Golfers and Tennis Elbow

The frequent medical complaint of a tennis elbow with pain on the outer side of the elbow (called epicondylitis humeri radialis) and the slightly less common problem of a golfer’s elbow with pain on the inner part of the elbow (epicondylitis humeri ulnaris) are caused by painful tissue changes in the tendons of the elbow through repetitive movement of the wrist- and hand extensors and flexors.

Often this complaint is caused by playing tennis and golf but this phenomenon is also found in people working in maintenance, long hours on the computer keyboard, in cleaning jobs, athletes in ball sports, but it is also more generally caused by intense monotonous straining of the corresponding muscles of the forearm. An uncommon exposure (f.e. a house renovation) or a rapid increase of a particular strain (f.e. starting training after a break) are the cause of the complaints. This strain might lead to inflammation of the sinewy area at the transition of bones to muscle structure at the elbow.

Not only the shortening and the hypertension of the muscles of the forearm, also a missing stabilization and unfavorable coordination of the shoulder girdle or changes in the cervical spine caused by degeneration or blockages lead to the longer lasting symptoms of epicondylitis.

Pain caused by inflammatory processes and tiny injuries, so called micro-injuries, initially start while straining the arm and later on will also occur in resting mode. Typically the pain radiates along the muscular tissue to the forearm.

A diagnosis can already be made with a thorough examination. In the examination and in the subsequent treatment it is important to include the shoulder girdle, the cervical spine and the nerve function.

The treatment should be holistic. Measures to ease the pain like local heat or cold, ointment with anti-inflammatory creams, f.e. with comfrey extract or nightly curd compresses are beneficial. Plant-based anti-inflammatory preparations to take internally, like bromelain or curcurmin and in persistent cases also the intake of traditional anti-inflammatory painkillers like Ibuprofen is commonly advised.

Accompanied by manual treatment of the tendon insertions and treatment of tensed muscles by a physiotherapist, preferably in combination with physical methods like ultrasound therapy.

Special exercises for stretching and relaxation are important, also in form of daily self practice (concentric muscle training). The increasingly popular fascia roll is able to support the relaxation of tensed muscles and will help to continue the work of the therapist.

Also, the so called epicondylitis-brace, worn close to the elbow on the forearm, diverts the pull of the muscles from the origin at the elbow to less strained areas and can provide relief.

Well applied kinesiotapes bring about an increased blood circulation of the affected area and increase a relaxation of the strained muscles underneath through permanent relocation of connective tissue.

Athletes should always have their techniques inspected by an experienced coach in order to correct postural deficits.

Osteopathy with local and holistic treatment is very helpful to shorten the duration of symptoms which often last several months.

A set of specific exercises to practice at home are often passed on to the patient.

Shots of cortisone and operations meanwhile are normally not recommended any more.

For athletes a slow progression of strain of any kind (so called pacing) and continuous stretching and relaxation of muscles proved very effective to prevent recurring injuries.

In long histories of complaints injections with platelet rich plasma extracted from the patients own blood show excellent results to speed up the healing.