PT Perspective

with Jason Lau, Doctor of Physical Therapy

Question: I have sharp pain on the inside of my right elbow. It bothers me most after golf or from gripping and turning my wrist sometimes. It has already lasted for five months and has not gotten much better. What’s up?

Answer: Golfer’s elbow or medial epicondylitis is a common overuse injury of the medial tendons of the elbow. It occurs due to overuse of the wrist flexors and pronator muscles and tendons that result in inflammation and micro tearing of the soft tissue.  

The symptoms usually present as sharp pain directly on the tendon or where the tendon attaches. The more severe the condition the more the pain can spread into the muscle, resulting in a tight and achy muscle. 

Treatment depends on the severity of the case. Most cases can be treated with physical therapy, which includes decreasing inflammation, stretching, strengthening, and soft tissue work. Some cases require an injection to decrease the inflammation. In all cases, rest is the key component of recovery.

Sounds simple enough, but why does the condition tend to drag on for months and months?

The primary challenge of recovery from epicondylitis is not physical, it’s psychological. Most people tend to underestimate the severity of the condition and they do not make recovery enough of a priority. Put it this way, if you broke your leg would your recovery be at the top of your priority list? Of course it would be; the consequences are too high - nobody wants to walk around for the rest of their lives with a crooked leg. When it comes to golfer’s elbow, however, most of us are willing to role the dice and take a chance on continuing our activity even at the risk of prolonging our pain. 

It’s not that people don’t want to get better, of course they do, it’s just that chronic, longterm tendinosis often stems from the fact that we have lived most of our lives with our bodies being able to heal themselves from most of our physical ailments. It is normal for us to expect to heal from the condition because that is what our bodies have always done. The problem is that we underestimate our contribution to the injury. It is our current state of activity that got us where we are, whether that be playing golf, using the computer, using a screw driver, etc. . . .

Our tendons take time to heal. We need to wait for the glue to dry before we pick up the mug by the handle we just glued back on. Otherwise, the handle will break off again, and we’ll need to glue it back on. In the same way, when we continue our activity, we continue to reopen the micro-tears on the tendon and end up with a condition that lasts much longer than it should.   

Remember, it’s better to sacrifice the loss of the short term activity for the longterm gain. We do it for our broken bones, we can do it for our tendons. 

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