Tennis elbow and golfer's elbow

As the name implies, this form of injury is very common in golfers and affects the inside of the elbow on the bony prominence called the medial epicondyle. Golfers who use a tight grip while moving the club apply a lot of strain to the tendons of the flexor muscles - those that curl the wrist and close the fingers to make a fist. The strain is greatest at or near the top of the backswing and at the downswing just before it hits the ball. Repeated curling can even tear off a piece of bone. Golfer's elbow affects not just golfers, but baseball throwers who put load on the elbow by straightening too forcefully and on weight lifters when 'rotating out' during a snatch lift.

Golfer's elbow can be compared with tennis elbow which affects the bony prominence on the outer part of the elbow, called the lateral epicondyle. Tennis elbow is very common among tennis players, although it affects people who do not play tennis at all. Tennis elbow is an overuse injury caused by bending the wrist backward as in tennis, badminton or squash. The injury can occur suddenly after one game, or it can occur within 24-72 hours of intense training. This article looks at the similarities and differences of both conditions.

Symptoms of golfer's (and tennis) elbow include:

• Pain on the medial (inner) aspect of the elbow. In tennis elbow pain is felt on the lateral (outer) aspect. Pain is much worse when resistance is given to the wrist while bent, or when you grip something hard. Pain may also occur at rest.
• Tenderness on the inside of the elbow. For tennis elbow it's on the outside.
• Weakness of the flexor muscles - those that curl the wrist.
• Decreased grip strength due to inflammation and pain.

Your doctor may prescribe anti-inflammatory medications and surgery will be necessary if a bone was torn. In some cases steroid injections may be given. Recovery may take about two weeks, but the problem may linger much longer. Initial treatment for golfer's and tennis elbow is to use the RICE formula.

• Rest. It is important to rest the elbow to allow the injury to heal.
• Ice. This should be applied in the first 2 to 3 days to reduce pain, inflammation and swelling.
• Compression. Wearing of an elbow brace helps to reduce the load and allow the elbow to heal.
• Elevation. Reduces bleeding and swelling.

We will help you identify the mechanism of injury and develop techniques to prevent future injury. For tennis elbow, this may involve modifying your backhand technique to avoid future injury. Intervention focuses on pain management with the use of ultrasound or laser. Once the symptoms have subsided, gentle stretching exercises can begin. Isometric exercises (contracting the forearm without movement) will performed initially for strengthening followed by concentric (raising) and eccentric (lowering) exercises. Graded resistance exercises with equipment, Thera-band® and thera putty can be done to increase wrist, forearm and grip strength. As with any injury, a gradual return to previous activity is encouraged.