I am a 15 handicap and really suffering with tennis elbow - help!

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Published 07/02/2011 07:19:00
 

Question:

Why it's called tennis elbow, I don't know, as I haven't played tennis in 10 years. But, I have a very sore left elbow (righthanded golfer). I am a 15 handicap and began developing this almost one year ago. First it began as a sore spot only noticeable when I brushed against something, then in November while I was playing 3 days in a row, it came on very strong. Currently I haven't played in five weeks, I take Advil a few times a day, have worn several braces, but am chronically in pain. Do I see an orthopedist, a sports medicine guru, what can I do and should I try to continue with golf? This thing has severely limited my lifestyle. I am 55 and in fairly good physical shape, but haven't worked out with weights in 5 years. Help!

 

Answer:


Although it is called tennis elbow, pain on the outside of the elbow is a common occurrence among golfers. Consistent with your presentation, pain predominantly occurs on the outside (lateral) part of the lead arm and the inside (medial) of the trailing arm in the golfing population. These symptoms are magnified by taking excessive divots or slicing with iron shots. Although this pain on the outside of your lead arm is called tennis elbow, a multitude of factors, golf included, can be responsible for the condition.

 

Robert P. Nirschl, MD, a pioneer in operative and non-operative treatment of tennis elbow, has published numerous articles and studies delineating the true nature of the pathology. Tennis elbow, as it is commonly known, has also been called an epicondylitis or elbow tendonitis. It is more correctly labeled an elbow tendonosis. Kraushaar and Nirschl, in their review of lateral elbow tendonosis (tennis elbow), describe the condition as a chronic overuse injury resulting from multiple microtraumatic events that accumulate to disrupt the internal structure of the tendon and lead to degeneration of the cells and cellular matrix. More directly, repetitive low level stress which may occur during golf accumulate over time to injure the tendons which insert at your lateral elbow. These are the tendons that allow your forearm musculature to operate at the wrist.

 

Individuals suffering from the condition are frequently advised to rest and give up the sport, at least temporarily. While rest is appropriate in the acute elbow, rest and pain medication alone is not enough to treat your problem, according to Nirschl. Rest and pain relief offer no stimulation to the injured tissue and are not enough to promote healing. Injured tendons must increase vascular supply, synthesize new protein, and ensure that collagen matures into healthy tissue for recovery to occur. Consequently, the physical therapists at the Virginia Sportsmedicine clinic advocate an alternate definition of rest. Rest is defined as the absence of abusive activity, not absence of activity. All tissues, particularly injured tendons, require tension and motion to return to and maintain health. A properly designed rehabilitative exercise program is the only way to safely and effectively return to sport.

 

Specific to your case, you stated that you have not lifted a weight in more than 5 years. This may certainly be contributing to your symptoms. Poorly conditioned muscles allow more stress and strain to be placed upon your joints, ligaments, and tendons. A rehabilitative exercise program not only promotes healing in the injured tissue but also reduces the likelihood of reoccurrence of injury as well as associated problems. This program need not be overly time consuming nor involve lifting heavy weights to be effective.

In regards to the elbow, patients with acute lateral elbow tendonosis are started with exercises for the forearm and wrist with seldom more than a 1 pound weight. What is critical is that the program you begin does not reproduce your pain. Continued aggravation of your condition will only lead to further tissue degeneration and pain. You must begin at a level you can tolerate with the help of a rehabilitation professional and slowly but effectively progress from there.

 

Again, the goal of rehabilitation is to promote optimal healing of the injured tissue. Rehabilitation promotes strength, flexibility, and endurance in the injured and adjacent tissue. The S.A.I.D. principle (specific adaptations to imposed demands) is followed whereby demands are placed on the body in order to force the body to make adaptations. These adaptations include neural adaptations such as increased motor unit activation with increased motor unit coordination, recruitment, and firing, as well as intrinsic muscle adaptations including increases in the number and size of myofibrils, in the number of mitochondria and in enzymaticcontent of the muscle cells. Studies have demonstrated that training increases the tensile strength of tendons as well as promotes invasion of vascular elements in tissue.(iii,iv)

 

A concept Nirschl and the clinic emphasize is that you cannot play your way into shape. You get in shape to play a sport, not play a sport to get in shape. Consequently, it is the duty of the therapist to better prepare the individual for return to participation in work, recreational activities, and sports.

 

With this in mind, I would take three immediate steps given your condition. First, consult an Orthopedist and ask him or her for a referral to a physical therapist, particularly one specializing in golf or sports related injuries. Second, obtain treatment from a physical therapist. Physical therapists are experts at non-operative treatments of the elbow and are excellent sources of information on rehabilitation of elbow injuries. And third, consider having your swing analyzed by a golf pro to correct any faulty mechanics which may be contributing to your injury.

 


Bill Johnson, MSPT


i) Nirschl, RP, Sobel, J.,: Arm Care: A Complete
Guide to Prevention and Treatment of Tennis Elbow. Medical Sports Inc. 1996.

ii) Kraushaar B., Nirschl, RP:Tendonosis of the Elbow (Tennis Elbow). The Journal of Bone and Joint Surgery (Am) 81-A: 259-278.

iii) Tipton, CM, James, SL, Mergner, W, and
Tcheng, T: Influence of Exercise on Strength of Medial Collateral Ligaments of Dogs. Am J. of Physiol. 218:894-902. 1970.

iv) Woo, SL-Y, Gomez, MA, Woo Y-K, and Akeson,
WH.: Mechanical Properties of Tendons and
Ligaments. Biorheology. 19:397-408. 1982.





Comments


1.  The mechanism for tendonitis in the elbow often is the result of poor shoulder mobility, especially external shoulder rotation. Chances are you chicken-wing during your follow-through (keep your elbow close to your body vs. extending out to the target). If you were to measure your shoulder rotation, chances are you're restricted. Big correlation there. Once your elbow starts feeling better, you need to correct the deficiency, if present. Fairly easy to do. If you don't fix the mechanism for injury, you don't fix the problem!

comment by bob forman - 26/07/2012 00:51

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