Golfer’s elbow should well have been given a different name. For most people who suffer this type of elbow pain, it’s not golf that caused it.
Like tennis elbow, golfer’s elbow is an over-use injury where the muscles in the forearm are affected. This time, the flexor muscles attached to the medial epicondyle are impacted. Thus, the true name for golfer’s elbow is medial epicondylitis.
Golfer’s elbow is much less common than tennis elbow. Although, interestingly, golfer’s elbow is something that tennis players may also experience ! Especially those who put a lot of top spin on their shots.
Let’s review a little arm anatomy, how the elbow may become injured, and how Bowen Therapy can help.
a little anatomy
Golfer’s elbow is usually caused by overusing the muscles in the arm that allow wrist flexion, rotation and finger flexion.
Wrist flexion is where the palm of the hand moves closer to the wrist. Finger flexion is curling the fingers to grip something. The picture above, with the grip on the golf club, shows both wrist and finger flexion.
There are a number of key muscles in the forearm that enable the wrist and fingers to flex. Most of these muscles originate as one mass from a tendon attached to the medial epicondyle. (Take a look here for more information about bony markings of the elbow)
muscles of wrist flexion
Flexor carpi radialis, palmaris longus and flexor carpi ulnaris are the muscles that flex the wrist (and assist flex of the elbow).
– The flexor carpi radialis inserts at the base of the second and third metacarpal (index and middle finger near the wrist). This is used when you’re holding or gripping something like a strap, phone or tap.
– Palmaris longus inserts at the palmar aponeurosis in the palm of the hand, so also tenses the palmar fascia. It is the key muscles used when holding a large ball or making a snowball.
– Flexor carpi ulnaris (inserting near the medial side of the wrist at ring and little finger) is also involved with wrist adduction, so is key for trying to unscrew a tight jar lid.
muscles of arm rotation
Key to enabling the forearm to rotate “outward” are pronator muscles.
– Pronator teres lies in the upper forearm, and also originates from that tendon attached to the medial epicondyle.
– Pronator quadratus lies in the lower forearm, near the wrist.
These muscles are key to rotating the forearm, such as when you turn a doorknob or turn cups over when packing a dishwasher.
muscles of finger flexion
Finger flexion is achieved by flexor digitorum muscles.
– Flexor digitorum superficialis inserts on the sides of the middle phalanges (on the fingers)
– Flexor digitorum profundus inserts on the distal phalanges (finger tips).
Together with muscles controlling the thumb, these allow control of fine movements of the fingers, including the ability to pick up small items, hold pens, do up buttons, play guitar, etc.
These flexor group muscles are part of the superficial front arm fascia line. These fascia lines begin on the trunk of the body, linking with the pectoralis in the chest and latissimus dorsi in the back.
what is golfer’s elbow ?
Golfer’s elbow is generally considered an over-use injury. It is usually caused by overusing the muscles in the forearm that allow wrist flexion, forearm rotation and grip.
Pain is felt on the inner side of the elbow, and feels worse with heavy lifting and gripping. In untreated cases, grip strength may be reduced. It may actually end up so severe that the hand, wrist or arm can barely be used.
The injury usually comes about when muscles and tendons in the forearm are strained. This is normally through repetitive or strenuous twisting of the forearm and wrist.
As the muscles are strained, inflammation and small tears can develop near the medial epicondyle, on the inner side of the elbow. This strain can be the result of suddenly doing a certain activity that the forearm muscles aren’t used to. It can also be due to long-term muscle strain.
Golfer’s elbow is less common that tennis elbow, although both can be quite debilitating, preventing certain activities or limiting work.
what causes golfer’s elbow ?
Like tennis elbow, suffering this type of elbow pain is not the pure domain of golfers. In fact, tennis players who use a lot of top-spin may feel golfer’s elbow pain rather than tennis elbow !
Grip action of the hands, together with some rotation of the forearm (static or dynamic), are key contributors to medial epicondylitis.
For golfer’s, elbow pain may develop if using swing techniques that aren’t good, or repeatedly hit the ball incorrectly.
The action of a baseball pitcher gripping the ball with controlled rotation of the forearm may result in the same pain. Thus some know it as baseball or pitcher’s elbow.
Another group of people who may commonly suffer medial epicondylitis includes many of my friends – rock climbers ! The constant tension in the wrist and fingers to grip small crevices in walls, including at some odd angles, can create strain and inflammation that makes itself felt near the elbow.
Everyday activities around the home such as using a screwdriver, raking the garden or painting can cause golfer’s elbow. Carrying heavy shopping bags or suitcases, with the hand gripped firmly and wrist rotated can also result in medial elbow pain. Gripping and moving a computer mouse may also result in elbow pain (either golfer or tennis elbow) – mouse elbow !
golfer’s elbow treatment
Golfer’s elbow may get better without any treatment. Key to this is resting the arm, and stopping doing the action that caused the injury. For acute minor elbow injuries, rest, ice and some anti-inflammatories (medication or cream) may speed up recovery.
However, if the pain doesn’t subside or is a chronic issue, then further treatment options need to be considered. That may be with a physio, or your favourite Bowen Therapist. These therapists can help take the body out of it’s painful state, and begin to help prevent the muscles and ligaments from being irritated.
If the action that caused the pain needs to be continued, it’s important to look at how that action is being done and how it could be modified to prevent re-injury. If you’re a golfer, maybe see your local golf pro and have them look at your actions. (A client with back pain did this – not only does the golf swing no longer result in injury, but he’s hitting better than ever !)
In absolutely extreme cases, cortisone injections or surgery is considered.
Bowen Therapy to help Golfer’s Elbow
Gentle Bowen moves are fantastic for helping people recover from golfer’s elbow pain.
Arms and shoulders are often at the mercy of what’s going on in the rest of the body. Therefore it’s important that the whole body still be assessed and addressed, even when arms are where pain is felt.
The muscles involved with golfer’s elbow follow the front arm fascia lines. The superficial front arm line includes the pectorals in the chest, and the latissimus dorsi in the back. The line then passes over the medial epicondyle and continuing down into the flexor group of muscles to the palm.
Bowen moves are targeting to help restore tensegrity to the arm line. This would include the entire back (including latissimus dorsi), as well as the front of the body, over the pectorals and sternal area. Gentle forearm moves are bliss for those struggling with golfer’s elbow !
A range of assessments are key to help identify tensegrity issues in the body that result in strain of muscles around that medial epicondyle.
In the case of one of the guys I work with on weekends, his golfer’s elbow pain was making it hard to do his work in the shop. Scooping grain hurts, as well as lifting bags – even shaking customer’s hands hurt ! Some quick assessments showed that one shoulder was much higher than the other. His pelvis was also hitched and twisted. Bringing the body back to some degree of levelness would help take the arm fascia lines out of tension, and start to bring relief.
how quickly to help ?
For more painful cases, or chronic problems, resolution will likely require a number of sessions. Between sessions, addressing actions that cause the pain will give longer term pain relief, and prevent the pain recurring.
For climbers, golfers and baseballers, treatment early in the week helps the body recover from the weekend’s work. This gives time to be in better shape for the next weekend’s sport. For tradies, where work causes the elbow issue, the best time to have treatment is at the end of the working week. Let those Bowen moves continue to work over the weekend while resting.