The elbow is subjected to large forces during a golf swing, especially an amateur golf swing, statistics indicate elbow complaints range from PGA circuit rate of 4% to amateur golfers 24% (includes both medial and lateral complaints in right and left elbows). The most common site of injuries is not on the "inside" - (medial aspect) of the elbow which has the name "golfers elbow", but on the "outside" - (lateral aspect), traditionally termed "tennis elbow".
The right handed player can suffer lateral elbow pain in the right arm, and medial elbow pain in the left. The most likely cause is overpractice (and probably incorrect overpractice at that) - remember "practice does not make it perfect it makes it permanent", and the swing faults causing the excessive load on the tendons at your elbow are just being made permanent by practice of your swing. A lesson or two is probably a good starting point if you feel any discomfort following play. There are seven factors in elbow injuries: overuse, age, swing mechanics, conditioning, warm up, equipment and pathology.
Repetitive play can lead to complaints of medial elbow pain in the right, and lateral elbow pain in the left elbow in the dominant right handed player.
Incidence of elbow injuries increases in golfers aged 35- 55. 2 or 3 rounds of golf per week seem to be the threshold.
Most professional golfers what constitutes a good swing, achieving the mechanics of a good swing is a matter of considerable controversy. The "natural swing concept" proposed by Ernest Jones in the 1920's allows the club to swing in a natural relaxed manner toward or over the right shoulder in one motion, returned to the target with arms swung to the right shoulder with a neutral grip, the lower extremity follows the tempo of the upper body.
If the club deviates from the plane of the swing (too flat or too steep) the stresses on the arm and wrist may lead to injuries.
Off season conditioning is less relevant in Australia, when we play year round, however 3/week 20 minutes per session using small hand weights, or theraband - stretchy exercise tubing, will develop the muscular-tendon junction.
Gradually increase the swing arc from short irons to woods.
The cavity back irons with their larger "sweet spot" dampen the vibration from an off centre shot.
Assessment involves ruling out your neck or thoracic spine as the origin, nerve entrapment (which sometimes occurs together with tendon problems) it may be the radial nerve (giving lateral pain) or branch or the ulna nerve (giving medial pain) or pathologies with the joint/bone. The pain may be due to primary tendonitis, or degenerative arthritis, or rheumatic disorders. There will be pain on resisted flexion/extension, the "traditional" tennis elbow is painful on resisted extension of the middle finger, more if the hand is turned away from the bodies midline (pronated) and wrist extended. Spurring or loose bodies may require surgery.
Epicondylitis has many treatments available - none are totally successful in all cases. Most successful protocols recognize R.I.C.E. - (rest, ice, compression, elevation), bracing, muscle-tendon conditioning, medication, steroids, physical therapies, swing mechanics, equipment: Bracing will alleviate minor symptoms, some electro muscle studies support the use of an "air" cushion bracing. The theory goes if you compress the tendon it will not swell as much, which will reduce the damage done. Physiotherapy offers, initial rest - reduction in exacerbating activities.
Some techniques available are specific muscle activation while stretching, ultrasound, electrotherapies, heat/ice, taping, frictional massage, bracing and/or acupuncture and all have (in my experience) proved useful, however sometimes not. Steroid injections, while popular with some, have been shown to be of limited long term value (i.e. not as effective at 12 months as physical therapy), however often the relief is profound.
Increased forearm muscle strength, flexibility, endurance. A change in the understanding of the nature of the underlying condition has shifted treatment to improving the eccentric strength (eccentric exercise produces greater tensile force on the tendon).
Please ! If you don't understand the terminology, don't try treating it yourself.
Physioworks: Lateral Epicondylitis Treatment
Pronate the forearm with the elbow extended, flex (volarflex) the wrist, for medial epicondylitis: supinate the forearm with the elbow extended, dorsiflex the wrist. Following the stretches (sets of 3-4 each lasting 30 seconds), weights are introduced, with the emphasis on the change from concentric to eccentric loading - slow eccentric, quick concentric contractions, repeat stretches and ice the area. Daily stretches/exercises and expect relief in 2-3 weeks. Look to increase weights after 30 repetitions are pain free, but remember a golf club does not weigh that much, so why use large weights?
Technique will need the opinion of a professional, and also look for equipment, with particular reference to grip size, a larger grip making grasping easier with the proviso that a free and easy swing demand uninhibited wrist movements.
Non steroidal anti-inflammatories, but should be in conjunction with strengthening program. Capsaicin has been shown to be effective - watch for skin reactions however. Steroid injections - up to three per year, however, in my opinion these are not to be overly recommended, studies have indicated that at twelve months a better outcome was physical therapy rather than injections.
Avoid moving outside the swing plane.
Clubs with a larger sweet spot, more flexible shafts.
Not a consideration prior to six months of no improvement, post op recovery taking about 4 months. Calcifications or spurs require removal, so if treatment is not proving successful an x-ray/ultrasound may be a good idea.
Forces on the elbow during a golf swing
Backswing: A one piece take away places little force on the elbow, the movement should be slow and smooth to minimize the eccentric load on muscles of forearm and wrists. At the top of the backswing - translation phase - is critical, shoulders are coiled, arms extended, the forearm muscles are stretched. The peak negative moment of force occurs at the time the backswing becomes the downswing - the club is still moving in the direction of the backswing, the wrists exert a force to stop this and commence the downswing. This force is exerted when the right wrist is dorsiflexed and the right elbow flexors are stretched - the right flexor tendons are stressed and medial epicondylitis may result.
Downswing: the peak positive moment of force of the entire swing happens milliseconds before impact. The club is moving at close to maximum velocity, and the golfer squares the club face by rotating the forearms. The right wrist remains dorsiflexed which retains the stretch on the wrist flexors Impact: the left hand should face the target as the forearms continue to rotate. There is a counter force of the ball, and the divot taken: this places stress on the forearm muscles. To reduce the stress on the forearm and elbow, allow the wrists to "cock" and "uncock" naturally.