“Golfer’s elbow” is one of the most common golf injuries. Technically called medial epicondylitis, it is an inflammation of the tendons that attach your forearm muscles to the bone on the inside of your elbow. It is most common in the right elbow of a right-handed novice golfer.
Those who develop the condition often have an incorrect weight shift and tend to “throw the club down” at the ball. This is sometimes referred to as “hitting from the top” or “casting”. This can increase the stress on the muscles on the inside of the forearm. Specifically, there is increased muscle activation of the pronator teres, an inner forearm muscle, during the acceleration phase of the swing. Transferring your weight smoothly from your back to your front foot while keeping your shoulders level will ensure proper contact between the club face and the ball.
Golfer’s elbow can also develop in the left arm of a right-handed golfer, if their follow-through is generated by turning over the wrist. In these cases, there is increased strain on the inside of the left elbow as the golfer’s wrist turns palm-up.
The most common symptom is inner elbow pain and/or pain in the inside of the forearm, but feelings of stiffness, weakness and/or tingling may also occur. Pain and tenderness are usually felt on the inner side of the elbow but may also spread to the forearm and wrist.
How do you prevent golfer’s elbow?
Several factors play a role in preventing this injury. Stretching, using proper equipment, and maintaining proper swinging form will help prevent injury. New golfers should consider lessons and club fitting to avoid excessive strain.
During the off-season, a balanced training program can be helpful to improve the mobility and strength necessary to complete the golf swing. Early in the golf season it is important to be mindful of a gradual progression of swing volume to avoid doing too much too quickly. Warm up and stretch appropriately before playing and listen to your body. Don’t make what could be a relatively minor condition into something more severe by playing through pain.
The following tips can help protect your elbow from injury on the golf course:
- Ensure proper weight shift: poor weight shifting, or limited use of the legs, hips and trunk may put more stress on the elbow. Poor kinetic linking from the lower body to the upper body can result in more strain on the elbow, as well as power leaks.
- Normalize the swing arc: adopt a flat or more elliptic swing plane. This will allow the hands to be kept at or near shoulder height during transition and at the completion of follow through. This allows the golf ball to be swept off the ground and may help to reduce the likelihood of injury.
- Remember, stronger grips lock the wrists and neutral grips only work if proper grip force is applied. Often, in an attempt to get more power and distance, there is a conscious attempt to hinge or cock the wrist and then rapidly uncock it through impact. This can create an inflammation of the wrist muscle tendons found in the forearm. This is the “misconception” of the delayed hit. What delivers the speed at impact is acceleration by a quick rolling of the forearms.
- Try not to do too much, too soon. The forearm performs repeated quick, forceful movements during the golf swing. During repeated swings, the arm may be subjected to too much stress, increasing risk for an overuse injury. Golfers should progress gradually in play time, duration and game frequency.
- Limit the amount of golf balls hit at the range. If you have an injury, consider teeing up ball shots to avoid taking divots.
- Use caution when hitting off of mats.
- Address any weaknesses in upper body strength and flexibility. Do exercises to build up your upper body to decrease stress and strain on the elbow and arm muscles. Strengthening exercises can be done in the off-season, as well, so a golfer is in good shape when getting back to the game.
- Increase the width of grips, change grip position. Oversized grips that are generally larger and softer help to reduce compressive forces and pressure when holding a club.
- Avoid “flicking” the wrists at ball impact.
In the presence of symptoms, be mindful of painful sleep positions, as this can be an overlooked source of persistent symptoms.
Billy Marrone, PT, DPT, SCS, CSCS is a Board Certified Sports Clinical Specialist in Physical Therapy. Billy has experience treating a wide variety of orthopedic clinical issues including surgical and non-surgical cases. He has a special interest in working with knee ligament and cartilage injuries in field and court sport athletes and conducts return to sport testing and movement assessment.
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