer's elbow?" Well firstly it doesn't only affect golfers, personally I don't play golf, instead I go rock climbing a lot and I have had at least 3 (possibly 4 - memory fails me!) episodes of golfer's elbow (at the moment my elbow is fine - fingers crossed). To understand what it is and what the problem might be it is unfortunately necessary to have a brief look at some of the anatomy around the elbow. So the elbow comprises of 3 bones the humerus (upper arm bone), the ulna (forearm bone) and the radius (other forearm bone).

The main elbow joint is formed by the humerus and the ulna and is a basic hinge joint that allows flexion and extension (bending and straightening), there is also another joint just to the side of this between the radius and ulnar which allows rotation of the whole forearm (pronation and supination). Now in the forearm itself are all (well actually the majority) the muscles that are responsible for the action of gripping and bending the wrist. If you place your hand palm up on a table and now make a fist, you should see these muscles moving in the forearm. All of these muscles have a joint origin at the medial epicondyle of the humerus (otherwise known as the common flexor origin), this can easily be found by putting your forearm on a table palm up and feeling for a bony bump on the inside part of your elbow. The extremely large bump on the back of the elbow is the olecranon and the medial epicondyle is a smaller bump just to the inside of it. This point where all the flexors originate and a muscle called pronator teres (responsible for forearm pronation) originate is the site where the pain from golfer's elbow is located. Due to its location at the medial epicondyle of the humerus it is also called medial epicondylitis. So, Golfer's Elbow put simply is pain at the inside part of the elbow usually felt when gripping objects. Its called Golfer's Elbow because as you might have guessed it is a common complaint amongst golfers!

What Causes Golfer's Elbow?

So now we know where it is and some of the anatomy, what causes it? Well, although the research is inconclusive and ongoing it seems most likely that some form of overload is the initial cause. By this I mean that the elbow or grip strength has been used a bit too much and the tendon experiences some micro-trauma that possibly the patient didn't feel at the time but then carried on using it and causing more damage. Now, usually when the body experiences trauma or an injury it goes through a healing process but in the case of golfer's elbow this healing process fails and the tendon stops repairing itself. Tendon repair is a subject of much research at present and golfer's elbow is part of a series of tendon problems called tendinopathies where despite the original injury occurring a long time ago, for some reason pain continues to persist.

In general someone with golfer's elbow will complain of pain at the medial epicondyle of the elbow when they are gripping an object and for most people this pain will be generated by the conjoined tendon of the forearm flexors. However there is an exception to this which is reasonably common in someone who goes rockclimbing and it is where the tendon of pronator teres which also inserts into the medial epicondyle becomes irritated. For these patients it is likely that their basic grip strength is still good and pain free and they only get the pain in certain specific positions. To decide which version you may have it really does need a thorough assessment by an experienced physiotherapist.

Treatment for Golfer's Elbow:

There are a range of treatment options available for Golfer's Elbow and below we have tried to cover the majority:

1. Eccentric Exercises: As with other tendon pain the mainstay of treatment for golfer's elbow revolves around the use of eccentric loading, the evidence for this comes mostly from research into other tendons such as the Achilles tendon which may explain why it sometimes doesn't work as well. Eccentric exercises involve loading the tendon and letting the muscle lengthen. To know exactly how to do this and which particular exercises would be best to help with Golfer's Elbow it would be necessary to see a physiotherapist.

2. Epicondyle Clasps: these are a common piece of equipment that are helpful for some people with Golfer's Elbow. An epicondyle clasp is a strap that goes around the elbow and in theory offloads the tendon. As mentioned they can be helpful and having had Golfer's Elbow in the past myself I have used an epciondyle clasp in the past with some success.

3. Ultrasound for Golfer's Elbow: in the past therapeutic ultrasound has been popular and potentially it can be helpful for some patients.

4. Acupuncture: some patients find that acupuncture can be helpful in alleviatig the pain associated with Golfer's Elbow but effects can be variable.

5. Steroid Injections: For patients for whom physiotherapy and conservative management is not working then a steroid injection can be a useful alternative.

6. Surgery: finally should nothing be working and a patient has been persistent with their exercises for Golfer's Elbow, surgery can be used as a last resort.

To decide which treatment option is going to be the most suitable for you and which type of golfer's elbow you have it is essential to see a good physiotherapist.

I hope that you have enjoyed reading this blog post. For anyone reading this blog who hasn't come across our site before: we are a home visit physiotherapy service, based in Lichfield but serving anywhere within a 20 minute drive including areas such as Sutton Coldfield, Tamworth, Cannock, Burton and Rugeley. We offer a wide range of services including paediatric physiotherapy, post-operative rehabilitation, neurological physiotherapy and neck and back pain relief. If you need further information or would like to book an appointment we can be contacted on 0788 428 1623 or via enquiries@threespiresphysiotherapy.co.uk