Sun's Out, Clubs Out: It's Golfer's Elbow Season

Living Well

Written by: Dr. Mehran Tabrizi, Chiropractor, Cambridge Clinic

For a long time before Tommy John surgery, the elbow was not the sexiest part of the body to treat but, when you think about it, it is a part that is crucial for survival and day-to-day activity.

If you have a problem with your elbow, you can't feed yourself. It can actually affect every aspect of your life.

While the incidence of tennis elbow is seven times greater than golfer's elbow, for the avid golfer, this is an injury to be aware of to keep yourself in the game.

Formally known as medial epicondylitis, golfer's elbow is an overuse injury in which there is inflammation at the bony knob on the inside of your elbow where the muscles in your forearm that flex your wrist attach. This can lead to pain locally in the elbow and also affect your grip strength.

When you look beyond the muscular to the neurological implications, the ulnar nerve, which runs through the medial side of the elbow, supplies some of the lumbricals (which are the some of the intrinsic muscles of the hand), and these muscles have the second most sensory afferent receptors in the body after your tongue. So, if this nerve is compressed, your brain is not getting as much sensory input from your hand, and the dexterity of your golf grip—and everything else—is also affected.

In considering all of this, a couple of things become evident. One, there is a downstream effect, it is not just about the elbow. Two, prevention is key. And, just as the effects are not just felt in the elbow,
prevention is also not just about the elbow.

When thinking about prevention, we also need to look upstream and take in the totality of the system. Here are a few areas to help in your health and performance:

• Strengthen the posterior cuff of the shoulder. Our tendency is to focus on the anterior shoulder in strengthening, and our typical posture has the shoulders forward. This lends itself to impingement in the shoulder, which will not favour elbow health.
• Mobilize the carpal bones in the wrist. There are eight bones that make up your wrist joint. Ensuring their mobility will help the tendons through there to glide optimally. When we know that the elbow pain is actually about the origin attachment of those forearm muscles that work the wrist and hand, we can help ease that pressure by ensuring that the insertions of those muscles are not compressed at the other end. And, if we spend a lot of time typing, for example, the wrist may end up in more of an extension pattern or just stiff from immobility, so a little extra love to those carpal bones may be needed.
• Stack your neck over your thorax. Neck retractions are a simple exercise that can help you to maintain alignment of the spine. The nerves that operate the arms originate in the neck so this, once again, is about acknowledging that it is all connected and maximizing the health of the whole chain.
• Create a better ratio of strength between the forearm flexors and extensors. Part of overuse of one muscle group is the neglect of the antagonist muscles. For the health of the entire region, balance is key.

Like most sports, golf has us using our bodies in a very asymmetrical way, so these principles can be considered throughout the body—even down through the torso and hips. Following the complex
movement of a golf swing, there are many areas where the imbalances in strength or mobility can lead to compensation and the overuse of a muscle or muscle group that leads to injury.

After a long winter and the amount of time missed on the golf course in the past couple of years, I'm sure all golfers are eager to hit the links, and no one wants to take the time away from the game that
healing an overuse injury requires. While overuse injuries are self-explanatory in their origin, a key factor that is overlooked is that they stem from being under-prepared. So, if you are wanting to learn more about injury prevention, join me for a workshop on June 16, 2022.

To RSVP for the workshop, please contact Dr. Tabrizi directly.