As a Physical Therapist, I see many patients who complain of elbow pain. Elbow pain is very common and leads to lost time working and playing sports. I have had an increase in patients that I have treated recently who seek my help due to either tennis elbow or golfers elbow. Ironically, only a small percentage of these patients actually play tennis or golf.
Tennis and golfers elbow are often overuse injuries. Overuse injuries are the cumulative effect of many tiny injuries caused by stress or strain on body tissue. It can occur suddenly but often develops slowly over time. Every time we use our bodies we create these microscopic injuries or tears in the muscles, tendons (connect muscles to bones), ligaments (connect bones to bones), and even in the bones. Our bodies become stronger by responding to these microscopic injuries by building stronger muscles, tendons, ligaments, and bones. This is what happens each time we exercise. Overuse injuries occur when we exceed our bodys ability to rebuild tissue as fast as we are damaging it. This causes inflammation and can limit our bodys ability to heal itself. Over time this can become chronic and limit strength and range of motion. It can also be very painful. Overuse injuries are common where anyone motion is repeated such as running, tennis, using a computer keyboard, or lifting something overhead.
Tennis and Golfers Elbow
By definition, tennis or golfers elbow is an inflammation of the tendons where they attach to the bony areas on the elbow. Tennis elbow, which is actually called lateral epicondylitis, affects the tendons on the outside of the elbow. The opposite of this is golfers elbow, which is called medial epicondylitis and affects the tendons on the inside of the elbow. Often times any elbow pain is called tennis elbow simply due to popularity of the term. Tennis and golfers elbow are actually misnomers as there are many causes and activities related to medial and lateral epicondylitis.
As the muscles of the forearm work to move the wrist and hand, they contract and pull or tug on the bony areas on the inside or outside of the elbow. Repeated pulling on these muscles causes these microscopic tears in the muscles and tendons. If we injure the tissue faster than our bodies can repair it, the result is pain, tenderness, inflammation, decreased strength, and decreased range of motion at the elbow and wrist. It may be difficult to fully bend or straighten the elbow, to turn the forearm (as in turning a key in a door or the ignition), type, or grip items (raising a cup of coffee or pulling a door open).
True tennis elbow is often caused by in improper grip, repeated use of a backhand swing, faulty swing mechanics, arm weakness, poor warm-up or cool-down, or any combination of these. The muscles that attach to the outside of the elbow draw the wrist backwards so any other activity that mimics that motion may also contribute to elbow pain. Golfers elbow, on the other hand, affects the muscles on the inside of the elbow. These muscles work to draw the wrist forward and with gripping or making a fist. Golfers elbow, similar to tennis elbow, can be caused by faulty swing mechanics, tight or improper club grip, increased wrist action during the golf swing or any other action that causes the wrist to be flexed forward or a tightened fist position.
There are many other causes of elbow pain. Tennis or golfers elbow can easily be caused by non-sport activities. Repeated use of a keyboard, especially with poor computer set-up, is one of the most common non-sport-related causes of tennis elbow. Repeated gripping activities such as using a screwdriver or hammer also frequently cause elbow pain due to the strain on the muscles of the wrist and elbow. This commonly occurs both with people who perform this motion for a living such as painters as well as weekend do-it-yourselfers.
Elbow pain can also be caused by many other factors not directly related to the elbow. Often times as Physical Therapists, we look beyond the elbow and wrist at the neck, shoulder, and posture as potential sources of contributors to elbow pain. Degeneration in the neck leading to pressure on the nerves going into the arm, poor rotator cuff strength, and a slouched posture are examples of other causes that may mimic tennis or golfers elbow.
If you have elbow pain, there are things that you can do to treat it. The sooner you treat the elbow pain you are more likely to have better and quicker results.
The first step is to rest the arm. Stop doing the activity that you think is most bothering your elbow. If that is impossible (such a professional athlete in season or someone who uses the computer keyboard at work) try to modify or change the activity so it places less stress on the elbow.
The second step is to ice the area that hurts. You can either use a gel ice pack or rub ice cubes on the painful area. Use the ice for 10-15 minutes several times per day. Also, you may want to take over-the-counter pain reliever or anti-inflammatory such as Advil, Motrin, or Aleve. Please consult your health care professional before starting any medications.
Also, compression wraps for the elbow are available at drugstores and may help distribute the load on the elbow.
If these options are not helpful, consult your physician, physical or occupational therapist. Your physician may prescribe medications or recommend a cortisone injection. Your physical or occupational therapist will show you specific stretches and strengthening exercises as well as examine you for other potential causes from the neck, shoulder, or wrist.
The most important factor in long-term success in reducing or preventing elbow pain is to address the factor that originally placed too much stress on the elbow. If you are a golfer, consult your coach on the mechanics of your swing and the equipment that you are using. If you are experiencing elbow pain related to your job or daily activities, a physical or occupational therapist will look at the ergonomics to ensure the optimal set up.
NOTE: Erin Hurley Booker, MPT, is a GFM Advisory Team Member and Clinic Director for Physiotherapy Associates, in Ocoee, Florida. For further information on Erin, log onto the Golf Fitness Magazine website at www.golffitness-magazine.com.
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