A full treatment and rehabilitation program is important for successful recovery and prevention of Golfers Elbow.
In order to maximize the chance of successful rehabilitation it is important to apply as many treatment approaches as you can. There is unlikely to be one single cure and different people will respond differently to certain treatments.
Aims of rehabilitation
- Reduce pain and inflammation.
- Identify possible causes of injury.
- Stretching and strengthening.
- Gradual return to activity.
It is important throughout the rehabilitation process to maintain fitness in ways that do not stress the elbow such as cycling or running so long as it is not painful.
Reducing pain and Inflammation
Rest from activity that causes pain. If you are a golfer or a thrower then stop playing. It is not just sports that causes this injury or may aggravate it. Gripping anything tightly or for long periods may make it worse, even opening heavy doors. Rest means rest!
Cryotherapy or cold therapy should be applied in the early stages - the first 2 to 3 days when it is in it's acute stage. This can ease the pain, reduce swelling and later on encourage blood flow. Elevation uses gravity to reduce swelling by allowing fluids to flow away from the site of injury.
Wear a brace, support or heat retainer. This will give support and help prevent further injury. A tennis elbow type brace is worn around the fore-arm just below the elbow and changes the angle that the forces transmit through the tendon, hence taking some of the strain off the injured part.
NSAID's (Non Steroidal Anti-inflammatory Drugs) such as Ibuprofen can help reduce pain and inflammation, especially in the early stages. It is thought they are less helpful later in the rehabilitation process. Always check with a Doctor before taking medication. You should not take Ibuprofen if you have asthma.
This initial acute phase can take from 2 days to 2 weeks depending on how bad the injury is and how much rest it gets.
Identify possible causes
Overuse is the main cause of throwers elbow. Doing too much, too soon without allowing your body to recover. Keep a training diary. This will allow you to look back and identify if you have been over training.
The chance of suffering over use injuries is greatly increased if you have faulty technique. For example throwing a javelin or ball with a 'low elbow' technique will place far greater stress on the tendons on the inside of the elbow than a correct technique.
Particular attention needs to be paid to the technique of the golf swing or tennis forehand if the athlete is involved in these sports.
Sports massage can in the rehabilitation process, especially after the acute stage and for stubborn injuries that fail to heal. Cross friction massage to the tendon can help stimulate healing and stripping techniques on the muscles will help relax tight and knotted muscles that may increase the strain at the elbow. Apply cold therapy after massage treatment.
Stretching should begin as soon as possible, gently at first and continue throughout the rehabilitation process and after. Stretches for the wrist flexor muscles are most important. Hold stretches initially for 10 - 15 seconds - during the acute stage. Later stretches should be held for up to 40 seconds. Repeat stretches 5 times and aim to stretch at least three times a day.
Strengthening should begin as soon as pain allows and this will depend on how bad the injury is. If it hurts during the exercise, after or makes it worse the next day then do not do strengthening exercises. Be patient.
Start with static exercises. When these can be done comfortably without any pain then move onto concentric and eccentric exercises, particularly for the wrist flexor muscles. It is important that strengthening exercises are done before trying to return to activity so the load through the tendon is gradually increased. Apply cold therapy after strengthening exercises
Return to Activity
- This should be done gradually and begin only when you can perform the activity without pain.
- When you can comfortably manage the strengthening exercises then it may be possible to return to activity. If you are a thrower, ensure you have the correct technique. Wearing a brace can help take the strain off the elbow during the return to full fitness.
- For golfers, practice strokes without a ball to start with. Introduce a ball and gradually increase power in shots and number of practice shots played. For example session 1 - 20 strokes at 20% effort. Session 2 - 30 strokes at 40% effort and so on.
- This gradual increase should take place over a six week period. If you find you have pain during, after or the next day then take a step back.
- Throughout this phase it is essential that stretching and strengthening routines are maintained.
The following guidelines are for information purposes only. We recommend seeking professional advice before attempting any rehabilitation.