Golfer’s Elbow: How Physical Therapy & Dry Needling Can Help
Golfer’s elbow, medically known as medial epicondylitis, is a common condition characterized by pain and tenderness on the inner part of the elbow. It is typically caused by repetitive stress or overuse of the forearm flexor muscles. It is not to be confused with tennis elbow, which is a condition characterized by pain and inflammation on the outer part of the elbow due to overuse of the forearm extensor muscles. Both conditions involve tendon inflammation but target different muscle groups and parts of the elbow. This blog post explores what golfer’s elbow is, its symptoms, and how physical therapy and dry needling can offer effective relief.
What is Golfer’s Elbow?
Golfer’s elbow, or medial epicondylitis, is a common condition characterized by pain and inflammation on the inner side of the elbow, specifically at the medial epicondyle. This condition often arises from repetitive stress or overuse of the forearm muscles and tendons, particularly the forearm flexors. This issue typically comes on over a long period of time since it is a repetitive overuse injury. This means that you may slowly and gradually start to feel pain in the inner part of the elbow, especially after activities that place undue stress on the tissues there. It’s called “Golfer’s Elbow” because golf is a really common sport that places high stress on the elbow joint when not performed with excellent form. We are going to dive deep into the pathophysiology of golfer’s elbow, its symptoms, and how physical therapy and dry needling can offer effective relief.
Pathophysiology of Golfer's Elbow
Tendon Overuse and Microtrauma:
Mechanism: Golfer’s elbow arises from overuse or repetitive stress, especially from activities that involve gripping, twisting, or forearm rotation, such as golfing or weightlifting. This repetitive strain causes microtrauma to the tendons, particularly the flexor tendons that attach to the medial epicondyle.
Microtears: The excessive stress leads to small tears in the collagen fibers of the tendons. These microtears provoke an inflammatory response, resulting in pain and tenderness at the medial epicondyle.
Degenerative Changes:
Tendinopathy: Over time, the repeated microtrauma can lead to degenerative changes in the tendons, a condition known as tendinopathy. This involves the breakdown of the tendon’s collagen matrix and the accumulation of disorganized collagen fibers.
Cellular Response: There is a shift from an acute inflammatory response to a more chronic degenerative process. The tendons may show changes such as increased vascularity and the presence of fibroblasts and myofibroblasts, which contribute to the remodeling process.
Pain and Inflammation:
Inflammatory Mediators: The inflammatory response in golfer’s elbow includes the release of pain mediators such as prostaglandins, cytokines, and other inflammatory substances. These mediators contribute to pain, swelling, and tenderness at the elbow.
Pain Pathways: The pain experienced in golfer’s elbow is due to both the local inflammatory process and the involvement of nociceptors (pain receptors) in the affected tendons. The pain can radiate down the forearm, affecting daily activities and movements, particularly those that involve gripping.
Muscle Imbalance and Dysfunction:
Forearm Muscles: Muscle imbalances, particularly between the flexor and extensor muscles of the forearm, can exacerbate the condition. Weakness or tightness in the forearm flexors and extensors can increase strain on the medial epicondyle, perpetuating the cycle of injury. Issues almost always exist higher up the kinetic chain, like in the shoulder joint or in the thoracic spine. Deficits in mobility and/or strength in these regions can cause dysfunction at the elbow joint.
Biomechanical Factors: Poor biomechanics or improper technique in sports or activities that involve repetitive gripping or twisting motions can contribute to the development and persistence of golfer’s elbow. Sometimes, a simple form correction can offer relief and a break for the overused muscles.
Understanding the pathophysiology of golfer’s elbow highlights the complex interplay between mechanical stress, tendon degeneration, inflammation, and pain. Effective treatment strategies often involve addressing these factors through rest, physical therapy, and sometimes medical interventions to alleviate pain and restore function.
Symptoms of Golfer’s Elbow
Localized Pain:
Location: The primary symptom of golfer’s elbow is pain on the inner side of the elbow, specifically at the medial epicondyle. This pain may also radiate down the forearm and into the wrist.
Onset: Pain often starts gradually and can intensify with repetitive activities that stress the forearm muscles, such as gripping or lifting. In some cases, the pain may develop suddenly after a specific activity or increase in intensity over time.
Tenderness and Swelling:
Tenderness: The area around the medial epicondyle is usually tender to the touch. Pressing on this region may elicit pain and discomfort.
Swelling: Mild swelling around the inner elbow may be present, although it is typically less pronounced compared to conditions like tennis elbow.
Stiffness and Reduced Range of Motion:
Stiffness: Individuals with golfer’s elbow often experience stiffness in the inner elbow and forearm, particularly in the morning or after periods of inactivity.
Range of Motion: Reduced flexibility and range of motion in the elbow and wrist may occur, making it challenging to perform movements such as bending the elbow or extending the wrist.
Weakness in the Forearm:
Grip Strength: Weakness in the forearm muscles can affect grip strength and the ability to hold objects firmly. Activities requiring a strong grip, such as shaking hands or holding a golf club, may become difficult or painful.
Functional Limitations: Difficulty with tasks that involve wrist flexion, such as typing or lifting objects, may be noticeable. The weakness can contribute to impaired performance in sports or daily activities.
Pain with Specific Movements:
Wrist Flexion: Pain often worsens with activities involving wrist flexion or repetitive gripping motions. For example, swinging a golf club, lifting weights, or doing activities that require repeated wrist motion can exacerbate symptoms.
Resistance Testing: Pain may be triggered by specific resistance tests, such as extending the wrist against resistance or gripping an object tightly. These movements put additional strain on the affected tendons and can increase discomfort.
Discomfort During and After Activities:
Activity-related Pain: Individuals with golfer’s elbow typically experience pain during activities that involve the forearm muscles. This discomfort may be accompanied by a dull, aching sensation that persists after the activity.
Post-Activity Pain: Pain and stiffness may continue after activities and can interfere with rest and sleep. This prolonged discomfort often signals that the condition is affecting daily life and requires attention.
By recognizing these symptoms early, individuals can seek appropriate treatment and prevent further aggravation of golfer’s elbow. If you’re experiencing any of these signs, it’s essential to consult with a healthcare professional, such as a physical therapist, to receive a thorough evaluation and personalized treatment plan.
How Physical Therapy and Dry Needling Can Help
Physical Therapy:
Rehabilitation Exercises: Physical therapy involves tailored exercises to strengthen the wrist, forearm, shoulder and core, improve flexibility, and restore functional movement. Specific exercises can help reduce pain and prevent recurrence by addressing muscle imbalances and improving biomechanics.
Manual Therapy: Techniques such as soft tissue mobilization and joint mobilization can alleviate pain and improve range of motion. Manual therapy helps to address the underlying musculoskeletal issues contributing to golfer’s elbow.
Dry Needling:
Targeted Treatment: Dry needling involves inserting fine needles into specific muscles and around tendons and nerves to relieve pain and muscle tension as well as improve blood flow and the body’s natural healing response. This technique can help release tightness in the forearm flexors and reduce pain associated with golfer’s elbow.
Enhanced Healing: By promoting local blood flow and reducing muscle tightness, dry needling can enhance the healing process and improve overall function of the elbow joint.
Conclusion
Golfer’s elbow is a condition characterized by pain and inflammation on the inner side of the elbow due to overuse and repetitive stress on the forearm tendons. Understanding the pathophysiology of golfer’s elbow is crucial for effective treatment and prevention. Physical therapy and dry needling offer valuable approaches for managing symptoms, addressing underlying issues, and supporting recovery. If you’re experiencing symptoms of golfer’s elbow, consider consulting with a one of our physical therapists to develop a personalized treatment plan and get back to your activities pain-free.
Combining Physical Therapy and Dry Needling for Optimal Results
The pathophysiology of golfer’s elbow involves a complex interaction between mechanical stress, tendon degeneration, inflammation, and pain. Addressing these factors through rest, physical therapy, and appropriate medical interventions is essential for effective treatment. By understanding the underlying mechanisms, individuals can better manage and prevent golfer’s elbow, improving function and reducing discomfort.
Combining physical therapy with dry needling provides a comprehensive approach to managing elbow pain. Physical therapy addresses the underlying causes and contributes to long-term recovery, while dry needling offers targeted relief for muscle pain and tightness. Together, these treatments can effectively reduce symptoms and enhance function.
If you’re struggling with golfer’s elbow or seeking effective treatment options, consider consulting a physical therapist who specializes in elbow rehabilitation. At Wildflower Physical Therapy & Wellness, our team of experts offers personalized physical therapy and dry needling services to help you achieve relief and restore optimal elbow function. Now with locations in downtown Indianapolis, IN and Iron Mountain, MI.
If you are struggling with illness or injury and would like to get your body moving, schedule a physical therapy appointment with us today! At Wildflower Physical Therapy & Wellness, we can help you to get back to the life you want to live through pain management strategies, activity promotion and exercise. Our Cash Based Physical Therapy model allows us to deliver a highly individualized treatment plan without the fuss of insurance companies. Interested in trying dry needling to support your exercise routine and maximize recovery? Reach out to us today!