Tennis and Golfer’s Elbow: Trouble on the Court and Course.

Dr. Gabriel Ariciu, DC

Dr. Gabriel Ariciu, DC

These are a common issue amongst tennis players and golfers. It can really interrupt your game. It is not unique to them either. Many people experience different types of elbow pain and it can be quite frustrating. It gets in the way of work too. Loss of productivity can be a major issue. In this article, I want to tease out a little more about these two conditions and provide some helpful tips.

Tennis Elbow

Lateral epicondylitis, that’s a mouthful, better known as tennis elbow is an irritated area on one side of the elbow. Of the two, it is the most common. It is a repetitive use injury often due to poor technique. Beginners are often prone to it because they hit the ball from a slightly flexed wrist position leading to eccentric loading of the extensor muscles. Usually, the area just keeps getting battered and battered. Finally, it becomes irritated and inflamed making it hard to use.

If you were to have your palm facing forward, the lateral epicondyle is the bony prominence on the outside of your elbow. As you can see from the picture above there are multiple muscles that are attached to the epicondyle. These include your wrist and finger extensors, supinator, and anconceus. Any one of these not functioning properly can cause major issues but not necessarily this condition.

Golfer’s Elbow

This is the opposite condition. Rather than the lateral epicondyle, this is the medial, the one closest to our body with your palm facing forward. It is the “funny bone” area, which I am sure you are all familiar with. But similarly, medial epicondyle tendinopathy comes from repetitive use too. Usually from repetitive loading of wrist and finger flexion. Overtime, the area becomes beaten and inflamed.

The muscles that attach to this area are generally all the wrist and finger flexors and pronator teres. Likewise, any one of these muscles can cause major issues if they are not functioning properly.

Telling the Difference

Generally speaking the pain is located on either the outside of the elbow or the inside, laterally or medially respectively. It will be typically right below the epicondyles or even on them themselves. But everyone is different. It can also be felt in the forearm and wrist. For tennis elbow, the pain will typically happen with contraction of the extensors. The opposite is true for golfer’s elbow.

But knowing me, I don’t care much for labeling things too strictly. Plus the terminology of golfer’s elbow and tennis elbow is kind of a misnomer. As each sport could have either issue. Not to mention, you could have these conditions while never having lifted a racket or a club. To me the most important thing here is evaluating movement and applying the appropriate treatment.

Movement

First things first, I want to see how someone is moving. What is their posture like. What are they doing each day. Their work and daily activities are very important in determining what initiated this issue. Then I want to know what makes the pain worse, what makes it better. Can I reproduce the pain? That is a question I often ask myself.

After evaluating these things, I want to test the muscles via manual muscle testing. Not just the flexors and extensors of the wrist and fingers, but also the other muscles of the elbow, wrist, and shoulder. There could be issues downstream or upstream too. It may be good to evaluate the muscles of the back and neck too. Muscle testing each one gives me a good overview of what is functioning and what is not.

Myofascial Therapy

Now I get into the treatment. As you all know by now, I love myofascial therapies. I term it myofascial reconfiguration because what I am doing is reconfiguring the muscle and fascia to rehydrate and heal. Myofascial restrictions form due to a variety of reasons including improper movement and repetitive use like the two conditions I am talking about. These areas become dehydrated and compressed leading to inflammation and adhesions. This disrupts the overall movement pattern.

Myofascial adhesions are the crux of these conditions and most other structural problems. They are the root cause of the pain as well as the improper movements that caused them.

Myofascial reconfiguration addresses these areas of injury by concentric rubbing of each adhesion. One by one these areas are treated, compensations removed, and normal movement patterns return. I determine each spot by testing the muscles of the elbow or shoulder and then utilizing the body’s nervous system and memory. The body keeps a score of these adhesions or injuries. It really sounds more complicated than it is. It is just the matter of reading the body properly and engaging the appropriate treatment as the body directs.

What Can You Do at Home

I don’t want to leave you hanging though. Not every situation warrants a trip to our office. I do often say that I like to help people become independent in their own health care. Though we are very skilled at getting you back on track quickly and effectively. Let me give you a few tips.

  1. One thing you can do is evaluate what is making it worse yourself. See if there is something you are doing that is increasing the pain and then try to change it. Maybe it is a sport or at the gym, it could be simply poor technique. Maybe seek out a trainer.
  2. Another thing you can do is apply some of your own myofascial therapy. Carefully and thoroughly go around the elbow, down the forearm to the wrist, and up the arm to the shoulder. Feel for tender spots and then rub them out with firm pressure for about 30 seconds each. Not too hard, but also not too light either. It should be tender, but not excruciating. See if this helps. The spots will be tender for a few days most likely, maybe some light bruising too. Of course, be careful, I don’t want anyone hurting themselves further, this not meant to be medical advice. If it doesn’t go away, feel free to call and come on in.
  3. Lastly, make sure you are eating a healthy diet. Good nutrition goes a long way in decreasing overall inflammation and providing adequate nutrients for maintenance and healing. If you need something quick and easy check out Whole30. If you need some recipes check out this guy, the Domestic Man, or check out my Pinterest.

Conclusion

Hopefully, this overview gave you some answers concerning these two issues. They are not the only two conditions of the elbow that cause pain. But they are fairly common and since it is still nice and warm outside you may be dealing with one of them yourself. Please let us know if you have any questions or concerns. We are here to help!

Sources:
1. Featured image of Tennis Player: 4 PM production/shutterstock.com
2. Physiopedia contributors, “Medial Epicondyle Tendinopathy,”Physiopedia,
https://www.physio-pedia.com/index.php?title=Medial_Epicondyle_Tendinopathy&oldid=240303 (accessed August 29, 2020).
3. Physiopedia contributors, “Medial Epicondyle tendinopathy,” Physiopedia, https://www.physio-pedia.com/index.php?title=Medial_Epicondyle_Tendinopathy&oldid=240303 (accessed August 29, 2020).
4. Eygendaal, Denise, F Th G Rahussen, and R L Diercks. “Biomechanics of the Elbow Joint in Tennis Players and Relation to Pathology,” November 1, 2007. https://bjsm.bmj.com/content/41/11/820.