HOW TO FIX SPORTS RELATED UPPER EXTREMITY GOLF INJURIES: A SPORTS PHYSIOTHERAPY APPROACH TO TREATMENT, PAIN MANAGEMENT & RECOVERY.
19 Sep 2021
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HOW TO FIX SPORTS RELATED UPPER EXTREMITY GOLF INJURIES: A SPORTS PHYSIOTHERAPY APPROACH TO TREATMENT, PAIN MANAGEMENT & RECOVERY.

Have you ever undergone excruciating ache on the inside of your elbow?

You are likely to suffer from what is termed medial epicondylitis which is a tendinopathy of the medial common flexor tendon of the elbow or also well-known as either thrower’s elbow or golfer's elbow, this condition, like tennis elbow, is one of the most common causes of elbow pain. Golfer's elbow is an inflammation of the insertion of the tendinous soft tissues and muscles. The pain of this lesion appears on the inside of the elbow when performing certain movements with palpation performed in a physical clinical assessment.

Physiotherapeutic treatment and appropriate self-management is required to alleviate this pain. In this blog post, you will learn about golfer’s elbow signs and causes, golfer’s elbow symptoms that allow it to be detected, golfer’s elbow treatment, and correcting it through sports physical therapy and sports massage therapy treatment.

Medial epicondylitis (golfers elbow) represents 10% up to 20% of all tendinopathies of the inner elbow prominence. Golfer's elbow or medial epicondylitis is less frequent than tennis elbow or lateral epicondylitis. Its prevalence is 0.4% worldwide. Affecting mostly people between 45 to 65 years old, being more common in women than in men. 3 out of 4 cases of golfer’s elbow are found in the dominant arm of the affected subject, pointed out byJohn Kiel et la (2021).


It is also considered an occupational disease, which has a high prevalence of 3.8% to 8.

2% in some occupations, and although it is known to affect some who play sports (golfers, baseball players, and American football players), it should be noted that 90% to 95% of all patients diagnosed with this injury are not even athletes, stated out by Shiri R et la (2006).

The leading treatment includes releasing restrictions, strengthening and stretching underlying tissues, and exercises for the golfer’s elbow which can be guided by our Sports Injury Specialists at My Sports Injury Clinic based in Manchester City.

Sports physiotherapy, sports massage and manual therapy are essential services carried out by our experts specialized in treating and managing sports-related injuries that will help alleviate elbow pains.

What movement & motion causes the golfer’s elbow?

Golfer's elbow symptoms manifest themself with pain in the area of insertion of the tendons on the inside of the elbow, due to strenuous or repetitive movements, direct trauma or over-exertion when doing flexion and pronation twisting movements, and also when performing sports activities like golf, baseball or simply carrying out manual work, i.e. it does not have to be caused just by sports practices.  Nevertheless, you might feel pain in the entire arm as the pain may radiate to the full length of your limb, published by the Institute for Quality and Efficiency in Health Care (IQWiG)


Due to the high mechanical demand to which the golfer's elbow flexors are exposed, this type of injury frequently occurs in them, which is why it is often thought that this is an exclusive condition of this type of sporting activity and that it is the only one related to golf, however, people who have never played golf can suffer from it, as well as it is important to make clear that golfers not only suffer from this tendinopathy but are exposed to many more sports injuries.

Golfer's symptoms and signs, how do you know if you suffer from golfer's elbow?

If you have got Golfer's elbow you will perceive a notable discomfort, which will present as a stabbing pain inside the elbow, which can sometimes radiate throughout the flexor or anterior side of the forearm, in addition, the discomfort can occur when applying pressure on the internal region of the elbow, what we call the epicondyle.

Golfer’s elbow symptoms often appear more intensely when the muscles of the affected tendons (i.e. the wrist flexors or pronators) are activated.

For instance, when a fist is formed, the wrist is flexed, or when you want to reach an object at a certain distance. These movements can create pain in the inner side of the elbow referring to the golfer’s elbow.

Golfer's elbow tends to affect flexion and pronation of the hand and forearm even more when performing movements against resistance, so affected patients are increasingly restricted in their activities of daily living, even simple tasks such as writing or lifting light objects can become a problem due to the presence of pain.

In addition, not only does active movement causes discomfort, but also passive stretching, and if the injury progresses without treatment, pain at rest can also take place.

In the case of a golfer's elbow or epicondylitis, the degenerative process that occurs in the tendons (tendinopathy) becomes increasingly aggressive, which can cause neuropathy in the ulnar nerve that is adjacent to the affected area, this leads to the appearance of symptoms such as tingling or paresthesia in the flexor region of the hand and fingers, also called golfer’s hand.

Does golfer's elbow merely come about in elite athletes?

Although the injury is called golfer's elbow or thrower’s elbow, as we previously mentioned, this does not imply that these athletes are the only ones affected, in fact, the prevalence of this condition is lower in them.

Hence, we can enlighten that the foremost reason for this condition to happen is a result of keeping the forearm muscles inactive, and then having sudden exercises or activities that require to overly use the muscles steadily.

That being the case, the most frequent activities that prompt the golfer’s elbow are sports like weightlifting, golf, and sporting events that involve throwing movements (e.g. shot put, baseball, cricket, hammer throw, American football, and javelin to name a few).

 

In the same way, it is relevant to understand that golfer’s elbow can arise by performing manual work tasks like chopping wood, hammering, repairing things, and painting. It is for this reason that we can point out that certain occupations such as plumbing, construction, and carpentry are directly linked as the source of golfer's elbow injury, as well as when cooking, for instance, peeling, and chopping, presented by Kimberly Kaiser et la (2021).

Another issue to clarify is that contrary to popular belief, the "swelling" that is usually present at the beginning of this condition does not cause pain. Thus, pain on the inner side of the elbow is due more to tendinopathy and tendon degeneration than to inflammation. The inflammation is just a reaction of your body, in an attempt to repair the tendon when it is overstressed or injured, said by Christopher L. Reece et la (2021).

Some situations can promote tendon degeneration of the elbow and therefore lead to medial epicondylitis, such as tobacco use and the presence of type II diabetes.

Our Sports Injury Clinic in Manchester is formed by top-notch sports rehabilitators such as sports physiotherapy Manchester clinicians and sports massage Manchester practitioners that implement their knowledge and expertise in the area of primary health care, physical rehabilitation, and sports therapy  Manchester, in order to provide specialized patient care, sports injuries management, and get the patients back to their optimal capability and well-being as the main aim, in this sense, we summarize our services below.

·      Physiotherapy for Sports Injuries regarding sprains, bruises, muscle injuries.

·      Traumatological Physiotherapy regarding fractures, contusions, post-surgical rehab, fissures, sprains, dislocations, tendinitis, lumbago.

·      Rheumatological Physiotherapy regarding arthritis, osteoarthritis, fibromyalgia.

·      Neuromuscular Bandage to reduce pain, inflammation, improve blood circulation, amongst other benefits.

·      General Conditioning includes Manual Therapy and Acupuncture.


Golfer's elbow prognosis, how long does a golfer’s elbow take to heal?

In accordance with our Physio Manchester specialists in untreated cases, this condition usually takes to heal 6 months up to 2 years or becomes chronic, this means symptoms for a lifetime.

Notwithstanding, in most of the treated cases the prognosis is favorable since the golfer's elbow responds very well to sports physiotherapy Manchester conservative treatment, i.e. nonsurgical procedure, pointed out by Amrit V Vinod et la (2015).

This gets across that in a few weeks the symptoms shall wear off with conservative management as sports therapy Manchester is significantly an effective management modality to treat elbow joint pain, accordingly discomfort and soreness might disappear utterly in one year. Nonetheless, conservative management usually works for golfer's elbow treatment, if symptoms do not subside within a few months, operative treatment may be required, and also some patients who suffer a relapse after being treated conservatively, ranging from 5% up to 15% but this occurs when the rehabilitation process has been disrupted or was not effectuated as physio Manchester indicated, displayed by Michael C Ciccotti et la (2004).

How can a golfer’s elbow be diagnosed?

To give an accurate diagnosis, a thorough physical clinical assessment and the patient clinical history are mandatory, the evaluation will be conducted by your doctor or physiotherapist Manchester specialist who will detect if by pressing or flexing the arm, the pain appears or worsens., this physical examination will be composed of tests, imaging studies, and lastly an MRI which is the gold standard to determine and confirm the condition and rule out the presence of other pathologies such as ulnar neuritis. and ulnar collateral ligament instability, indicated by Michael A. Schwartz et la (2004).

How to speed up the recovery process for the golfer’s elbow?

What’s the cure for elbow pain? The Physical therapy provided in MY Sports Injury Clinic can help relieve elbow pain and increase the recovery process. Using prescribed pain killers alongside golfer’s elbow exercises can reduce stress on the elbow, speed up the recovery process, and minimize the risk of recurrence. Recent innovations in Platelet-Rich plasma injection (PRP) have also shown optimistic results in the process of getting better, explained by Ankit Varshney et la (2017).

How to get rid of the golfer’s elbow? The Sports Physiotherapy approach is the cornerstone of care to cure elbow joint pain

It is indispensable to attend to the specialist doctor | Sports physiotherapy in Manchester as soon as possible to prevent this injury from progressing and complicating. Pain relievers and anti-inflammatories alone do not improve the problem. Rest, wearing a golfer’s elbow brace, and applying local ice can help relieve symptoms, but it is still not enough. It is necessary to obtain professional help to treat this injury, which is not only limiting, but also very painful.

As highlighted above, the treatment to be selected in most cases is conservative, due to its high recovery rate and the few contraindications and side effects. The objectives to be met are mainly to reduce pain and recover functional capacity, for this it is vital to restore flexibility and normalize the strength of the forearm muscles. In addition, it is worth mentioning that non-surgical supportive care reports an 85% up to 90% of effectiveness rate, published in a research study of the Division of Sports Medicine, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital/Rothman Institute, Philadelphia (2004).

From our point of view, we maintain that for the definitive solution of medial epicondylitis or golfer’s elbow symptoms it is imperative to assess all the aspects that may cause said injury, not only those of musculoskeletal origin but also visceral and emotional ones. Bearing this in mind, the various techniques and therapeutic tools of sports physiotherapy will be oriented not only to cease the pain and other symptoms but also to the resolution of the present causes.

Next, we will present to you the most effective physiotherapeutic techniques and measures for the treatment of this condition:

·      Postural education.

·      Pain education.

·      Immobilization or preion of a golfer’s elbow brace.

·      Neuromuscular bandage.

·      Cryotherapy.

·      Transcutaneous Electrical Nerve Stimulation (TENS).

·      Ultrasound,

·      Eccentric exercises.

·      Myofascial relaxation of the wrist flexor muscles.

·      Ischemic compression for myofascial trigger points.

·      Decontracting massage of the epitrochlear muscles.

·      Golfer’s elbow stretching exercises.

·      Intratissue percutaneous electrolysis (EPI).

·      Dry needling.

·      Shock waves.

·      Neurodynamic exercises

·      Medicinal plants and sports phytotherapy.

·      Stress control and nutritional corrections.

The choice of any of the aforementioned techniques will depend on the characteristics of the patient to be treated, the causes, and the objectives that the sports physiotherapist specialist and the patient wish to meet.

 

Published by Rafael Peña for www.mysportsinjury.co.uk

 

 

References

·      InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Golfer's elbow: Overview. 2018 May 30. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507002/

·      Amin NH, Kumar NS, Schickendantz MS. Medial epicondylitis: evaluation and management. J Am Acad Orthop Surg. 2015 Jun;23(6):348-55. doi: 10.5435/JAAOS-D-14-00145. PMID: 26001427.

·      Ciccotti MC, Schwartz MA, Ciccotti MG. Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med. 2004 Oct;23(4):693-705, xi. doi: 10.1016/j.csm.2004.04.011. PMID: 15474230.

·      Reece CL, Susmarski A. Medial Epicondylitis. 2021 Jul 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 32491792.

·      Vinod AV, Ross G. An effective approach to diagnosis and surgical repair of refractory medial epicondylitis. J Shoulder Elbow Surg. 2015 Aug;24(8):1172-7. doi: 10.1016/j.jse.2015.03.017. PMID: 26189803.

·      Varshney A, Maheshwari R, Juyal A, Agrawal A, Hayer P. Autologous Platelet-rich Plasma versus Corticosteroid in the Management of Elbow Epicondylitis: A Randomized Study. Int J Appl Basic Med Res. 2017;7(2):125-128. doi:10.4103/2229-516X.205808.

·      Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006 Dec 01;164(11):1065-74.

 

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