Are you one of the thousands of golfers that consistently battles with elbow issues? As a physical therapist, I have seen countless golfers in the clinic with the diagnosis of either Golfer's elbow or Tennis elbow. In most instances, we were able to decrease their pain, improve their strength and get them back to the course, but many times the golfer never totally recovered from the nagging symptoms. Why is this? With all of the stretching, massage, strengthening, ultrasounds, electrical stimulation, ice packs, cold packs, and even rest, you would think that it would be pretty simple to tackle, right? That's not always the case.

First, let's briefly look at what these diagnoses are. Most simply put, Golfer's elbow is tendonitis (or inflammation/irritation of the tendon as it attaches to the bone) at the inner elbow, whereas Tennis elbow is located at the outer elbow. The majority of the tendons of the hand, wrist and forearm attach to these areas. The tendons from muscles on the palm side of the hand/wrist attach at the inner elbow and those from the backside of the hand/wrist attach to the outer elbow. When we experience repetitive stress on these tendons, this causes irritation, which then causes pain and an inflammatory response.

What does this mean and what can I do to fix it? Well it basically boils down to the movements we create and how we create them. As a therapist, if I am able to make someone's elbow feel better with stretching, strengthening, etc., but they still go out and swing at the ball the same way they always have, odds are they are going to continue to perform the stressful motions that caused the problem to begin with. So if we have exhausted our traditional methods of rehabbing the issue with no significant long lasting results, then we must look at the cause of the stress and see how we can change/improve something in their movement. (Ideally we would be able to look at this first, but in many cases, due to the pain, we are unable to have the patient/client reproduce their typical movements.)

So you're probably thinking that we need to do a bunch of wrist and forearm drills to teach them how to properly manipulate the club to reduce the stress on the elbow, right? It may not be that in depth. I suggest that you first look at the golfer's posture in standing, specifically at the arms and hands. Most often you'll find that the hands, forearms and even shoulders are slightly turned inward, forcing the palms to face back toward the body. If you then have the golfer get in their setup with the arms hanging in front of their body, you'll notice that the hands/arms do the same thing.

If a golfer begins in this position, then the first thing they have to do in order to grip their club is to rotate their forearms (otherwise known as supination), which puts stress on the tendons near the elbow. Therefore, they are starting from a position that already creates some tension. Combine that with gripping the club, swinging at 100mph, and making contact with a stationary object, and you have a recipe for repetitive irritation.

A simple trick to work toward improving this common fault is to teach the golfer better posture when initially setting up (just improving their posture in general will benefit their game in numerous respects). Try this: stand up, and see where your hands/arms hang. Do they sit in front of your thighs and face in more of a backward direction, or do they rest more at the sides of your hips and face inward toward your body (almost like the palms of your hands are facing each other)? The second is a more ideal position. This shows that you maintain a better posture throughout the shoulders and upper body while at rest. This doesn't always transfer to the golf swing though. Once the club is in the hands, many things can happen to that previously nice posture.

If your hands are in the first position mentioned, then I suggest pulling your shoulder blades down and back, which will cause the hands to rotate to their proper position. If you do this little drill many times throughout the day, you will be amazed at how much your daily postural habits can change. You can then apply this to your golf setup and you may notice the reduction in tension through the hands, wrists, and elbows. In fact, this may not only help your elbow pain, but it can improve your overall posture during the swing, often times creating a more consistent and "connected" feeling throughout the motion.
It is amazing what just a small improvement to one's posture can do for their game and how significantly it can help reduce likelihood of injury!

Jeff Pelizzaro MPT
Physical Therapist/Golf Specific Trainer
Performance United Fitness

www.PerformanceUnited.com