As the weather improves and the state of New York loosens the reigns on our captivity, many people will be seeking refuge through outdoor activities such as golf and tennis. Ironically, while these two activities carry with them a specific elbow disorder, you can actually get either one with either activity. So even though you may be playing golf, it is possible to end up with “tennis” elbow. While there are ways to reduce the incidence of acquiring these conditions, completely preventing them is far more difficult.
Tennis elbow is a disorder or injury of the outside (lateral) side of the elbow. It was first described in 1873 as a breakdown of the wrist extensor tendons as they attach into the boney prominence on the outside of the elbow (lateral epicondyle). There is consensus agreement that it is most common between the ages of 30 and 50 years old. Patients who smoke are also more likely to develop tennis elbow. Activities that require forceful gripping, such as tennis, golf or weightlifting, can produce tennis elbow pain by overloading the tendons as they attach into the bone. Low-force activities such as typing, texting, playing a musical instrument, etc. can create tennis elbow symptoms through low force repetitive strain. If you do either forceful or repetitive strain activities frequently over time, the wrist and finger flexor muscles will get tight and this will also overload the extensor tendons on the outside of the elbow.
A contributing factor in the development of tennis elbow in tennis is an incorrect racket grip for the size of your hands. This is the same for golf. Poorly fitting grips will cause you to grasp harder and this will put increased stress on the outside of the elbow. If you start to develop elbow pain, examining the grips on your golf clubs or the grip on your tennis racket is a good place to start.
Golfer's elbow is a disorder or injury of the wrist and finger flexor tendons as they attach into the boney prominence on the inside of the elbow (medial epicondyle). Golfer's elbow pain can occur from repetitive throwing, lifting, grasping (tennis or golf) or rapid deceleration when a golfer takes a large divot or hits the ball “fat.” This rapid deceleration can put high forces on the inside of the backside elbow. Similar to tennis elbow, golfer's elbow usually involves patients over the age of 40 unless it is in a throwing population, then it is more likely to occur in younger patients. Medial elbow pain is also more common in the construction, carpentry and plumbing populations.
While there is no consensus about the management for either tennis or golfer's elbow, there are some common treatment methods that have shown to be effective. First, over-the-counter non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can be helpful for pain control. Ice massage for four to six minutes directly to the site of pain is also recommended. Manual therapy techniques that specifically address the structure of the tendon include active release techniques, instrument-assisted soft tissue mobilization, cupping therapy and/or extra-corporal shock wave treatment. Therapeutic exercises include both stretching and strengthening exercises.
Therapeutic ultrasound has been shown to increase the tensile strength of the tendon itself. So while it may not help with pain control specifically, it can assist in healing the tendon connection to the bone.
The method of strengthening is highly specific and must be performed with low resistance, slowly and with high repetition. For example, lift a 3-5-pound weight by bending the elbow with the thumb pointing to the ceiling, taking two seconds to lift the weight. Then turn the hand so the palm faces up. Now lower the weight, taking four seconds to lower it and repeat that process 20-30 times for golfer's elbow. In order to change the exercise for tennis elbow, you will still lift the weight with the thumb up. However, when you lower the weight, turn your palm so it faces the ground and lower it in this position using the same time frames of two seconds up and four to six seconds while lowering. One set of the appropriate maneuver should be performed two to three times per day. Once the pain has resolved, you can maintain the status with one set per day.
A stretch for golfer's elbow can be performed by placing the palm of your hand on a chair or low table, with the crease of the wrist facing forward and your fingers facing backwards. Keep the crease against the table and gently lean back until you feel the stretch. For tennis elbow, place the back of the hand on the surface with the fingers pointing toward you. Lean back slowly until you feel the stretch. Hold the stretches 30 to 60 seconds, and perform three to four times per day.
If you begin to experience elbow pain, the faster you establish the cause and create an aggressive treatment plan, the faster you can get to the course or the court.
Dr. Dale Buchberger is a licensed chiropractor, physical therapist and certified strength and conditioning specialist with 32 years of clinical sports injury experience. He can be contacted at (315) 515-3117 or www.activeptsolutions.com.
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