How Osteopaths Treat Golfers Elbow

Golfers elbow, more technically called medial epicondylitis, is a similar type of condition to tennis elbow or lateral epicondylitis, but is less common. Since there is little or no inflammation present in these syndromes, they are known as tendinopathies, where degeneration of the tendon occurs and gives symptoms. Typical aggravating factors are racquet sports, golf and sports which involve throwing, although other sports people may be affected such as weight lifters, archers and cricket bowlers.

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.

Typical symptoms are an ache or pain over the front of the inner elbow which is worsened by repeated wrist bending and improved by rest. Hand, forearm, elbow and shoulder pain may be reported, with grip weakness in the hand. If the ulnar nerve is involved this can also contribute to the weakness and give pins and needles in the forearm. The physio palpates the muscles and their tendinous insertions, the elbow joints and the groove behind the elbow where the ulnar nerve lies. To exclude other significant diagnoses the osteopath will perform a neurological examination.

The main treatment of golfers elbow is conservative, including anti-inflammatories, wrist and forearm splinting, corticosteroid injection and osteopathy. Modifying the provoking activity is a first line of management, making patient education about the condition and the eliciting factors vital. An example is modifying the golf swing mechanics to avoid setting the problem off continually. The patient is taught to avoid aggravating positions and activities, such as leaning on the elbow if there is nerve involvement.

In the acute phase of golfers elbow the osteotherapists aim is to reduce any pain and inflammation using ice treatment, stretching gently, deep frictions, ultrasound and anti-inflammatory medication. Progression into the sub acute phase changes treatment to increasing flexibility, strength and returning to normal activities in a paced manner. Counterforce forearm bracing can help realign the tendon stresses, or a wrist brace can give the muscles a rest. For a chronic syndrome the treatment is similar with reducing splint use and returning to sporting activities.

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.

Correction of sporting technique, such as the golf swing, is best achieved by engaging a professional instructor who can also advise on stretches, fitness work and muscle strengthening. Athletes should warm up well before sport and stretch effectively afterwards, choosing good technique and selection of appropriate equipment. Doctors and osteotherapists may need to monitor patients, especially athletes, very carefully as they tend to continue to perform through the pain.

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The content of this page is informed by feedback from osteopathic practitioners in Middlesex and also clinics in Worcester. Further input was received from osteopaths in the Croydon area and a practitioner in Cardiff. Finally a contribution was made by practices in Hove