Sometimes, clients tell me that they think their Doctor is crazy. "(S)He told me that I have golfer's elbow, but I don't golf". I hear a similar remark concerning tennis elbow. The difference between golfer's elbow and tennis elbow is only it's location. The names were given because of the predominance of these injuries among athletes.
The truth is that unless you're a professional golfer or hitting an large number of drives every day, you will not likely develop golfer's elbow from playing golf - but golfing will make it worse and not be much fun.
Golfer's elbow is designated on the medial epicondyle of the elbow. That is, the area of the elbow closest to your body is swollen, tender and it hurts each time that you grasp something with that hand. It could occur on either elbow but tends to be on the dominant hand side.
Tennis elbow on the other hand is designated on the lateral epicondyle or the outside of the elbow joint. Either condition can occur whether you are playing golf, tennis, shuffleboard or nothing at all.
Perhaps you have just read a new golf article or you are receiving golf instruction or golf lessons and you can't wait to start swinging again. If so, then you need to pay attention to the following information:
These conditions are usually a result of what is termed a CTD or cumulative trauma disorder. In other words, over time when the muscles are not given enough rest and continuously overloaded, they become inflamed where the muscle forms a tendon and attaches to the bone.
Four factors play into CTD's whether at work or play and they are Rest, Posture, Time and Force.
REST
Muscles need time to recover from activity. Anyone who has had a muscle injury knows that the pain is often worse at night. This is because the body does most of its repair work during our rest and sleep cycles. When there is a severe inflammatory response, it interrupts our sleep and the repair becomes less effective.
If you are not giving your muscles enough time to rest, they will not repair properly and more scar tissue will develop than what is necessary. This makes the muscle more susceptible to re-injury.
Taking antioxidants, vitamin supplements and when necessary, anti inflammatories can bring this repair process under control only if enough rest is also introduced into the picture.
Trying to 'power through' pain will in most cases only make it worse. So, take a break, stretch, relax, drink lots of water, xango, monavie or your favorite juice.
POSTURE
When we think of posture we usually tend to sit up straight, but you probably don't pay much attention to the position that your hand may be in right now on the mouse or the keyboard.
The same thing is true for the golf grip. Trying to develop force in a bad posture is just a bad idea.
FORCE
If you have job that requires you to wear gloves, hold on to small objects firmly and manipulate them with your wrist bent outside of neutral, you are trying to work with only 10-15% of your available strength.
When muscles are either stretched or shortened out of their optimal length, they are weaker. So if you can normally generate 100 pounds of grip strength at 1.5 inch diameter grip, when you deviate your wrist out of neutral, you are only going to be able to generate 60 to 80 pounds of force, or even less. If you decrease or increase the grip diameter, depending on your hand size you will lose even more strength.
So, if your wrist is either extended or flexed at impact with the golf ball, you will be trying to generate increased force through a weakened posture. If you are already inflamed, this will not be a fun round of golf for you.
TIME
The last thing to consider in the care of your elbow is the time factor. This refers to the number of repetitions of movement that occur in a given period of time.
As muscles contract they use oxygen, calcium and potassium along with a number of other electrolytes. As a by-product of muscle contraction, lactic acid builds up in the tissues. This contributes to delayed muscle soreness. As these electrolytes and oxygen are depleted, muscle fatigue and force production is lost. If more force is required through poor postures and/or increased weights, this depletion occurs faster.
When the muscles are not replenished quickly enough, cell death occurs and the body begins an inflammatory response to repair this tissue. One reason for training with low load, and higher repetition exercises is to introduce fatigue in the right amounts that signal the body to increase capillary perfusion into the muscles. This creates greater efficiency for our bodies to replenish electrolytes, oxygen and remove lactic acid residues.
Muscle design is such that it produces tension with less energy when it contracts eccentrically as opposed to concentrically. What this means is that when muscles shorten (concentric loading) they use more energy than when they lengthen (eccentric loading).
This allows opposing muscle groups to act as brakes or dampers producing smooth movement. For instance, when bending the elbow, the biceps muscle contracts with a concentric load and the triceps produce an eccentric load that acts as a brake on the biceps muscle contraction. Without this opposing force, movements become jerky and erratic.
When muscles lengthen, the increased tension will increase the potential for tissue damage and cell death. If there is too much repetitive loading, there will be an increased inflammatory response and the condition of tendinitis can develop.
So all of these factors of posture, force, rest and time play a role in the development of tendinitis. If you are suffering or have suffered with golfer's elbow or any other form of tendinitis, then you did not get better or will not get better until these factors are addressed.
Not only, do you need to rest your elbow, you need to check the postures, the forces and the repetitive nature of your everyday activity that you subject your hands to. Making some simple adjustments can go a long way to healing your elbow and getting some fun back in your game.
Steve McMurray MPT
