Golfalbue / Medial epicondylitis

Golf elbow, known as medial epicondylitis, is caused by overload of the flexor muscles of the wrist (wrist flexors). Golf elbow / medial epicondylitis can greatly affect quality of life and ability to work.

Cause of golf elbow / medial epicondylitis?

Golf elbow / medial epicondylitis is often caused by repetitive movements such as computer work, painting or the like. Treatment of golf elbow / medial epicondylitis involves relief from the causative cause, eccentric training of the muscles involved, as well as any pressure wave and / or laser treatment. It is the wrist flexors that give the condition golf elbow / medial epicondylitis (among other things flexor carpi radialis or flexor carpi ulnaris myalgia / myosis).

The image above illustrates a medial epicondylitis injury. In the muscle / tendon attachment to the medial epicondyle (which you find on the inside of the elbow) small micro-tears occur, which often due to continuing with the causative cause can worsen so that it becomes difficult for the body's own healing process to do something about. An inflammatory process can also occur on the part of the body. In such cases, external help is needed physical therapist, chiropractor or manual therapist. The treatment will usually consist of eccentric training in combination with a pressure wave and / or laser treatment, as well as relief from the causes that started the problem.

Medial epicondylitis - definition:

Medial epicondylitis: An extraarticular overload condition located at the origin of the wrist flexor or tendons on the inside of the elbow. Repeated full flexion (forward bending) of the wrist during the workday is the most common cause.

Symptoms of golf elbow / medial epicondyliat

- Pain and tenderness on the inside of the elbow. The pain can also go down towards the forearm and worsen with certain movements.

- Stiff elbow. The elbow may feel stiff and it can be painful to tie the hand to a fist.

Weakness in the hands or fingers. Occasionally, golf elbow may give weakness in the hand on the affected side.

- Iling down towards the hand, especially towards the ring finger or little finger.

Treatment of golf elbow / medial epicondylitis

What has the best evidence for the treatment of medial epicondylitis is eccentric training (see example of exercises here ), preferably in combination with pressure wave and / or laser treatment - other forms of treatment with evidence include elbow joint mobilization / manipulation. Standard protocol for treatment of golf elbow with Shockwave Therapy is on about 5 treatments, with 1 week in between treatments so that the recovery / rest period should be optimal.

Recommended products for pain relief for pain due to golf elbow / medial epicondylitis

Biofreeze (Cold / cryotherapy)

- Use discount code Bad2016 for 10% off!

needle treatment used frequently for elbow pain. It can be effective against conditions such as tennis elbow (lateral epicondylitis), golf elbow (medial epicondylitis), and general muscular dysfunction (myalgia). Here you can watch a video of an acupuncture treatment for tennis elbow.

Other treatments for golf elbow / medial epicondylitis:

- Acupuncture / needle treatment

- Soft tissue work / massage

- Electrotherapy / current therapy

- Ice treatment

- Laser treatment

- Joint corrective treatment

- Muscle knot treatment / trigger point therapy

- Ultrasound

- Heat treatment

Shockwave Therapy of plantar fasciitis - Photo Wiki

Evidence of golf elbow treatment

A larger RCT (Bisset 2006) - also known as a randomized controlled trial - published in the British Medical Journal (BMJ), showed that physical treatment of lateral epicondylitis consisting of elbow joint manipulation and specific exercise had a significantly greater effect in terms of pain relief and functional improvementcompared to waiting and looking in the short term, and also in the long term compared to cortisone injections. The same study also showed that cortisone has a short-term effect, but that, paradoxically, in the long term it increases the chance of relapse and leads to slower healing of the injury. Another study (Smidt 2002) also supports these findings.

Measures against golf elbow / medial epicondylitis

One of the most important things about congestion injuries is that you simply and easily cut down on the activity that has irritated the muscle and tendon attachment, this can be done by making ergonomic changes in the workplace or taking a break from the painful movements. However, it is important not to stop completely, as this hurts more than good in the long run.

Elbow relief support is also recommended. We recommend Shock Doctor elbow support.

Picture of the elbow support:

Training for golf elbow / medial epicondylitis

Grip Training: Press a soft ball and hold for 5 seconds. Perform 2 sets of 15 reps.

Forearm pronation and supination strengthening: Hold a soup box or similar in your hand and bend your elbow 90 degrees. Slowly turn the hand so that the hand is facing upwards and slowly turn back to face down. Repeat 2 sets of 15 reps.

Resistance training for elbow flexion and extension: Hold a soup can or similar with your hand facing up. Bend your elbow so that your hand is facing your shoulder. Then lower your arm until it is fully extended. Do 2 sets of 15 reps. Gradually increase your resistance as you get stronger.

Golf elbow / medial epicondylitis stretch

Wrist mobilization in flexion and extension: Bend your wrist into flexion (forward bend) and extension (back bend) as far as you can get. Do 2 sets of 15 repetitions.

Wrist extension: Press the back of your hand with your other hand to get a bend in your wrist. Hold with custom pressure for 15 to 30 seconds. Then change movement and stretch by pushing the front of the hand backwards. Hold this position for 15 to 30 seconds. Keep in mind that the arm should be straight when performing these stretching exercises. Perform 3 sets.

Forearm pronation and supination: Bend the elbow on the aching arm 90 degrees while holding the elbow to the body. Turn the palm up and hold this position for 5 seconds. Then slowly lower your palm down and hold this position for 5 seconds. Do this in 2 sets of 15 repetitions in each set.

Golf elbow / medial epicondylitis surgery

If conservative treatment is fully tested and the pain only persists, golf elbow / medial epicondylitis surgery may be appropriate. But due to risk and chance of deterioration, this is a last resort.

Pain injection of golf elbow / medial epicondylitis

If conservative treatment is fully proven and the pain only persists, then it may be relevant with injection in the treatment of golf elbow / medial epicondylitis. Normally, cortisone injection is the most commonly used. This is something you want to try before any surgery, but we remind you that cortisone is known to break down tendons and has the risk of making the condition worse over time.

Learn more in this book: Injection Techniques in Musculoskeletal Medicine (for clinicians and especially interested)
Picture of the book:

Eccentric exercises against golf elbow / medial epicondylitis (example of eccentric exercises)

Eccentric exercise is recommended in the treatment of golf elbow / medial epicondylitis. The following video shows eccentric training for lateral epicondylitis.

Did you know: - Blueberry extract has a proven analgesic and anti-inflammatory effect?

Image diagnostic study of golf elbow / medial epicondylitis

Both MRI examination and diagnostic ultrasound can be useful imaging investigations in case of suspected golf elbow / medial epicondylitis. Normally you will be able to do without such imaging tests, as the diagnosis is usually very clear.

MRI examination image of golf elbow / medial epicondylitis

Ultrasound examination image of golf elbow / medial epicondylitis

This ultrasound image shows a thickened muscle attachment to the medial epicondyle.

Also read:

- Pain in the elbow - Learn more about what causes elbow pain

- Pain in the muscles - Learn more about muscle pain and trigger points

 

Training:

• Chin-up / pull-up exercise bar can be an excellent exercise tool to have at home. It can be attached and detached from the door frame without the use of a drill or tool.
• Cross-trainer / ellipse machine: Excellent fitness training. Good for promoting movement in the body and exercising overall.
• Rubber exercise knit is an excellent tool for you who need to strengthen the shoulder, arm, core and more. Gentle but effective training.
• Kettlebells is a very effective form of training that produces fast and good results.
• Rowing Machines is one of the best forms of training you can use to get good overall strength.
• Spinning ergometer bike: Good to have at home, so you can increase the amount of exercise throughout the year and get better fitness.

Also read:
- Eccentric exercise in the treatment of lateral epicondylitis / tennis elbow

Sources:

1. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilization with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomized trial. BMJ. 2006 Nov 4; 333 (7575): 939. Epub 2006 Sep 29.
2. Smidt N, van der Windt DA, Assendelft WJ, Devillé WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomized controlled trial. Lancet. 2002 Feb 23; 359 (9307): 657-62.

Recommended Literature:

- Understanding Repetitive Strain Injury (click here to learn more)

Description: Understand load damage. A very good book written for an evidence-based approach to stress injuries.

 

- Pain Free: A Revolutionary Method for Stopping Chronic Pain (click here to learn more)

Description: Painless - a revolutionary method of stopping chronic pain. The world-famous Pete Egoscue, who runs the well-known The Egoscue Method Clinic in San Diego, has written this very good book. He has created exercises that he calls E-Cises and in the book he shows step-by-step descriptions with pictures. He himself claims that his method has a full 95 percent success rate. Click here to read more about his book, as well as see a preview. The book is for those who have tried most of the treatment and measures without much success or improvement.

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Frequently Asked Questions About Golf Elbow / Medial Epicondylitis:

Should I get treatment for golf elbow / medial epicondylitis?

Yes, if you do not take any action, the condition will probably only worsen further. Seek help for the plague today, so you don't have to carry it with you for the rest of your life. If you cannot afford treatment, then it is probably okay to start with relief measures (elbow support) and customized exercises (see earlier in the article).

Should I ice down golf elbow / medial epicondylitis?

Yes, in situations where it is clear that the attachments to the medial epicondyle are irritated and perhaps even swollen, then icing should be used according to the usual icing protocol. Take care not to damage the tissue with too much cold.

What are the best painkillers or muscle relaxant tablets for golf elbow / medial epicondylitis?

If you are going to take non-prescription pain medication then they should be anti-inflammatory, e.g. ibuprofen or voltaren. It is not recommended to apply to painkillers without addressing the very cause of the pain, as this is likely to temporarily mask the pain without any particular improvement to the elbow attachment. The doctor can print prescription muscle relaxing if needed; then most likely tramadol or brexidol. Always consult your doctor or pharmacist before taking any pain medication.