“You swing your best when you have the fewest things to think about.” Bobby Jones
“Through years of experience I have found that air offers less resistance than dirt.” Jack Nicklaus
Introduction: If you have read this blog any time, you know how much I love the game of golf. It is a fun sport that requires your brain and body to operate well to play well. However, playing well is always an issue with most golfers; there is always tomorrow.
Most of your joints and muscles, and body parts are used to execute a proper swing. But the same joints, muscles, and body parts are also used for an improper swing. But that story is for another time.
Not to ‘showcase’ an article of mine, but I published a paper recently on playing golf to reduce the risk of falling from Parkinson’s. Part of the story was an analysis of the golf swing. To check this out, click on the following URL (open access article): Bliss, R.R. and F.C. Church. Golf as a Physical Activity to Potentially Reduce the Risk of Falls in Older Adults with Parkinson’s Disease. Sports (2021): 9, 72. https://doi.org/10.3390/sports9060072
This post is focused on a common golfing injury, “Golfer’s Elbow,” or as known in the medical community as Medial Epicondylitis. Mine has been hurting for some weeks, and I finally went to the Orthopedic Surgeon, who prescribed an inflammatory drug (Meloxicam), rest, stretching, and reparative exercises over the next 6-8 weeks. No, this is not a short turnaround. Thus, in my rehab time, I have been reading and thinking I should write a blog post about this sport’s injury. Keep it straightforward and focused, and describe the best exercises from my experience.
“The only time my prayers are never answered is on the golf course.” Billy Graham
The Injury in Golfer’s Elbow: Golfer’s elbow is a painful process that originates in the bony bump on the inner side of your elbow, nearest your body. This condition occurs in many people and happens to anyone who uses the frequent rotation of the elbow, like butchers, carpenters, and plumbers, which all require repetitive forearm, wrist, and hand motions. It also happens in athletes, like baseball pitchers, archers, weightlifters, and golfers. Most medical literature indicates that the cause of the golfer’s elbow is an overuse or repetitive stress of the flexor-pronator musculature.
The elbow joint is composed of the upper arm bone (humerus) and one of the lower arm bones (ulna). The bumps at the bottom of the humerus are called epicondyles. The bony bump near the side of the body is called the medial epicondyle. The bony bump further away from the body is termed the lateral epicondyle (which is injured in “tennis elbow”). The tendons attached to the muscles responsible for bending your wrist are connected to the medial epicondyle. Thus, the golfer’s elbow results in pain and inflammation at this spot where the tendons join the medial epicondyle. And the pain can be intense, resulting in muscle atrophy and lack of mobility.
“It took me seventeen years to get three thousand hits in baseball. I did it in one afternoon on the golf course.” Hank Aaron
How is Golfer’s Elbow Diagnosed? Your orthopedic surgeon or healthcare provider examines your arm, and guess what? They find tenderness at the medial epicondyle. They usually x-ray your elbow to ensure no apparent bone-related injuries.
“It is more satisfying to be a bad player at golf. The worse you play, the better you remember the occasional good shot.” Nubar Gulbenkian
How is Golfer’s Elbow Treated? In the beginning, you follow “RICE,” which is the immediate application of Rest, Ice, Compression, and Elevation (if the area is swollen). Compression is likely not needed since this is not a sprain. But rest and ice, possibly with elevation. In the early period, ice packs for 15 min every 3 to 4 hours for several days or until the pain lessens. The key is to rest. Instead of using your arm to play golf, go for a walk. My Doctor cleared me only to putt.
“I’m not saying my golf game went bad, but if I grew tomatoes, they’d come up sliced.” Lee Trevino
*Rest. Stretch. Rehabilitation Exercises for Golfer’s Elbow:
*Please read the medical disclaimer at the end. And as always, a reminder, I am neither a physician nor a physical therapist; no matter how hard I try, they are the trained experts. Contact them for further details about these and other exercises.
Rest. Rest Some More. Keep Resting. The stretching exercises can begin immediately. Stretching out the muscle near the injured area may relieve some inflammation. Please do not begin the rehabilitation/strengthening exercises until the pain is gone. Try the strengthening exercises. If there is pain the next day, you have gone too fast. Go back to the beginning.
The recommendation is to perform stretching exercises daily and let pain guide you.
1. Wrist flexor stretch. Extend the affected arm in front of you, the palm away from the body. Bend back your wrist, pointing your hand up toward the ceiling. With your other hand, gently bend your wrist until you feel the stretch in your forearm at the injured site. Hold for 15-20 s. Repeat often during the entire day. You can also reverse this by pointing your fingers down in the affected arm, then bending your wrist with your other hand so your fingers are pointing toward the floor. Hold for 15-20 s. The video below shows the first method.
2. Elbow range of motion. Gently bring your palm up to your shoulder. Bend your elbow as far as possible. Then straighten your elbow and arm out as far as you can. Do three sets of ten.
3. Pronation/supination of the forearm. Your elbow is bent 90o at your side, turn your palm upward and hold for several seconds. Then slowly turn your palm downward and hold for several seconds. Do three sets of ten.
Pronation/supination of the forearm (top image) and elbow range of motion stretches (bottom drawing). From Copaci D, Cano-Marin E, Moreno L, Blanco D (2017) New Design of a Soft Robotics Wearable Elbow Exoskeleton Based on Shape Memory Alloy Wire Actuators. Applied Bionics and Biomechanics 2017, 1-11.
The recommendation is to perform rehabilitation/strengthening exercises every other day and let pain guide you.
There are a lot of different exercises to consider doing, but they are all a variation of the same theme. I tried a bunch, and below are the ones that gave me the best feeling afterward. They did not cause pain, and it felt like each exercise was helping rebuild/restore strength in the arm.
The tools (weights) you will need are shown in the photo below:
TheraBands are resistant exercise bands that are helpful (far left side). They come in different resistance levels (I have yellow, green, and blue TheraBands; http://www.TheraBand.com; I purchased mine from my PT); 2 cans of different weights; hammer; and 2 dumbbells (these are 3 and 5 lbs, respectively).
1. Wrist curls. Start with the can of beer, progress to a heavier can, then go to the 3-pound dumbbell weight, and if needed, the 5-pound dumbbell weight. Place your injured forearm on a table with your hand hanging over the edge, palm up. Use the various weights described above in their order, respectively. Slowly raise and lower the weight while keeping your forearm on the table. Do three sets of ten. Next, you can reverse this exercise by starting with your hand facing down towards the floor and then raising the weight in reverse to the previous activity. Both directions are important in regenerating strength and mobility as your arm is in the healing procedure. For the reverse wrist curls, do three sets of ten. Please carefully increase the weights here; any pain means going too fast.
2. Resisted wrist extension exercise with a resistance exercise band. Place your injured arm on your leg with your hand wrist ahead of your knee from a sitting position. Grasp one end of an exercise band, palm down and step on the other. Slowly bend your wrist upward from this starting position, and hold it there for a few seconds. And then, over five seconds, slowly bring it back to the starting position. Repeat this exercise ten-twelve times.
3. Wrist extension exercise (Alternative). Use the can with your wrist facing down in place of the exercise band. Slowly lift your wrist upward and slowly return to the starting position. Do three sets of ten.
4. Wrist flexion exercise with a resistance exercise band. Start sitting, place your injured arm over your knee, grasp the exercise band with your palm up, and step on the other end. Next, slowly bend your wrist upward, hold it there for a few seconds, and then, over five seconds, slowly bring it back to the starting position. Repeat this exercise ten-twelve times.
5. Wrist flexion exercise (Alternative). Use the can with your wrist facing up in place of the exercise band. Slowly lift your wrist upward and slowly return to the starting position. Do three sets of ten.
6. Forearm pronation and supination exercise with a hammer. Start with a can, then migrate to the hammer. First, hold the hammer by the handle, and bend your elbow 90o. Next, slowly rotate the hammer with your palm up, go back and forth, and then go palm down. Do three sets of ten. [You can also use the resistance exercise bands in place of the hammer if you so desire.]
“The only thing you should force in a golf swing is the club back in the bag.” Byron Nelson
Returning to the Golf Course: The typical injury that causes a golfer’s elbow is due to overuse. Thus, the process from injury to returning to the golf course must transition over several weeks. Most studies suggest six-eight weeks. The key is to be pain-free, and can you comfortably handle all of these exercises? Usually, the beginning of golf recovery is to practice swinging without striking golf balls. Once comfortable, introduce the ball over several sessions: #1- 20 hit golf balls using about 25% effort; #2- 30 hit golf balls at 50% effort and continue from there. Always do some stretching exercises before swinging and hitting any golf balls. If you experience pain, take a step back to exercise again; use pain, or the lack of it, as the barometer.
“There is no movement in the golf swing so difficult that it cannot be made even more difficult by careful study and diligent practice.” Tom Mulligan
Is There a Link With Golfer’s Elbow and Parkinson’s? Considering the motor dysfunctions in Parkinson’s, it makes sense that most sports injuries may heal more slowly than others without Parkinson’s. Furthermore, the stiffness and reduced extension/mobility might predispose one to an injury like a golfer’s elbow. However, before the injury, I had been playing golf several times per week and separately hitting 80-100 golf balls 2-3 times per week. Maybe I was set up for this by practicing a lot (overuse). However, this is a training tradition I have used for many years. I find it helps my Parkinson’s tremendously.
I believe that my troubles began a few weeks ago because I had lowered the degree of my driver (to get more distance). I also tried to hit the ball further by swinging fuller and with increased force. I also mishit a drive and accidently drove my club into the ground (which definitely jerked my arm around). I think these events were the ‘problem’ that contributed to my injury. I also felt it was coming on and did not react fast enough to deal with the oncoming pain and disability. That was my mistake.
“I’ve always made a total effort, even when the odds seemed entirely against me. I never quit trying; I never felt that I didn’t have a chance to win.” Arnold Palmer
Closing Thoughts on Golfer’s Elbow: Golf is a popular sport for seniors. And as weekend warriors, we are also prone to sports injuries. The total body movement from the golf swing is physically demanding; thus, painful and debilitating injuries like the golfer’s elbow are possible. I also realize that a golfer’s elbow is not a typical subject matter on a blog focused on Parkinson’s. However, since exercise is critical for Parkinson’s, taking the time to heal and rehabilitate following any sports injury is essential. Hopefully, some will find this post helpful in dealing with the golfer’s elbow.
“Don’t play too much golf. Two rounds a day are plenty.” Harry Vardon
*Medical Disclaimer Statement on Performing these Exercises
MEDICAL DISCLAIMER: Always consult your physician before beginning any exercise program. This general information is not intended to diagnose any medical condition or to replace your healthcare professional. Consult with your healthcare professional to design an appropriate exercise routine. Stop and consult your healthcare provider if you experience any pain or difficulty with these exercises.
WHEN TO CONTACT YOUR PHYSICIAN: If you experience any symptoms of weakness, unsteadiness, light-headedness or dizziness, chest pain or pressure, nausea, or shortness of breath. In addition, mild soreness after exercise may be experienced after beginning a new routine. Contact your physician if the soreness does not improve after 2-3 days.
Ciccotti, Michael C., Michael A. Schwartz, and Michael G. Ciccotti. “Diagnosis and treatment of medial epicondylitis of the elbow.” Clinics in sports medicine 23, no. 4 (2004): 693-705.
Van Hofwegen, Christopher, and Champ L. Baker. “Epicondylitis in the athlete’s elbow.” Clinics in sports medicine 29, no. 4 (2010): 577-597.
McMurtrie, A., and A. C. Watts. “(vi) Tennis elbow and Golfer’s elbow.” Orthopaedics and Trauma 26, no. 5 (2012): 337-344.
Lin, Kenneth M., Todd S. Ellenbecker, and Marc R. Safran. “Rehabilitation and Return to Sport Following Elbow Injuries.” Arthroscopy, Sports Medicine, and Rehabilitation (2022).
Kiel, John, and Kimberly Kaiser. “Golfers elbow.” In StatPearls [Internet]. StatPearls Publishing, 2021.
Mass General Sports Medicine: https://www.bostonsportsmedicine.com/rehabilitation-protocols/golfers-elbow/
“For many years I had an impression of my golf swing, which was that I vividly resembled Tom Weiskopf in the takeaway and Dave Marr on the downswing. Unfortunately, there came a day when I was invited to have my golf swing filmed via a video camera. Something I will never do again. When it was played back, what I saw – what you would have seen – was not Weiskopf and Marr but a man simultaneously climbing into a sweater and falling out of a tree.” Alistair Cooke