Golf is not exactly a high-intensity sport like football or basketball or even tennis.
But just because you don't run around, and sweat buckets don't mean that golf is not a physically demanding sport!
Contrary to popular perception, Golf can cause stress and injury, whether you are seasoned Pro or a regular weekend warrior.
The explosive and repetitive swing is what hurts your body in the long term, especially the back, shoulders, neck, arms and wrist.
The more you swing golf clubs over an extended period, the greater the stress on your body. If you have pain and tenderness in the elbow region when you attempt your swing, it might be a sign of Golf Elbow/Golfer's Elbow.
Though a common injury associated with the sport, it is still relatively less known and rarer compared to its cousin, the Tennis Elbow.
Do you play more than a couple of hours of golf every week? If so, you might be at a higher risk than the general population to fall prey to this condition.
Read on to learn more about Golfer's Elbow, its symptoms, treatment, and prevention.
DISCLAIMER: Kindly note that this guide is purely for informational purposes alone, and is not to be taken as doctor's advice.
The information in this guide is just a theoretical overview of the medical condition, purely for public awareness and reference purposes.
This guide should not be used in place of expert medical advice for either diagnosis or treatment purposes. If you suffer from any symptoms similar to the ones described in this guide, please visit a qualified medical doctor for treatment.
1. What Is Golfer's Elbow And How Is It Caused?
A golf swing is one of the several physical activities that can cause this type of injury, hence the name.
Anything that involves a repetitive movement of the hand, wrist, or forearm can cause this type of injury. This can include both holding and hitting with clubs and racquets, as well as pitching baseballs.
As a matter of fact, rock climbers are at most risk of getting this type of injury, since it involves a lot of pressure on the wrist and forearms.
Other sports that can cause this type of elbow injuries include bowling, baseball, and racquet sports like tennis. Pitcher's Elbow and Climber's Elbow are two other common names for Golfer's Elbow.
Individuals doing work that involves repetitive hand movements, like carpenters and iron smiths are also at risk of getting these injuries.
Some other notable potential causes include operating chainsaws, hand tools, chopping wood, weightlifting, playing guitars, throwing javelins, shoveling snow, raking leaves, and any other activity that involves a lot of repetitive hands and wrist motions
The medical term for Golfer's Elbow is medial epicondylitis. It means damage to a particular tendon in the elbow, called the medial epicondyle.
To understand the nature of this injury, we need a basic understanding of the anatomy of the elbow.
Probe on the inside of your elbow with your fingers, and you will feel a bony knob, this is the tendon we are talking about.
Anatomy of the Elbow
To explain the anatomy of the elbows lets start at the upper arms. The humerus is the upper arm bone which attaches to the forearm at the elbow joint.
At this joint, this bone flares out into two bumps called bony prominences. These bumps are the medial and lateral epicondyles.
Bony prominences are the points where ligaments and tendons attach. Tendons are tough, cord-like tissues that latch muscles to bones.
Tendon injuries lead to pain and weakness in the area.
The muscles in your fingers, wrist, and forearm on the inner palm side connect to the medial epicondyle through tendons.
These are the muscles that we use to grip things with our fingers, and move and flex our wrists, like when we grip and swing a golf club.
Then there are the muscles on the back of our arms and forearms, used mainly to open/straighten our fingers and straighten/cock the wrists.
They attach to the medial epicondyle as well as the other "bump," the lateral epicondyle at the back of the elbow.
Causes of Injury
Any repetitive action that involves closing and opening of fingers, along with movement and flexing of wrists uses these group of muscles and can cause stress to the tendons to which they attach.
When these groups of muscles are overused, the tendons they attach to, also get stressed and damaged. When the activity is continued without rest, small micro-tears develop in the cells of tissues inside and around the tendons. The body tries to repair these by creating specialized repair cells.
When you have a lot of repair cells in a tendon, its strength is reduced, and it is weakened and vulnerable to injury.
And if the physical activity continues unchecked, this eventually leads to a large tear or rupture of the whole tendon itself. This, in a nutshell, is how injuries like Golfer's Elbow, Tennis Elbow, and Achilles tendon injury occur.
If you play golf very frequently, think about the total number of times you swing a golf club.
The drive from the tee and the second shot on longer fairways, where distance is the primary objective, cause maximum stress to the tendons.
When you spend hours and hours on the local course (or the driving range) on a regular basis, the strain on your tendons tends to add up.
Once they go beyond the breaking point, you get Golfer's Elbow. Age is a major factor for this condition. Though it can happen to golfers of all ages, those above 35 tend to be the most at risk.
Golfer's Elbow vs. Tennis Elbow
As we already mentioned, Golfer's Elbow is less common when compared to tennis elbow. It is estimated that Golfer's Elbow incidents are almost 15% less frequent than Tennis elbow.
The nature and causes of both the injuries are the same, and the only difference lies in the location of the trauma. They are both referred to as types of elbow tendinitis or damage to tendons at the cellular level.
While Golfer's Elbow is the injury to the medial epicondyle, tennis elbow is caused by injury to the tendons which attach onto the lateral epicondyle, the other bump at the back of the elbow.
The medical term for tennis elbow is lateral epicondylitis. Chronic stress caused by frequent overuse of the tendons and frequent, forceful impacts are considered to be the common reasons for both injuries.
Talking about forceful impacts, think about the jolt or feedback you get when you forcefully drive the golf ball or smash the tennis ball.
The reverberations caused by these actions can exacerbate the injury to the tendons.
Both injuries have similar symptoms, but can usually be distinguished based on where the pain or discomfort occurs.
Tennis elbow symptoms are concentrated on the back of the elbow and forearm, while Golfer's Elbow symptoms are usually found on the inside of these regions.
For a more visual representation of the anatomy and nerves involved refer to this video:
2. How Do You Know You Have It (Common Symptoms Of Golfer's Elbow)
The onset of symptoms in golfer's elbow is often gradual and takes place over a period of few weeks. In the initial stages, all you would feel is probably a minor niggle or stiffness.
This discomfort continues for some time before developing into the full blown symptoms of tendon injury. The symptoms usually happen in your dominant arm, though the injury can happen to either side.
Though there are several common symptoms of this condition, do remember that individual experience may vary, and you may not have all the symptoms mentioned here.
You should consider consulting a doctor if you have any of the following symptoms:
the location is on the elbow and forearm, on the inner side when you have Golfer's Elbow. Pain on the outer side indicates tennis elbow.
The pain is usually focused on the bony bit on the inside of the elbow, the medial epicondyle. It may also spread to the forearms.
Pain and discomfort will increase as you use the muscles in your wrists, fingers, and forearms to grip the club and swing it.
Pain can also result from flexing your wrists on chip shots or doing something as simple as picking up the golf ball on the green.
These muscles on the arm, palm and fingers may all experience pain of some sort.
The pain is often accompanied by a feeling of tenderness and sensitivity at the bony bump on the inside of the elbow.
The stiffness can also extend to the forearms and hand, and you might experience an inability to make a fist.
A feeling of weakness or fatigue is a common symptom of tendon injury.
You may be tired, unfocused and lacking energy.
The weakness can be in the elbow region, the hands as well as the wrists.
Numbness & Tingling
These symptoms mostly manifest away from the actual point of injury, and are found on the wrist, and often radiating into individual fingers.
Two fingers tend to be more severely affected than others, normally the ring and little fingers.
These symptoms tend to worsen when you try to move or flex your wrist and fingers.
Once the symptoms start, you may find it difficult to perform these everyday tasks:
- Swinging golf clubs or tennis rackets with the affected arm.
- Pitching a baseball
- Shaking hands
- Squeezing things
- Picking up stuff from the floor with your palms down
- Lifting weights at the gym
- Turning a doorknob
If left untreated, the symptoms will progressively worsen, with increasing pain and weakness in the affected arm.
Daily functioning may be severely affected, and the condition may lead to permanent damage and disability.
Other Conditions & Injuries With Similar Symptoms
If you have any of the above-mentioned symptoms, it doesn't necessarily mean that you have Golfer's Elbow.
You should avoid making a diagnosis of symptoms on your own since other potentially dangerous conditions also have symptoms similar to Golfer's Elbow.
Biceps Tendonitis: This condition occurs above the elbow joint in the biceps tendon, but the symptoms of pain or discomfort may extend below the joint and are usually found in the inner elbow and inner forearm area.
It is easy to mistake this for Golfer's Elbow unless you are a trained medical professional.
Called cervical spine injuries, these can also lead to some pain being transferred to parts of the elbow along the medial region when golf joint injuries occur.
The nerve that connects to this area is the median nerve, and it is also linked to a particular neck joint, the C67.
If that joint is injured, the pain from it can be found along this nerve on the elbow joint region.
The nerves in our body are only fixed at 5 points in the extremes of the body: the head, the two hands, and the two feet.
In the rest of the body, they are flexible like cords and aid in movement. When a particular nerve, like the median nerve in the elbow, loses its flexibility and mobility due to a variety of reasons, it can cause tension, tightness and even pain in the area.
Stress Fractures: not all fractures result in extreme pain and swelling. That is a common misconception.
Stress fractures, or hairline fractures as they are also called, can occur gradually and may cause swelling and extreme pain only in later stages.
Though they mostly occur below the waist in weight bearing bones, they can also occur in hands wrist and arm where stress is consistently felt.
As you can see, some of these conditions are severe and require urgent medical attention.
So do seek expert opinion if you find any of the symptoms closely associated with Golfer's Elbow!
3. How Can You Treat It?
The treatment for this condition is primarily dependent on the severity of the injury and how early the diagnosis has been made.
Treatment can take several different pathways depending on the gravity of the tendon injury.
The diagnosis of Golfer's Elbow is made primarily based on a physical exam as well as an evaluation of your past medical history and physical activities.
The physical examination will usually involve the doctor asking you to perform various movements on the affected area. He/she may also put pressure on the area to gauge the level of discomfort, pain, and swelling if any.
X-Rays are only useful in ruling out other causes, like fractures, or symptoms related to arthritis. Since this condition is caused by a rupture of a tendon, which is not a bone, the actual injury will not show up in X-rays.
Advanced MRI imaging and scans can reveal the extent of the damage, but these may only be required in later/more advanced stages.
Preliminary Treatments: R.I.C.E Method
In the earliest stage of treatment for Golfer's Elbow, you may not even need any medication.
The baseline treatment involves providing the injured tendon some rest and time to recover.
A standard conservative treatment therapy includes the "R.I.C.E" method. It comprises the following steps:
"R"- Rest: This injury is a common result of over-extension an overuse of your hand muscles and tendons.
By providing complete rest, the tendon gets some time to recover and heal.
You will probably have to leave golf for some time completely. Failure to do so will only result in increasing the injury and making it chronic.
"I"- Ice: Applying cold packs to the affected area for 10 minutes every hour in the initial days will help reduce pain and decrease any inflammation you may have.
Later on, the frequency of ice packs can be reduced to several times a day.
Do note that depending on the state of the injury, heat therapy might be better than cold. So, don't attempt this without a doctor's guidance, especially if you have had the injury for an extended period.
"C" & "E"- Compression & Elevation: Putting pressure on the muscles in the area, and keeping it at a high angle, often using an elbow support/brace, can help reduce the tension on the tendon.
To do this you can utilize compression sleeves which you can pickup at retail or on amazon.
You may even have to use elastic bandages, or splints, depending on the doctor's orders. As a doctor you trust for the recommended treatment.
If the pain is severe, you might be advised to take an over the counter painkiller like acetaminophen (Tylenol), or Ibuprofen (Advil, Motrin, etc.).
This baseline treatment is often enough to get you back on track. But it does take some time for the tendon to heal, and there is no way to speed up this process.
In less severe cases, recovery might be possible in a matter of weeks, while more serious injuries might require months of rest and other advanced therapies.
- Expense : (Highly Inexpensive)
- Complexity : (Very Simple)
- Effectiveness : (Highly Effective)
Supportive Treatment: Physiotherapy
Along with the RICE therapy, depending on the severity of the symptoms, you may also be advised to consult a physiotherapist for advanced treatment.
Ultrasound and laser therapy may be prescribed, but that is entirely up to the individual therapist to decide.
These treatments are usually carried out to speed up the healing of any inflammation present in the affected tissues.
Laser therapy seems to be especially effective in the case of tendon-related injuries.
Apart from these electrotherapy methods, sports massages are another option when the RICE treatment fails to get adequate results.
Massage of the muscles and connective tissue in the affected hand helps by relaxing the muscles and reducing the tension and stress on the elbow tendons. Usually, multiple sessions are required to produce positive results.
- Expense: (Moderately Expensive)
- Complexity : (Somewhat Complex)
- Effectiveness : (Moderately effective)
Advanced Treatment: Steroids, Platelets, and Surgery
Steroids: Corticosteroids are a class of drugs taken to reduce inflammation in the body. For inflammation of the muscles, bones, and tendons, injections are the usual form of treatment.
This allows the doctor to concentrate the drug in the area of injury and reduce the chance of side effects. Steroids are only prescribed when other conservative treatments like rest, ice therapy, and physiotherapies fail to reduce the pain and inflammation.
And steroids are not considered appropriate for long term treatment. The number of injections is also kept as low as possible, just enough to reduce the inflammation and speed up the healing process.
The procedure can be quite painful and local anesthetics are often used before steroid injections.
- Expense: (Moderately Expensive)
- Complexity : (Complex with potential side effects)
- Effectiveness: (Somewhat effective)
Platelets: A relatively newer form of treatment, this involves taking some blood from your body, spinning it in a centrifuge, separating the platelet rich plasma from the rest of the blood and injecting that into the affected zone.
This plasma contains many healing factors that have a positive impact on the damaged tissue in your tendon.
- Expense: (Expensive)
- Complexity: (Complex, but with not many major side effects)
- Effectiveness: (New procedure that shows a lot of promise)
Surgery: If all treatment methods fail, then and only then may your doctor suggest surgery.
By this stage, the injured part of the tendon may have become diseased, and the best possible option might be to remove it surgically.
Modern keyhole surgery methods are available, which involve minimal cutting and resulting scar tissue.
- Expense: (Very Expensive)
- Complexity: (Very Complex with but with significant improvement)
- Effectiveness: (Very effective in stopping pain)
Some Effective Exercises For Rehabilitation
Under the supervision of a qualified fitness expert, several exercises can be very effective in aiding the recovery process in the early stages of treatment.
All exercises should be undertaken only when and if no pain occurs while doing them.
Stretches like the Neural Stretch and the Wrist Flexor Stretch should be started as soon as the pain subsides, ideally after a couple of weeks of treatment, and should be continued throughout the rehabilitation process.
See this video for a demonstration:
Strengthening Exercises on the other hand, though important, should be delayed until you are sure that the pain has gone down quite a bit.
Working the injured elbow too soon can result in increasing the injury.
Start off slowly with static exercises that involve minimal movement.
Once you complete a few days of pain-free exercises, dynamic exercises involving light weights (1kg) or a resistance band can be initiated.
As always, caution is the better choice to prevent any aggravation of the injury. If there is any pain, do not continue with the exercises.
Here are some YouTube videos of further Stretches and Exercises for Golfer's Elbow
DISCLAIMER: This is not qualified medical advice. Only undertake physiotherapy and exercises under expert supervision and after consulting your medical doctor.
4. Overcoming Common Misconceptions about Golf Elbow
- Not restricted to Golf: The name is pretty misleading, but Golfer's Elbow is not a condition that affects only golfers. In fact, it can affect anybody who indulges in regular physical activity that involves repetitive hand motions.
- Not restricted to Professional Golfers: any golfer can get this condition, though it is rather rare when compared to tennis elbow. It depends on your level of physical activity, not your handicap or skill level. If you play 5 hours of golf on a regular basis, say every few days/every weekend, you can get this injury.
- Can be self-treated: The basic treatment involves rest and some compression and cold therapy which can be done at home itself. But a correct early diagnosis is essential, and that requires a consultation with your doctor.
- Requires complex treatment and surgery: If diagnosed in the initial stages, all it requires is time and complete rest. It is only in less than 10% of the cases of Golfer's Elbow that patients end up requiring surgical intervention. Advanced treatment like steroid injections is only suggested in the rarer cases where inflammation refuses to respond to initial treatment.
5. What To Do To Prevent It In Future
It is not possible to completely prevent the chances of medial epicondylitis since it can result from stress on tendons induced by many daily activities.
But if you are an avid golfer, there are a few contributing factors that can increase the risk of tendon injury in golf.
- Improving your fitness levels is a great way to prevent future injuries. Strengthen your forearm muscles using simple exercises like wrist curls, reverse wrist curls, and squeezing a tennis/exercise ball for several minutes. Stronger muscles reduce the chance of injury in future.
- Using proper grips can reduce the stress on your tendons. Always make it a priority to get your golf clubs fitted by a professional club fitter.
- Improper swing and stance put a lot of unnecessary pressure on your body, especially on powerful drives and other long distance shots. Seek the advice of experienced pros or golf trainers to improve your swing and stance.
- Consider reducing the number of rounds you play, especially as you get older. The risk of tendon injury increases as you cross the age of 40. If you cannot maintain your fitness, playing extra rounds will increase the stress on your body.
- Consider slowing your swing speeds if you can not/do not want to reduce the number of rounds you play. This is applicable largely to senior golfers and those above the age of 40. Reduction in swing speeds can be mitigated by choosing club shafts with softer flex levels.
6. Tools You Can Use
It is pretty much mandatory during recovery workouts, including stretching and dynamic exercises. Wearing a sleeve can help reduce any recurring pain while playing golf after recovery.
Click here for the latest price on amazon: Elbow Compression Sleeves
This item can be used in conjunction with a compression sleeve. The brace can reduce any pain or discomfort associated with the movement and flexing of wrists during recovery exercises, as well as post-recovery golf.
Some improvements in grip and wrist strength have also been noted.
Click here for the latest price on Amazon: Elbow Brace
Improved fitness of these regions is essential to aid speedy recovery as well as future injury prevention.
Click here for the latest price on amazon: Flexible Twist Exercise Bar
7. Don't Work Out The WRONG Way
As we have already highlighted, two important factors can help prevent Golfer's Elbow.
One is proper fitness, of the shoulders, forearms, hands and wrist; and the other is proper form and technique in golf.
Many people get both these things wrong, because of a lack of expert supervision and guided training.
Take exercise for instance. The only way to prevent serious injury is to develop proper technique and form of exercise, be it while stretching, or lifting weights.
If your body is not properly aligned during workouts, your tendons, muscles are joints run the risk of being put in unnatural positions where excessive stress in exerted, leading to tears and severe injuries.
This is particularly the case in the case of lifting weights, and one cannot emphasize the importance of proper form enough.
Always learn the right way to lifting before increasing the weights, for maximum safety as well as effectiveness.
And in the case of golf, lack of proper swing and stance can not only reduce the efficiency of your swing; it can even lead to dangerous strains and injury as well.
Lack of flexibility and fitness will make matters worse, putting extra pressure on your spine, shoulders, and elbows. The earlier you try to correct this thing, the better since your body has a tendency to adapt to the way you swing.
If your swing style/posture is sub-optimal, in the long term, it will put extra stress on specific parts of your body, including the spine, shoulders and yes, the elbow tendons as well.
In golf, and equally in fitness workouts, practice and expert training is the only proper way to address these issues.
You may feel that watching a few YouTube videos will help you improve your workout form or golf swing.
But only an experienced eye can spot any mistakes or errors you make during the execution phase and let you know.
Golf Elbow is not an inevitability that every passionate golfer has to resign to at one point or another in their future. In fact, it is a quite uncommon injury that tends to affect older golfers.
Poor fitness and lack of proper technique are the two most important factors that hasten injuries that cause conditions like golfer's elbow.
Corrective measures, taken early enough, can reduce the risk of injury. And even if you do end up with this condition, the prognosis is extremely positive if you seek prompt medical treatment.
We hope you found this guide informative and helpful. Kindly refrain from using this guide as medical advice, and use it purely for awareness purposes.
Seek a doctor's advice if you suffer any of the symptoms described in this guide.
Any comments or suggestions you may have are extremely welcome and would help us considerably in improving this guide.
Further Reading and Sources
- Golf Injury Prevention – American Academy of Orthopedic Surgeons
- Cure & Prevention For Golfer's Elbow – Golfweek.com
- Golfer's Elbow – Flexxline.com
- Golfer's Elbow Exercises – Sportsinjuryclinic.net
- 10 Common Golf Injuries – GolfChannel.com
- Golfer's Elbow – PhysioWorks.com.au
- Elbow Tendonitis: Tennis & Golfer's Elbow – bootcampmilitaryfitnessinstitute.com
- Golfer's Elbow Exercises – Medi-Dyne.com
- Golfer's Elbow Exercises – ToddMarshFitness.com
- Treatment for Golfer's Elbow – WebMD
- Importance of proper form when strength training – National Federation of Professional Trainers
- Proper posture important in golf – HumanKinetics.com
- All About Golfer's Elbow – CorePerformance.com
- Medial Epicondylitis – John Hopkins Medicine
- Tennis Elbow Vs. Golfer's Elbow – NewYorkOrthopedics.com
- Medial Epicondyle Injection – Medscape
- Golfer's Elbow - Wikipedia