Tennis Elbow in the Amateur Golfer

    Despite the term Tennis Elbow, lateral epicondylitis is actually seen more often than Golfer’s Elbow (medial epicondylitis) in the golfing and general populations. Pictured above, it is characterized by lateral elbow pain when performing gripping tasks or activating the muscles that extend the wrist/fingers and supinate the forearm. The area can also be aggravated by having the muscles overstretched. Patients often describe it as painful to grip an object, turn a door knob or use a screwdriver, as it also affects the muscles that rotate the palm up. In golfers, lateral epicondylitis it is often seen in the lead arm. This is because the wrist goes from flexion to extension in the follow-through of the golf swing, therefore repeatedly activating these muscles. Eventually there is microtrauma to the extensor tendon that inserts into the lateral epicondyle, which leads to pain and inflammation over time. If the elbow is treated in isolation, for example, with myofascial release, dry needling, shock wave therapy or other common interventions, but the root cause is not identified and addressed, there is a strong likelihood that the condition will either not fully resolve or it will reoccur. You are not just simply playing too much golf. Our bodies are not that fragile and it is a discrepancy elsewhere that is leads to compensation at the elbow. There are many pathologies that contribute to the formation of tennis elbow, but for the purposes of this article I will discuss a common cause: poor scapular stability.

There are 17 individual muscles that attach to the shoulder blade They provide a strong base of support for any movement in the shoulder and arm. A weakness in one or any combination of these muscles, throws off the mechanics of the entire upper limb. If you have weakness in one joint, then the adjacent joints, in this case the elbow, are sure to suffer. Here is one clinical presentation: Patient presents with right lateral elbow pain after a week of steady golfing. On observation, the patient presents with the affected shoulder sitting further forward than the other and mild scapular winging (pictured above-notice how the middle border of the shoulder blade is slightly more pronounced on the right). This is due to a weakness of the serratus anterior- the muscle responsible for holding the shoulder blade tight to the rib cage while gliding it along the thorax as the shoulder moves forward (picture reaching out to grab something). The weakness is confirmed with dynamic testing and it is found that the lower trapezius and rhomboids are weak as well. These are important muscles for positioning the shoulder blade back and down. When the shoulder is manually stabilized, less tension is felt during elbow testing. Any combination of weakness in the scapular muscles, such as the described above, will lead to aberrant shoulder mechanics.

During the golf swing,  if you have weakness in your scapular stabilizers, then the forces buttressed at the elbow will exceed the capabilities of the forearm muscles through impact. If you suspect you may be at risk for this kind of problem, a simple push-up is often illuminating. Try doing a few with extra attention paid to your elbows. You should feel quite a bit of work in the shoulders and chest, but little tension in the elbow joint. If you do feel a considerable amount of tension in the elbow(s), it may be a hint that something isn’t right with your scapular stability. If you are suffering any form of elbow pain, it is important to get it addressed sooner rather than later. An acute injury is much quicker to treat than chronic injury, where more advanced tissue changes have taken place. You can reach out to your local physiotherapist or rehab-focused chiropractor to be thoroughly assessed. As golf season slows down, the time is now to get you back in shape for next season.

- Dr. Emily Wiggin, BA, RYT, TPI, DC