GOLFERS ELBOW
(MEDIAL EPICONDYLITIS)

If you suspect that you are suffering from golfers elbow, early action is advisable as this responds to physiotherapy treatment more quickly and satisfactory than does tennis elbow. Lack of adequate rest in the early stages too often makes for a chronic (long term) problem.

This is as real a condition as "tennis elbow" and like this, is obviously named after the sport which commonly causes the problem. The two are different - tennis elbow affects the muscles on the outer side of the elbow and golfers elbow affects the muscle group at the inner (medial) side of the elbow - the function of these latter muscles being to bend the wrist and fingers. This is usually an overuse injury and may be caused by faulty technique, inappropriately sized grips on the golf clubs or because too much of the striking impact is transmitted via the shaft to the forearm and elbow. A case in point is the pain of the right elbow of a right handed golfer when hitting (usually inadvertently!) a divot!

When seeking treatment from your chartered physiotherapist, a full history and assessment is necessary. This enables your physio to rule out the possibility of the symptoms mimicking conditions affecting the cervical spine (neck) which must be excluded in persistent cases. Previous injury to the arm, including falls particularly on the wrist could also cause some knock-on problems at the elbow. Of course tight muscles on the opposite side cause interference as well.

Physiotherapy treatment in the first instance involves manual techniques, electrotherapy, support and/or taping techniques. Advice on stretches and self help should also be given. A good chartered physiotherapist should be able to teach a number of effective stretches and a tailored self help program to keep you on the golf course. If possible, a short abstinence from the offending action (!) helps as does advice on modification of grip technique and further training.

It must be stated again that early treatment and good advice avoids an on-going repetitive problem, thereby cutting out the necessity for some of the more aggressive treatments often recommended by doctors. You will no doubt have heard of steroid injections and release surgery. Injections we are discovering give increasing risks to the surrounding healthy tissue, not to mention the problems of poor injection techniques. Over the last twenty four years, I have found that poor injection techniques have caused more problems than the original injury! If surgery is necessary due to inflamed, scarred and tethered tendon attachments, these can be slightly lengthened but recovery is disappointing and may take several months.

As always, early treatment means an earlier recovery with fewer problems.

Obvious injury to one of the structures of the knee due to a sport or other form of accident is readily identified and therefore treatment is sought and as always, early accurate treatment gives the best outcome.

General treatment following the RICE principal is advised:
R- Rest
I - Ice
C- Compression - as firm as possible without obstructing the circulation
E- Exercise appropriate to the problem.

Unfortunately, a great deal of knee pain is suffered that has no obvious trauma to identify it and therefore most individuals "put up with" a large amount of unnecessary discomfort that ultimately leads to not enjoying your sport or indeed general activity. Pain is a warning. Sadly, many will suffer needlessly due to inappropriate action the first time they had a problem or consultation as many injuries are incorrectly diagnosed by the original treating doctor.

Two basic and common causes of on-going non-specific knee pain are often missed:
1. foot posture problems
2. weak thigh (quadriceps) muscles.

An early appointment with a Chartered Physiotherapist who is an expert in joint assessment and its further management will throw a great deal of light on the problem and simple remedies can often be found.

A Chartered Physiotherapist with bio-mechanical knowledge will be able to assess you and hopefully with the supply of an orthotic (moulded) insole, you will be able to walk away with an easy and long term solution. Footwear advice in general will also be given. Some local electrotherapy may be required to settle the irritation at the knee and a specialised quadriceps exercise routine will be started. Weakness in these quadriceps muscles makes for inadequate support of the knee and can cause on-going problems

Some clues. In health, there is minimal swelling in the knee. Swelling indicates inflammation and needs treating - immediately. This swelling may not be painful but will stress the surrounding structures of the joint. If the swelling is painful and the knee is hot, this needs identifying in order to find a suitable solution. Unless this is cleared, on-going problems will persist. A careful history will provide many clues and liaising with your medical practitioner may be advisable.

Understandably then, cortisone injections into the knee or long courses of medication often in the form of anti-inflammatory tablets will not solve these problems.

Importantly (!), you should not be told to give up your golf, rather how to solve the problem and keep active therefore preventing more serious health risks such as heart problems!

As you can see, simple pain free remedies can often be found for a painful knee so help yourself to early advice and save yourself unwanted pain or discomfort.
Remember, pain of any sort is not a necessity!

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The most common cause of a whiplash injury is as a result of a car accident however, falls can often produce similar symptoms.

Unfortunately, much micro trauma of soft tissue and nerve tissue occurs and this is not detectable by normal investigation procedures. X-rays at the time are often reported as normal as the bones are unlikely to be damaged - examinations of the nerve supply are again often seen as normal. Pain is the major problem and interestingly, may not present itself until sometime after the incident - anything from a day later to many weeks or even months later! This results in a very anxious patient being told that there are no abnormal findings when often, the pain is severe enough to cause difficulty in moving the head, neck and upper body. Associated pins and needles may occur in hands and face (most common) but may also affect the feet however, these usually subside within a few days. Muscle spasm and difficulty or inability in moving occurs as well.

Whiplash is an emotional injury and sufferers often feel over anxious and tearful - these are normal emotions following trauma to nerve tissue. Also a feeling of disassociation (not quite being a part of this world) and in severe cases, this can lead to panic attacks that need specialised help. Most sufferers complain of difficulty with concentration and an inability to do anything for long. The head or arms feel too heavy and getting comfortable seems almost an impossibility therefore interrupting sleep. The knock on effects of all of this of course is reduced effective healing.

Despite the above, the sufferer should try and maintain as "normal" a life as possible as evidence shows that over resting and this may include a collar after 24/ 48 hours, causes more problems than it solves. Immediate treatment of an ice pack and pain relief coupled with support at the back of the neck is advised.

Physiotherapy should commence as soon as possible to allow a swift return to normal function. This would consist of mobilisation of small joints and soft tissues of the neck, and electrotherapy. This would then progress to gentle stretches and home exercises to maintain function as well as pillow, posture and management advice. To support the neck, try a rolled towel in the pillow case and following injury, a few more pillows than normal may be required.

Unfortunately, this sort of injury can take time to settle completely and if left untreated, can lead to more problems when normal or excessive activity is carried out. Sadly, as the investigations that are carried out are often reported as "normal", this prevents people from seeking further advice from an expert in joint rehabilitation and muscle re-education such as a Chartered Physiotherapist. A Chartered Physiotherapist will also be able to provide specific therapies for inflamed or damaged joints or soft tissue.

Help yourself to early advice and save yourself unwanted pain or discomfort.
Remember, pain is not a necessity!