Tennis Elbow and Golfer’s Elbow

How many people in Melbourne play golf and tennis? I don’t know the number, but it’s a lot.

Tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis) are related forms of elbow tendinopathy. They are characterised by pain around the area of the elbow, especially on impact or strong muscle contraction. The pain comes from overuse of the muscles and tendons of the forearm. The condition is a known type of OOS (Occupational Overuse Syndrome).

Any repetitive motion of the forearm, wrist or hand can result in one of these two conditions. Tennis elbow affects the outer area around the elbow while golfer’s elbow affects the inner area of the elbow.

There is still some debate among experts about whether the condition is tendonitis (inflammation) or tendinosis (fraying or tearing of the tendon fibres without inflammation).1 In my opinion tendinosis is much more likely.

Research has concluded that no inflammation is present in tennis elbow or golfer’s elbow.2 Thus, the terms lateral epicondylosis and medial epicondylosis are perhaps more accurate.

Origins

The term tennis elbow comes from a paper written by H. P. Major in 1883. The first common description comes from F. Runge, a German physician, who dubbed the condition “writer’s cramp” in 1873. It has also been called “washer women’s elbow”. Similarly, golfer’s elbow is also called pitcher’s elbow, baseball elbow and suitcase elbow.

The terms tennis elbow and golfer’s elbow became more popular even though few of those who suffer from these conditions play these sports.

Causes

Generally speaking, any activity that makes you use your hand, wrist or forearm in a repetitive motion of swinging, gripping or flexing can cause these conditions.

Some examples are painting, cooking, carpentry, typing, assembly-line work and playing a musical instrument. In rare cases, elbow tendinopathy can also occur with no recognised repetitive injury.

Tendons connect muscles to bones, and elbow tendinopathy usually occurs where the tendons in the forearm form a junction with muscle tissue. This junction is the weakest part of a muscle-tendon unit. Tennis elbow involves the extensor tendons on the back of the forearm; golfer’s elbow involves the flexor tendons on the front.

Overuse of these muscles and tendons can result in small tears and not just muscle pain or tendon strain. Tears in the tendon are what cause the pain associated with the condition. If there is inflammation it can, in turn, causes additional stress on the arm. This makes it painful to grasp, pick up or carry common items.

Tennis elbow is a common injury, affecting up to 3% of the population. Cases of golfer’s elbow are less common. It hits men and women equally and is concentrated in those who are between 35 and 45 years of age. Anyone involved in activities with such repetitive motions as mentioned above is at risk, however, regardless of age.

Treatment

Both tennis elbow and golfer’s elbow and related muscle pain are effectively treated with remedial massage such as we offer here at Massage Dot Melbourne clinics, both in South Melbourne and Brunswick East. Coupled with guided exercise, and medication in severe cases, these conditions can be alleviated or even completely resolved.

Without treatment, an elbow tendinopathy can become chronic and result in severe muscle pain and inability to use the affected arm. Even in chronic cases, though, remedial massage is effective at relieving or resolving the condition.

Using remedial massage therapy, tension is relieved by applying compression broadening, myofascial release, and then treating any remaining trigger points on the extensor or flexor tendons and surrounding muscles.

If there is tendinosis (fibre damage) we can apply gentle frictioning to soften the disorganised collagen matrix. We follow this with lightly resisted, pain-free muscle contractions. These contractions of the softened collagen help the fibres to re-align, changing from dysfunctional into functional scar tissue. This part of the treatment must be absolutely pain-free to work.

By allowing the muscles to relax, the tendons will follow. Muscle pain is relieved and the tendon can be given time to repair itself.

Following specific therapeutic exercises, the eventual goal is a full recovery and return to normal activities.


Sources:

  1. Bass, E. (2012). Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters. International Journal of Therapeutic Massage & Bodywork, 5(1), 14–17. Retrieved on 28 Jun 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/
  2. Cohen, M., & da Rocha Motta Filho, G. (2012). “Lateral Epicondylitis of the Elbow.” Revista Brasileira de Ortopedia, 47(4), 414–420. Retrieved on 27 Jun 2017 from http://doi.org/10.1016/S2255-4971(15)30121-X
  3. Dubin Chiropractic. “Medial Epicondylitis / Pitcher’s Elbow.” Dubinchiro.com. 15 Oct. 2013. Web. Retrieved 27 Jun. 2017 from http://dubinchiro.com/2013/10/medial-epicondylitis-pitchers-elbow/
  4. Dozier, T. and Ogiela, D. Medial Epicondylitis (Golfer’s and Baseball Elbow) – Health Encyclopedia – University of Rochester Medical Center. Urmc.rochester.edu. Retrieved on 27 Jun. 2017 from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P00928Web
  5. Calfee Rp , Et Al. (2008). “Management of lateral epicondylitis: current concepts.” – PubMed – NCBI. Ncbi.nlm.nih.gov. Retrieved 28 Jun 2017 from https://www.ncbi.nlm.nih.gov/pubmed/18180389