What is “Golfer’s elbow”?

Golfer’s elbow, also known as medial epicondylitis, is the tendinopathy of the muscles that attach to the inside of the elbow. These muscles originate from the inside of the elbow, but actually span the entire forearm to work on the wrist joint. They are a group of muscles that flex, pronate, and ulnarly (toward pinky) and radially (toward thumb) deviate the wrist. These actions are prominent through the golf swing, and for that reason, are seen mostly in frequent golfers. 

Golfer’s elbow related anatomy:

There is a prominent bony landmark on the inside of the humerus known as the medial epicondyle. Five muscles share a tendon that attaches to this bony prominence: 

  • Pronator teres 
    • Action = pronation (bring the palm down) of the forearm 
  • Flexor carpi radialis
    • Action = wrist flexion and radial (toward thumb) deviation 
  • Palmaris longus
    • Action = elbow, wrist, finger flexion; pronation of forearm
  • Flexor digitorum superficialis 
    • Action = elbow, wrist, finger flexion
  • Flexor carpi ulnaris
    • Action = wrist flexion and ulnar (towards pinky) deviation

As you can see, these muscles all contribute to flexion, pronation, and ulnar/radial deviation of the elbow, forearm, and wrist. When they perform their actions on the wrist, the tendon gets pulled on the medial epicondyle end and causes irritation. More often than not, eccentric strength is limited, and therefore controlled movement cannot be controlled, and repetitive stress cannot be withheld. Eccentric strength is the controlling of the lengthening of a muscle group. For example, everyone knows the biceps act to flex the elbow – but it also controls elbow extension during all movements.

Wrist and forearm positions during the golf swing:

In order to successfully complete the golf swing, the wrist and forearm must go through a series of different positions. These wrist/hand positions are required to keep the club face ideal during the back and front swing, as well as ball contact. We do not claim to be golf experts; however, below is a slight outline of wrist/forearm positions and its relation to the golf swing. 

  • Wrist flexion/extension – in order to hit the golf ball in an ideal spot, the club face must go through an open face and closed face spectrum. Good flexion of the wrist allows for good timing of club face closing. If too much wrist extension is present, it can delay the closing of the club face and mess up the direction of your shot. With this being said, wrist flexion is often prominent and overworked during the golf swing. As mentioned before, all the muscles that contribute to Golfer’s elbow are involved in wrist flexion. 
  • Wrist radial/ulnar deviation – during the backswing and follow-through, the wrists must undergo radial and ulnar deviation. During the backswing, the top hand undergoes radial deviation while the bottom hand undergoes ulnar deviation. During the swing and follow-through, the opposite occurs to bring the club face through the ball properly. As mentioned above, there are muscles that both radially and ulnarly deviate the wrist that attach to the medial epicondyle. 
  • Forearm pronation/supination – similar to wrist flexion and extension, forearm pronation (palm down) and supination (palm up) plays a crucial role in maintaining proper club face position during the golf swing. Similar to wrist radial/ulnar deviation, the top and bottom hands do the opposite of one another to complete the swing. The top hand supinates during the backswing and pronates as it goes through ball contact and follows through, while the bottom hand does the opposite. As mentioned above, there are two muscles that contribute to forearm pronation that attach the medial epicondyle. 

These actions, if not controlled well (whether due to weakness or poor stability), can create tension throughout those five muscles and lead to injury at their common origination site at the medial epicondyle. This irritation can cause swelling, fraying, or other tendon changes to cause Golfer’s elbow, or medial epicondylitis. 

Symptoms of Golfer’s Elbow:

The most common symptoms of Golfer’s elbow are the following:

  • Pain in the inside of the elbow during:
    • active wrist flexion 
    • stretching into wrist extension 
  • Swelling to the inside of the elbow
  • Tenderness to the inside of the elbow
  • Weak wrist flexion, deviation or pronation of the forearm

It is important that if you notice any of these symptoms either during daily activities or during your golf swing (or other sports tasks), to contact a healthcare professional. You can see an Ortho, or at Block Sports Chiropractic and Physical Therapy, we have Doctors of Chiropractic and Physical Therapy who can perform a skilled evaluation of you to determine what may be contributing to your symptoms.

How can Block Sports help?

As previously stated, Block Sports Chiropractic and Physical Therapy have doctors in both Smithtown and Selden, NY, who are highly skilled and experienced in treating Golfer’s Elbow. 

Our chiropractors are skilled in Active Release Technique (ART)®, which has been highly supported in the research to help with medial epicondylitis. This technique involves pinning the trigger point or irritated tissue in a shortened position, followed by the active lengthening of the tissue (while maintaining the contact). This can be painful, but it allows for increased circulation and improved tissue release. They can also perform adjustments, joint mobilizations, or other soft tissue techniques to fix other areas of dysfunctions that may be contributing to poor golf swing mechanics. 

Our physical therapist can also perform a thorough evaluation to create a treatment plan to get you out of crisis mode but also determine contributing factors that may have led to the injury in the first place. Our therapists will take a look at your cervical, thoracic, and lumbar spines, shoulders/elbows/wrist, as well as your hips! This may seem excessive, but if one of these areas is limited, the upper extremity is forced to overwork and can lead to Golfer’s elbow. The provider will create a skilled therapeutic exercise program for you to perform to improve the dysfunctions found, but will also use their own manual skills such as soft tissue massage, myofascial release, Graston® Technique, joint mobilization and modalities to improve your symptoms as well. 

Conclusion:

Golfer’s elbow is a very common injury experienced by novice, amateur and professional golfers. The muscles that attach the medial epicondyle can be irritated if the golf swing is not efficient and properly completed in a safe manner. If you have any of the aforementioned symptoms, you may have Golfer’s elbow and should seek out an evaluation at one of our Block Sports Chiropractic and Physical Therapy locations in Smithtown or Selden, NY.