How many times have you heard from a medical doctor, doctor of physical therapy, or other medical professionals say "You have golfer's elbow?"
Then you start to think...
"What's causing it?"
"How can I make the pain go away?"
We get the frustration... We've been there ourselves. But hopefully, this article can help you understand what might be happening when you have elbow pain as a golfer, and how to address it. The purpose of this article is to dive into the anatomy of the elbow and potential causes of elbow pain in golfers. First, let us just say, the elbow is a complex structure to examine as a sports physical therapist and sports medicine physician. Mainly because the body has a lot of anatomical structures that may be causing discomfort locally in the area. But also, patients can experience pain that is referred from the cervical spine (i.i Neck) and chest area. So, let's dive into it!
The elbow Is made up of your arm bone (humerus) and two bones that go down from your forearm to your wrist (radius & ulna) as you can see by the picture below.
The bony anatomy is surrounded by the joint capsule, ligament, and muscles that contribute to the stability of the elbow joint.
These are all the muscles that surround the elbow joint. But play close attention to the "common flexor muscles" on the inside of the elbow. (left picture). These all attach to the common flexor tendon as seen here.
In the medical field "Golfer's Elbow" is a broad term used to describe medial elbow pain or pain inside your elbow as seen here.
Sometimes these common flexor muscles can be chronically loaded over time or acutely in a short period of time.
So now that we understand the basics of the anatomy of the elbow joint we can start discussing what is causing this pain in your elbow that is preventing you from being able to golf pain-free. I want to highlight a couple of studies first that caught my attention!
1. A study in the '90s (Glazebrook et al. 1994) looked at the muscle activity of golfers during the golf swing. They found that the common flexor muscles produce close to 100% (90.77%) of their maximum voluntary contraction. So basically, every time you swing you are contracting those muscles near their maximal capacity.
2. Another study highlighted the differences in the amateur vs. the pro golf swing and its effect on muscle recruitment of one of the muscles on the inside of the elbow (pronator teres). This study showed that the pro golfers used their forearm muscles LESS when compared to the amateurs. So it might be that professional golfers might just be more efficient with their mechanics and not put themselves in suboptimal positions that might put an increasing amount of stress on the muscles or stabilizing structures (e.i ligaments) of the forearms throughout a golf match.
The forearm and more specifically the common flexor muscles are stressed constantly during golf. Not only do we use these muscles a lot during the course of a round, but oftentimes we are not efficient enough with our swings, have faulty movement patterns that increase the stress on the elbow over time (chronic overload). These faulty mechanics can potentially lead to injury and pain. It is important for golfers to find medical professionals that are specialized in golf performance and rehab to determine if the source of your problems stems from your golf swing, your muscular strength, movement patterns, or a combination of the previously stated. A TPI examination allows the provider to be able to detect movement faults in your swing with the goal in mind of improving performance. A doctor of physical therapy can perform the same examination and look at it from an orthopedic/musculoskeletal lens that can help determine if your limitation in your swing is also the cause of your pain during golf.
In addition to getting a TPI evaluation, or physical therapy evaluation, or one of our Medical Golf & Fitness Evaluations, another option to get a deeper look at the health of the tendon, fascia, and muscle is to get a diagnostic ultrasound with our Regenerative Specialist. From there, he can determine the overall health of the tendon and determine if regenerative treatments such as Prolotherapy, Platelet Rich Plasma, or adipose injections are appropriate options. Somethings this elbow pain, which is a tendon injury can become chronic in nature. When this tendon injury turns into a chronic problem, there are certain changes that happen to that tendon and because there is limited blood flow to that area, it sometimes needs a boost to get back to a healthy tendon! That is where regenerative medicine procedures come into play!
Ask us about our Alliance Rx Method Co-Evaluation