There are several golfer’s elbow exercises that you can do to help your pain. As a practicing orthopedic physical therapist, I have treated golfer’s elbow many times. It can be tricky to clear up, and the culprit is not always golf. In fact, golf rarely is the cause. Also, it has several other names including bowler’s elbow and, its medical name, medial epicondyle tendinopathy. Read on to learn more about this condition. Let’s start with anatomy!
The elbow
The elbow joint is where the humerus, ulna, and radius come together. The humerus is the upper arm bone and form individual joints with the ulna and radius, which are the forearm bones. Movements of the elbow include flexion and extension. Flexion is when the forearm and upper come closer together (bending the elbow) and extension is when they are moved farther apart (straightening the elbow). The upper parts of the radius and ulna will also form a joint which allow for the movements of pronation and supination. Pronation is rotating the forearm, so the palm faces downward, and supination is forearm rotation where the palm faces upward.
The medial epicondyle
At the elbow, there are two big bony bumps on either side of the joint. These are the epicondyles at the end of the humerus. Epicondyles are large bony bumps where the tendons of muscles and ligaments attach. There is a lateral epicondyle and a medial epicondyle. The muscles that are used to extend the wrist are attached to the lateral epicondyle while the muscles that are used to flex the wrist and pronate the forearm are attached to the medial epicondyle.
What is tendinopathy?
Tendinopathy is a term used to encompass any issue with the tendon. This includes tendonitis and tendinosis. There is a difference between tendonitis and tendinosis. Many of the conditions that were previously thought to be tendonitis are actually tendinosis. Let’s review the difference.
A tendon is the connective tissue that attaches the muscle to the bone. Tendons can get inflamed with a force that is too strong or quick. This tensile force on the tendon can cause micro-tears in the tendons. This is tendonitis. It is an inflammatory condition that has a recovery period of 1-6 weeks.
Tendinosos is a degeneration of the tendon’s collagen proteins. This is hypothesized to occur after a period of untreated tendonitis. Collagen provides the tendon with durability and strength. Tendinosis is caused by chronic overuse with no time for the tendon to rest and heal. It does not have signs of acute inflammation and is not improved with anti-inflammatory medication such as ibuprofen. Early-stage tendinosis can heal within 6 to 10 weeks, but chronic stage can take 3 to 6 months. Tendinosis is probably more common than tendonitis, but the term tendonitis is often used to encompass both.
What is medial epicondyle tendinopathy?
Medial epicondyle tendinopathy is a chronic irritation of the tendons of the wrist flexors and pronators where they attach to the medial epicondyle. This leads to tendinosos and degeneration in the tendons. It is an overuse injury that is caused by repetitive, forceful wrist flexion and forearm pronation. Without treatment or cessation of irritating activities, the tendon can eventually tear away from the bone.
“RCSI – Drawing Flexor muscles and tendons of forearm – English labels” by Royal College of Surgeons of Ireland, license: CC BY-NC-SA
What are the symptoms of medial epicondyle tendinopathy?
There are several symptoms associated with medial epicondyle tendinopathy. These include:
- Pain on or near the medial epicondyle with elbow, forearm, wrist, and hand movements
- Tenderness at or near the medial epicondyle
- Pain can radiate up and down the arm and is common in the pinky side of the forearm and hand
- Elbow stiffness
- Weakness in hand and wrist
- Decreased ability to grip items
- Numbness and tingling in fingers (most likely pinky and ring finger)
Who gets medial epicondyle tendinopathy?
Medial epicondyle tendinopathy is more common in females than males and is more prevalent in the ages of 40-60. There are some risk factors associated with developing this condition. These include:
- Performing activities that require daily repetitive wrist flexion and/or forearm pronation.
- Sports
- Throwing sports – e.g., baseball, javelin
- Tennis players
- Racquet ball players
- Golfers
- Bowlers
- Weightlifters
- Rock climbers
- Occupations
- Plumbers
- Carpenters
- Utility workers
- Butchers
- Caterers
- Smoking
- Diabetes
- Obesity
- Sports
Is this the same as tennis elbow?
Tennis elbow is not the same as golfer’s elbow. Tennis elbow is lateral epicondyle tendinopathy. This occurs at the bony bump on the other side of the elbow. It is a chronic irritation of the tendons of the wrist extensors where they attach to the lateral epicondyle. Tennis elbow is approximately 7 to 10 times more common than golfer’s elbow.
Who should I see?
- Physical therapy – This would be my first stop. Physical therapy can help decrease pain and inflammation with techniques including manual therapy and dry needling. PT can evaluate and address abnormal joint mobility, muscle weakness, muscle tone, and flexibility. With medial epicondyle tendinopathy, it is important to decrease the amount of work the pronator teres and wrist flexor are performing. Your PT can help you activate other muscles to decrease the load on these muscles. They can assess your posture during work or sports to prevent the problem from happening again.
- Orthopedic physician – An orthopedist might be necessary if the condition is not responding to physical therapy, or a tear is suspected. Your physician can prescribe medication, give a steroid or PRP injection, or order imaging if needed. Surgery is an option if all conservative measures fail.
What can I do?
- Relative rest – Resting the area to decrease further pain and damage from occurring is one of the best ways to treat golfer’s elbow. Basically, stay away from the activities that are causing pain. This gives the tendon time to rest, relax, and heal. If you keep doing what is causing the injury, it is not going to get better. This might include not participating in your sport or changing how you perform a task or job. If you are not able to participate in your activity or sport, then you can supplement with non-irritating activities such as biking, walking, or jogging while your condition is being treated.
- Ice – Ice can help decrease pain and symptoms at the elbow. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- Posture – Having forward, rounded shoulders can lead to muscular imbalances in the shoulder and elbow. It decreases the ability of the scapular stabilizers to stabilize the shoulder joint. With decreased stability, the muscles at the elbow have to work more. It also shortens the pectoralis major, pectoralis minor, and biceps and decreases their flexibility. Stretching this area will make better posture more attainable. Below is a video showing how to stretch the pecs and biceps and also how to use a wall to check your posture.
- Soft tissue mobilization – Soft tissue mobilization helps release the muscles around the elbow and decreases the tension on the tendon. Use a massage ball, lacrosse ball, tennis ball, or your own fingers to massage painful areas all around the elbow. Spend a good 3 to 5 minutes rolling. Do not roll so hard that you bruise the area, but it should be a pretty painful sensation. Roll out the area no more than a few times a week. See the video below.
- Pronator teres stretch – Stretching out the pronator teres after rolling it out is a great way to lengthen the muscle. It is a good idea to perform soft tissue mobilization first because you will get a better stretch afterwards. Below is a video on how to stretch the pronator teres.
- Wrist flexion and extension stretching – You will also need to stretch out the wrist flexors and extensors. This will decrease the pull on the tendons. See the video below.
- Median nerve flossing – You can mobilize the median nerve to ensure that it is not entrapped in an area. Flossing will free-up the nerve if it is stuck and allow it to move along its pathway. Below is a video of median nerve flossing.
- Strengthening wrist flexor and pronators – Strengthening the muscles around the wrist and elbow are also important in being able to return to your activity. Decrease your resistance or number of repetitions if the pain is severe during the exercise or returns after the exercise. Using dumbbells or resistance bands can increase strength and difficulty. See the video below.
- Strengthen the rotator cuff and scapular stabilizers– Elbow injuries tend to occur because of weakness of the rotator cuff muscles and scapular stabilizers. These are the stabilizing muscles of the shoulder that allow the arm to reach, lift, and hold without injury or irritation. Using loop resistance bands and resistance bands can increase strength and difficulty.
In review
- The elbow joint is where the humerus, ulna, and radius come together.
- At the elbow, there are two big bony bumps on either side of the joint.
- These are the epicondyles at the end of the humerus.
- There is a lateral epicondyle and a medial epicondyle.
- Medial epicondyle tendinopathy (golfer’s elbow) is a chronic irritation of the tendon of the wrist flexors and pronators where they attach to the medial epicondyle.
- This leads to tendinosos and degeneration in the tendons.
- It is an overuse injury that is caused by repetitive forceful wrist flexion and forearm pronation.
- Symptoms include pain on or near the medial epicondyle with elbow, forearm, wrist, and hand movements.
- Golfer’s elbow is 7-10 times less common than tennis elbow.
- Physical therapy is a key component in treatment.
- An orthopedist would be necessary if the condition is not responding to physical therapy.
- There are things that you can do.
- Relative rest
- Ice
- Posture
- Soft tissue mobilization
- Pronator teres stretch
- Median nerve flossing
- Strengthening wrist and elbow
- Scapular stabilization strengthening
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.ncbi.nlm.nih.gov/books/NBK557869/
https://www.physio-pedia.com/Medial_Epicondyle_Tendinopathy