how do tennis elbow braces work
Osteopathy â Treatment Of Golferâs Elbow
Golfers elbow is also known as medial epicondylitis and is the less common sister condition of tennis elbow, both conditions sharing the tendon degenerative nature without inflammation. They are referred to as tendinopathies due to the pathological changes which occur inside the tendon without an inflammatory process. Not just occurring in golfers, golfers elbow also appears in racquet sports, cricket bowling, weightlifting and archery.
The medial epicondyle is the bone prominence on the inside of the elbow where the forearm and rotatory muscle originate from. The muscles become tendinous near the bone and the tendon inserts into the bone to anchor the muscles. This area is where the pain occurs but there is no inflammatory process, rather a degenerative one. As the elbow is stressed by forces which would tend to push the elbow out into knock elbow, the tendon takes a lot of stress and changes occur.
The flexor tendons are put under stress by activities which force the forearm outwards away from the body and these stresses occur as the wrist is cocked prior to throwing, in the early acceleration of the throw and in the golf swing from high backswing to just before the ball is hit. The dominant hand is affected in golfers and in tennis players those who impart a heavy topspin to the ball are more likely to suffer.Golfers elbow is not as common as tennis elbow but is the commonest cause of medial elbow pain with about half as many women affected as men. The third to fifth decades of life are the commonest periods for pain onset and 60% of golfers elbow occurs in the dominant hand. An acute onset of pain is reported in a third of patients, with the other two-thirds developing over a period of time.
Pain and ache over the front of the medial epicondyle is the typical symptom, worse with repeated flexion of the wrist and improved with resting. Shoulder, elbow, forearm or hand pain can occur, with weakness or pins and needles in the lower arm. Osteopathy examination includes the bony tendon insertions, the elbow joints and the muscles, with palpation of the funny bone area behind the elbow where the ulnar nerve lies. Nerve involvement can give weakness in the forearm muscles and sensory symptoms, so an exclusion neurological examination is performed by the osteo.
The main treatment of golfers elbow is conservative, including anti-inflammatories, wrist and forearm splinting, corticosteroid injection and osteopathy. Modifying the provoking activity is a first line of management, making patient education about the condition and the eliciting factors vital. An example is modifying the golf swing mechanics to avoid setting the problem off continually. The patient is taught to avoid aggravating positions and activities, such as leaning on the elbow if there is nerve involvement.
Cryotherapy (cold therapy), gentle stretching, ultrasound, frictions and anti-inflammatory drugs are the main treatments for acute golfers elbow. Once it has settled down into the sub acute condition then the aim is to increase flexibility by stretches, improve the strength of the muscles and go back to normal daily jobs. Bracing can be used either to rest the musculature (wrist brace) or to realign the forces through the tendons (counterforce bracing). In the case of chronic golfers elbow the treatment can be the above plus gradual weaning out of the splint and paced return to sport.
Scientific work shows that steroid injections can be useful in the early stages of golfers elbow to reduce pain and the time to recovery, but they are also used in chronic situations. There is no evidence that shockwave or laser therapy has any effectiveness and surgery is contemplated when a significant period of osteopathy has been attempted without success. The surgeon removes the abnormal tendinous tissue and if the ulnar nerve is involved he may move it around to the front of the elbow from its posterior groove.
A professional instructor will allow correction of golf swing technique. Overall fitness including strengthening exercises, aerobic work and stretching is another aim of treatment. Proper sporting technique and equipment usage is vital in athletes, with a good warm up prior to performance and good stretching afterwards. Patients may need to be strictly monitored and treated by the osteopath as many sports people ignore pain during activity, worsening or prolonging their symptoms.
About the Author
Andrew Mitchell, editor of the Osteopath Network, writes articles about osteopathy, osteopaths, osteopath in worthing, back pain, neck pain, injury management. Andrew is interested in many aspects of alternative medicine.
Finger Hand Wrist Forearm Strength Exercise for Guitar & Bass