Explore the complexities of Golfer's and Tennis Elbow, focusing on their anatomy, biomechanics, and effective treatments. These common conditions, especially among athletes, often involve nerve compression—60% of Golfer's Elbow cases feature ulnar nerve issues, while Tennis Elbow can lead to Radial Tunnel Syndrome. We offer a clear path to pain relief, long-term recovery, and prevention using MSR manual therapy and targeted exercises.
Our Success Rate is Over 90%
Our 90% success rate in treating Golfer's and Tennis Elbow underscores the effectiveness of our multimodal, interdisciplinary approach, focusing on pain relief and improved function.
Article Index
Introduction
Introduction
Golfer's Elbow: Medial Epicondylitis
Golfer's Elbow, medically known as Medial Epicondylitis, is a condition characterized by pain and inflammation on the inner side of the elbow. It occurs when the tendons that attach the forearm muscles to the medial epicondyle of the elbow become irritated or damaged, often due to repetitive wrist flexion or gripping activities. This condition is common among golfers, hence the name, but can also affect anyone engaged in activities that strain these tendons.
Key Anatomical Components:
Medial Epicondyle: The primary site of pain and inflammation in Golfer's Elbow, acting as an anchor for important forearm muscles.
Common Flexor Tendon: This fibrous tissue connects key forearm muscles to the medial epicondyle and experiences high tension during activities like forceful gripping or wrist flexion.
Palmaris Longus and Pronator Teres Muscles: These muscles are crucial for wrist flexion and forearm rotation, driving much of the forearm's activity.
Vulnerable Structures:
Common Flexor Tendon: Prone to strain from excessive gripping actions.
Palmaris Longus Muscle: Important for wrist flexion and contributing to forearm pronation.
Pronator Teres Muscle: Plays a key role in forearm pronation and flexion.
Common Stressors:
Repetitive Golf Swings: The repetitive nature of the golf swing puts these structures under significant stress.
Intense, Sustained Grip: Tasks that require a strong grip can worsen symptoms.
Frequent Wrist Flexion: A common motion in various occupational and leisure activities, adding stress to the affected structures.
Tennis Elbow: Lateral Epicondylitis
Tennis Elbow, medically referred to as Lateral Epicondylitis, is a condition marked by pain and inflammation on the outer side of the elbow. It results from the overuse or strain of the tendons that attach the forearm muscles to the lateral epicondyle of the elbow, often caused by repetitive wrist extension or gripping activities. While commonly associated with tennis players, this condition can affect anyone who engages in activities that place stress on these tendons.
Key Anatomical Components:
Lateral Epicondyle: The main site for pain and inflammation in Tennis Elbow, serving as an anchorage for muscles involved in wrist extension and supination.
Common Extensor Tendon: A robust tissue that links extensor muscles to the lateral epicondyle, grappling with tension during wrist activities.
Extensor Carpi Radialis Brevis (ECRB): Vital for wrist extension and abduction, aiding in complex wrist maneuvers.
Vulnerable Structures:
Origin of Common Extensor Tendon: Subject to stress from repetitive, strenuous movements.
ECRB Muscle: Prone to overuse in activities requiring continuous wrist extension or supination.
Supinator Muscle and Extensor Carpi Radialis Longus: These muscles assist in forearm rotation and extension and are implicated under specific stress conditions.
Common Stressors:
Tennis Backhand Stroke: A high-impact, repetitive activity that strains the involved structures.Continuous Wrist Extension or Supination: Frequently observed in occupational and everyday tasks.
Intensive Use of Extensor Muscles: Activities requiring persistent use of these muscles can push them to their functional limits.
Kinetic Chain Contributors
To thoroughly understand Golfer's and Tennis Elbow, it's essential to analyze the kinetic chain—the interconnected system of musculoskeletal segments from the shoulder to the wrist. This comprehensive approach highlights the structural and functional relationships that contribute to these conditions.
The Shoulders: The Central Hub of Force Distribution
The shoulder girdle, comprising the scapula, clavicle, and humerus, is a key proximal component of the kinetic chain. This complex structure offers a wide range of motion, crucial for various athletic activities.
The rotator cuff, which includes the supraspinatus, infraspinatus, teres minor, and subscapularis muscles, serves as a dynamic stabilizer, ensuring both movement initiation and joint stability. However, postural deviations such as anterior shoulder carriage (rounded shoulders), common in sports like golf and tennis, can cause musculotendinous strain and disrupt biomechanics, potentially increasing stress on the elbow.
The Elbow: The Dynamic Force Transmitter
The elbow joint, composed of the distal humerus, proximal radius, and ulna, serves as a pivotal point for force transmission from the shoulder to the hand. The medial and lateral epicondyles of the humerus, where essential forearm muscles attach, are key structures involved in Golfer's and Tennis Elbow.
In medial epicondylitis (Golfer's Elbow), repetitive loading of the wrist and finger flexors places excessive strain on their attachment at the medial epicondyle. Conversely, in lateral epicondylitis (Tennis Elbow), the muscles responsible for wrist and finger extension and forearm supination exert excessive load on the lateral epicondyle.
The Forearm: The Director of Fine Movements
The forearm comprises a complex network of muscles organized into flexor and extensor compartments, facilitating precise wrist and finger movements. These muscles, enclosed in fascial compartments, are susceptible to myofascial adhesions from overuse, leading to pain and restricted range of motion.
The Wrist: The Force Conduit
The wrist joint, where the distal radius, ulna, and carpal bones converge, serves as the distal endpoint of the kinetic chain. It plays a vital role in transferring force from the body to the hand, crucial for activities like gripping a golf club or tennis racket. However, dysfunctional biomechanics and muscular imbalances in the forearm can lead to wrist discomfort and reduced grip strength, significantly contributing to the complex pathophysiology of Golfer's and Tennis Elbow.
The Treatment Roadmap
A successful treatment plan for Golfer's and Tennis Elbow necessitates a comprehensive examination of the entire kinetic chain. By identifying and addressing areas of musculotendinous restriction, weakness, and biomechanical imbalances, clinicians can restore optimal function and minimize the risk of further injury.
This holistic approach includes advanced manual therapies, evidence-based strengthening exercises, and targeted mobility work. It goes beyond merely treating the symptomatic elbow, encompassing the shoulder, forearm, and wrist structures to ensure a thorough and lasting recovery.
The Nervous System's Role
The significance of the nervous system in elbow health is often overlooked but essential. Beyond soft tissue concerns, nerve entrapment is a frequent issue, with Cubital Tunnel Syndrome being a prime example. This condition involves the ulnar nerve's entrapment at the inner elbow, a common nerve compression problem in the upper limb.
Approximately 60% of individuals with Golfer's Elbow also experience ulnar nerve compression, frequently reporting numbness or tingling in their ring and little fingers. Cervical spine issues, known as cervical radiculopathy, should also be considered as a potential source of numbness.
In lateral elbow conditions like Tennis Elbow, radial nerve compression, known as Radial Tunnel Syndrome, may occur. Some patients initially diagnosed with Tennis Elbow might actually have Radial Nerve Entrapment Syndrome. Therefore, a thorough physical examination is crucial to avoid diagnostic errors and develop an effective treatment strategy for both ulnar and radial nerve entrapments.
Physical Examination
An accurate and thorough diagnosis is the cornerstone of effective treatment. For conditions like Golfer's and Tennis Elbow, this means conducting comprehensive orthopedic, neurological, and vascular assessments.
Orthopedic tests allow us to evaluate the musculoskeletal system, including bones, joints, and soft tissues, to identify structural issues or restrictions.
Neurological assessments help detect any nerve-related issues, such as nerve compression syndromes and evaluate the health of the nervous system.
Vascular assessments are essential to examine the blood flow to the area and ensure that any circulatory issues that could influence healing and recovery are addressed.
Together, these assessments provide a holistic understanding of the patient's condition, enabling the creation of a personalized and effective treatment plan.
Elbow Examination - Orthopaedic Testing
This video goes through inspection and observation, palpation, Active and Passive Ranges of motion, and orthopaedic examination of the Elbow.
Upper Limb Neuro Exam
The upper limb neurological examination is part of the overall neurological examination process and is used to assess the motor and sensory neurons which supply the upper limbs. This assessment helps to detect any impairment of the nervous system.
Peripheral Vascular Examination - Key Points
A peripheral vascular examination is a valuable tool used for ruling out signs of vascular-related pathology. The detection and subsequent treatment of PVD can potentially mitigate cardiovascular and cerebrovascular complications. In this video we go over some of the common procedures we perform in daily clinical practice.
Motion Specific Release
The upcoming videos highlight our distinctive Myofascial Release (MSR) techniques specifically designed for treating Golfer's and Tennis Elbow. These methods combine soft-tissue procedures (myofascial and Traditional Chinese Medicine) with osseous (bone) manipulation. Our holistic approach goes beyond the pain site at the elbow, considering the entire kinetic chain when necessary.
By identifying and addressing contributing factors, we target interconnected muscles, joints, and fascia. This comprehensive strategy not only alleviates symptoms but also addresses root causes, enhancing overall musculoskeletal health and recovery. We believe in empowering patients through treatments that integrate the entire body, ensuring long-lasting relief and improved function.
Elbow Release Protocol - Golfer's & Tennis Elbow
Each case of elbow pain should be assessed and treated as a unique dysfunction that is specific to that individual. Certain cases will only involve local structures, while other cases can involve a much larger kinetic chain. The MSR procedures I am demonstrating are very effective at addressing elbow pain.
MSR - Ulnar Nerve Release
As mentioned earlier, up to 60% of patients with Golfer’s Elbow also suffer from Ulnar Nerve Compression. (3) Patients with ulnar nerve compression often complain about sensory changes in the fourth and fifth fingers. They may also complain of trouble when opening jars, or turning doorknobs, or experience weakness when performing work that requires repetitive motion. In this video, we focus on releasing the ulnar nerve by using Motion Specific Release (MSR) procedures.
MSR Fascial Expansion:
The MSR Elbow Pain Protocol - Using fascial expansions to treat elbow pain represents a holistic approach that combines a modern understanding of fascia's role, kinetic chain relationships, and essential principles from acupuncture or traditional Chinese medicine. This exploration will focus on how fascial layers interconnect with specific acupuncture points, namely LI11, LI12, TH5, TH10, and GB 34.
Tailored Treatment Frequency
Acute Care:
2 times per week with 15-minute appointments, or
1 times per week with 30-minute appointments, for 2-4 weeks.
Subacute Care:
1-2 times per week with 15-minute appointments
Maintenance Care:
Once every 2-4 weeks, with either a 15-minute or 30-minute appointment, as needed.
Treatment Frequency Logic
Our approach to treating Golfer's and Tennis Elbow is progressive and adaptable, customized to each patient's recovery journey. We offer flexible appointment options to suit your schedule while ensuring effective treatment. Regular evaluations keep our treatments aligned with your progress, optimizing recovery, reducing symptoms, and supporting long-term joint and soft tissue health.
Exercises
The upcoming videos showcase a selection of exercises we often recommend to patients experiencing elbow discomfort. Remember that this is just a glimpse of the many exercises we could suggest, which are shared to give you an idea of what might help. These exercises promote strength, flexibility, and overall elbow health for those with Golfer's and Tennis Elbow. We hope you find them helpful and encouraging on your path to recovery!
5 Minute Elbow Pain Relief
Have a sore elbow? Then try our "5 Minute Elbow Pain Relief" routine. Doing this routine several times per day can make a huge difference in eliminating your elbow pain.
Five Great Daily Shoulder Mobilization Exercises
Elbow problems often involve restrictions in the shoulder. For best results, you can perform these exercises throughout your day. These exercises can make a huge difference in your posture, especially when you have been sitting for long periods of time.
Strengthening Internal & External Shoulder Rotators
A very simple and effective way to strengthen the Internal & External Shoulder Rotators. Enhanced shoulder strength can also lead to better force distribution and decreased stress on the elbow tendons, mitigating pain and injury risk.
Single Arm Theraband Row
The Single Arm Theraband Row exercise is beneficial for addressing golfers and tennis elbow because it targets the muscles of the upper back and shoulder, specifically the rhomboids, trapezius, and rotator cuff muscles. Strengthening these muscles enhances shoulder stability and arm control, which are essential for activities involving repetitive arm motions like golfing and tennis.
Ulnar Nerve Flossing Exercises
If you have Ulnar Nerve Entrapment Syndrome (60% of patients with golfers elbow, then you can use the exercises in this video to floss, mobilize, and release this nerve from its surrounding tissues.
Why Choose Our Approach for Golfer's and Tennis Elbow Treatment
Our comprehensive approach to treating Golfer's and Tennis Elbow consistently achieves a 90% success rate in reducing pain and improving arm function. Here's why our method stands out:
Established Expertise: Developed by Dr. Brian Abelson, the MSR methodology is supported by over 30 years of clinical experience and the successful treatment of more than 25,000 patients, ensuring you receive the highest standard of care.
Thorough Assessments: We conduct detailed evaluations to identify all contributing factors, including nerve compressions such as ulnar or radial nerve involvement, which are often present in these conditions.
Advanced MSR Procedures: Our Motion-Specific Release (MSR) techniques target the exact areas of fascial restrictions and nerve entrapments, delivering precise and effective relief.
Customized Exercise Programs: We create individualized exercise plans that enhance nerve mobility, strengthen the arm, and restore function, facilitating your recovery.
Logical, Evidence-Based Approach: Our treatment protocols integrate manual therapy, exercises, and supportive measures, ensuring a well-rounded and lasting solution.
Choose our proven, patient-centred approach for effective, long-term relief from Golfers and Tennis Elbow. Take the first step toward your recovery with confidence.
References
Hayter, C. L., & Giuffre, B. M. (2009). Overuse and traumatic injuries of the elbow. Magnetic Resonance Imaging Clinics of North America, 17(4), 617-638.
Neal, S. L., & Fields, K. B. (2010). Peripheral nerve entrapment and injury in the upper extremity. American Family Physician, 81(2), 147-155.
Hariri, S., & McAdams, T. R. (2010). Nerve injuries about the elbow. Clinical Sports Medicine, 29(4), 655-675.
Thiele, S., Thiele, R., & Gerdesmeyer, L. (2015). Lateral epicondylitis: This is still a main indication for extracorporeal shockwave therapy. International Journal of Surgery, 24(Pt B), 165-170.
Descatha, A., Leclerc, A., Chastang, J. F., & Roquelaure, Y. (2003). Medial epicondylitis in occupational settings: prevalence, incidence and associated risk factors. Journal of occupational and environmental medicine, 45(9), 993-1001.
Huisstede, B. M., Miedema, H. S., Verhagen, A. P., Koes, B. W., & Verhaar, J. A. (2007). Multidisciplinary consensus on the terminology and classification of complaints of the arm, neck and/or shoulder. Occupational and environmental medicine, 64(5), 313-319.
Degen, R. M., Cancienne, J. M., Camp, C. L., Altchek, D. W., Dines, J. S., & Werner, B. C. (2018). Three common presenting symptoms of medial epicondylitis: pain, loss of strength, and functional disability. Journal of shoulder and elbow surgery, 27(6), 1072-1077.
Peterson, M., Butler, S., Eriksson, M., & Svärdsudd, K. (2014). A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis). Upsala journal of medical sciences, 119(4), 352-359.
Thiese, M. S., Hegmann, K. T., Kapellusch, J., Merryweather, A. S., Bao, S., Silverstein, B., ... & Garg, A. (2014). Effects of varying case definition on carpal tunnel syndrome prevalence estimates in a pooled cohort. Archives of physical medicine and rehabilitation, 95(12), 2320-2326.
Frontera, W. R., & Silver, J. K. (Eds.). (2014). Essentials of physical medicine and rehabilitation: musculoskeletal disorders, pain, and rehabilitation. Elsevier Health Sciences.
Bisset, L., Paungmali, A., Vicenzino, B., & Beller, E. (2005). A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. British Journal of Sports Medicine, 39(7), 411–422.
Kraushaar, B. S., & Nirschl, R. P. (1999). Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. The Journal of Bone & Joint Surgery, 81(2), 259–278.
Walker-Bone, K., Palmer, K. T., Reading, I., Coggon, D., & Cooper, C. (2012). Occupation and epicondylitis: a population-based study. Rheumatology, 51(2), 305–310.
Coombes, B. K., Bisset, L., & Vicenzino, B. (2010). Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. The Lancet, 376(9754), 1751–1767.
Olaussen, M., Holmedal, Ø., Mdala, I., Brage, S., & Lindbaek, M. (2015). Treating lateral epicondylitis with corticosteroid injections or non-electrotherapeutical physiotherapy: a systematic review. BMJ open, 5(10), e009949.
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DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.
Join Us at Motion Specific Release
Enroll in our courses to master innovative soft-tissue and osseous techniques that seamlessly fit into your current clinical practice, providing your patients with substantial relief from pain and a renewed sense of functionality. Our curriculum masterfully integrates rigorous medical science with creative therapeutic paradigms, comprehensively understanding musculoskeletal diagnosis and treatment protocols.
Join MSR Pro and start tapping into the power of Motion Specific Release. Have access to:
Protocols: Over 250 clinical procedures with detailed video productions.
Examination Procedures: Over 70 orthopedic and neurological assessment videos and downloadable PDF examination forms for use in your clinical practice are coming soon.
Exercises: You can prescribe hundreds of Functional Exercises Videos to your patients through our downloadable prescription pads.
Article Library: Our Article Index Library with over 45+ of the most common MSK conditions we all see in clinical practice. This is a great opportunity to educate your patients on our processes. Each article covers basic condition information, diagnostic procedures, treatment methodologies, timelines, and exercise recommendations. All of this is in an easy-to-prescribe PDF format you can directly send to your patients.
Discounts: MSR Pro yearly memberships entitle you to a significant discount on our online and live courses.
Integrating MSR into your practice can significantly enhance your clinical practice. The benefits we mentioned are only a few reasons for joining our MSR team.
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