Elbow Pain in the lead arm is the second most common injury afflicting golfers. In golf, as elsewhere, elbow tendinitis takes either one of two forms, commonly referred to as tennis elbow and golfer’s elbow.

EpicondyleGolfer's and Tennis ElbowTennis elbow causes pain in the outer side of the elbow (lateral epicondyle) and upper forearm, while golfer’s elbow causes pain in the innner side (medial epicondyle) and the forearm. Despite the names golfers are 5 times more likely to suffer from tennis elbow than they are from golfer’s elbow.

Both are deemed to be overload injuries, which typically occur after minor trauma to the proximal insertion of the forearm extensor muscles in cases of tennis elbow, or of the flexor muscles in those of golfer’s elbow. Injury occurs when the muscles that attach to each respective area become overloaded due to excessive repetitive forces, weak muscles, inflexibility and poor joint mechanics.  The tendon, therefore, cannot keep up with the demand of transferring forces and becomes inflamed. The onset of elbow pain is usually gradual, worsening when the affected muscles are used, and just gripping the club can cause pain. Elbow pain is exacerbated by active and resisted movements of the extensor muscles of the forearm, and by rotating the arm, both of which are movements repeatedly required of the lead arm during the swing. Pronating the forearm while the wrist is flexed and repeatedly bending and straightening your elbow, both actions performed by the trail arm, can also be problematic.ice-pack Poor physical conditioning and/or inadequate warm-up can be a factor in the onset of the problem and research suggests that susceptibility to elbow pain increases after the age of forty, with men being statistically more prone than women. If you do begin to experience symptoms, at your first opportunity apply ice (wrapped in cloth so it is not in direct contact with the skin) to your elbow for 15-20 minutes and repeat three to four times a day thereafter. Rest the affected elbow and avoid any movements that are painful. It is advisable to seek medical advice immediately, because if left untreated the condition can cause chronic elbow pain, limited range of motion and ultimately even a ‘frozen flex’ in the elbow.

Hidden Tree RootAlthough the complaint can result from direct trauma to the wrist flexors caused by the club head stopping abruptly after hitting a hidden tree-root for example, the most common cause is ‘wear and tear ‘ from overuse. Club golfers need to be aware that if their job involves any kind of repetitive finger, wrist or elbow flexion/extension activity such as painting, hammering, or keyboard work for example, they will be more prone to this injury.

Using a golf club that is too heavy or has a grip that is too large can be a factor, because it encourages the golfer to grip the club more tightly, but a much more common aggravation comes, I believe, from hitting far too many balls off unyielding mats at the driving range. Certainly once you turn forty, you would be far better served by hitting balls exclusively off grass!

There are, as always, a number of faulty swing mechanics that can be classified as ‘unhelpful’ in relation to this particular complaint, so let’s take a quick look at some of the more common ones.

Hyper-extending the lead arm at address is one such contributing factor. Some coaches advocate actively ‘squeezing’ the elbows together, which is not a great idea, because there is then a tendency to lock the lead elbow, thus putting it into hyper-extension. Make sure that your lead arm isn’t too ‘high’ and your lead elbow isn’t locked at address and also that your trail elbow is nice and ‘soft’, with just a hint of flex.

Chicken wingingAnother factor that I often see is poor alignment, with the body ‘closed’. If, as a result, the arms get ‘blocked’, in an attempt to ‘rescue the shot’, the golfer is tempted to pull inward and then lead elbow tends to ‘breaks down’. The momentum and weight of the clubhead must be allowed to extend the arms out away from the body in the early follow through. If you pull in with the lead arm, then all that weight (and centrifugal force makes it considerable, I assure you) is borne by the tendons at the elbow.

Hence any golfer, who has a tendency to ‘chicken wing’ the lead elbow, needs to be aware that he/she is putting excessive force on the outside of the elbow joint and thereby running a much greater risk of developing this complaint, especially as they get older, as previously mentioned. See: http://fittergolfers.com/your-swing-fault-physical-or-technical/chicken-winging/

In a naïve attempt literally to ‘hit down on the ball’ (not really understanding what is meant by that phrase) some golfers will hyper-extend their lead elbow. If their downswing is on the steep side, as it often is in higher handicappers, they can easily hit it ‘fat’ and then they can be in real trouble! The lead arm should straighten, but the lead elbow, like the lead knee, should never ‘lock’ and hyper-extend. Unfortunately, many golfers confuse keeping the lead arm straight with locking it. If you let your arm hang at your side, yes, it’s straight but it’s also relaxed. That’s what you want. The momentum of the downswing and swing-weight of the club will then pull your lead arm straight without you having to think about it.

Action ShotAround 50% of club golfers are guilty of either casting or scooping.  [See http://fittergolfers.com/your-swing-fault-physical-or-technical/casting/] Since both these faults result in loss of distance, in an effort to recoup some of that lost yardage, the golfer is tempted to swing harder and faster.  This can overload the wrist flexors, which of course attach to the medial epicondyle, and can thus cause golfer’s elbow. It is perhaps worth mentioning here that it is often faulty swing biomechanics in the lower body and/or trunk – typically improper weight shift and sequencing issues in transition, or mobility/stability issues in the ankles, knees, hips and spine – that force a golfer to compensate by manipulating the club with the wrists and exposing themselves to injury in this way. So, once again this is yet another argument for all golfers, who want to play regularly, play well and remain injury free, to undertake physical screening and then to remedy any physical restrictions they may have. [Click on this link http://fittergolfers.com/free-videos/self-assesment/ to access the Fitter Golfers free-to-download self-assessment screening programmes for the upper and lower body.]

A golfer who has suffered this injury, once the pain has subsided, should begin stretching and strengthening exercises for the forearms and wrists [see Fitter Golfers Foundation Level video ‘Arm/Wrist Strength and Mobility’]. However, prevention is always better than cure and it’s of little use to shut the stable door after the horse has bolted! Therefore I would recommend that all golfers improve and then maintain strength levels in their forearms and wrists and just as importantly increase flexibility in their wrists to facilitate proper lag and release techniques.

Finally, I cannot over-emphasize the importance of incorporating good preventative procedures into your pre- and post-round routines. For further details see the final section of the lower back pain page: http://fittergolfers.com/game-improvement/avoiding-injury/lower-back-pain/