by Aaron Day

The Rundown

A behind-the-scenes look at Epicondylitis, the rise of the overuse Injury affecting the elbow; we will go in depth and expose the truth behind medial/lateral Epicondylitis, its causes, and its long-term or temporary toll it places amongst today’s athletes.

The elbow joint is made up of three bones, the upper arm (humerus) and the two forearm bones (radius and ulna). At the end of the humerus, there are two bony landmarks called epicondyles (medial and lateral), and this is where muscles, tendons, and ligaments attach, and form the elbow.

Epicondylitis is the inflammation of the epicondyle, specifically the muscles and tendons that attach to the epicondyles. Epicondylitis can be either medial (inside) or lateral (outside), but most reported cases involve the lateral aspect. Some ways epicondylitis can occur is through overuse, poor technique/form, ADL’s, age, and other various factors.

An overuse injury is simply described as repeating the same motions over, and over, again. Some of the sports that come to mind are Tennis, Baseball, swimming, and golf. Although, they are not the only sports that require us to constantly repeat a motion, but epicondylitis proves to be most prevalent within these sports.

General signs and symptoms of epicondylitis include:

  • Difficulty holding onto, pinching, or gripping objects
  • Pain, stiffness, or insufficient hand and elbow movement
  • Forearm muscle tightness or insufficient functional strength
  • Point tenderness at/ near insertion sites of the muscles of the medial or lateral elbow

Lateral Epicondylitis (Tennis Elbow)

Originating from the elbow, lateral epicondylitis is an overuse injury that involves the extensor tendons that attach our (forearm) muscles to the lateral (outside) aspect of the elbow.

According to The University of Southern Florida’s Department of Orthopedics and Sports Medicine (USF), and the Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT), the most common mechanism of injury for lateral epicondylitis is the application of repeated stress to the muscles and tendons that attach to lateral epicondyle. Now, throw in improper technique or muscle weakness, and we have just made a lateral epicondylitis-cocktail!

The NISMAT explains lateral epicondylitis (Tennis Elbow) by using basic tennis examples: hitting a one-handed tennis backhand with poor technique, a late forehand swing that results in the wrist snapping to make racket perpendicular to the ball, or a powerful serve that causes the wrist to snap and places stress on the already-tight extensor tendons. Crazy as it sounds but, repetitive motions like twisting a screwdriver, constant gripping while mowing grass, or hacking away at the computer all day can pave the way to lateral epicondylitis as well!

Medial Epicondylitis (Golfer’s Elbow)

Medial Epicondylitis (Golfer’s Elbow) is less common, and is an overuse injury that involves the flexor tendons that attach our forearm muscles to the medial (inside) aspect of the elbow, and usually involves wrist flexion and pronation (palm down).

Golfers elbow occurs when the right elbow of a right-handed golf swing is “throwing” the head of the club towards the ball, rather than pulling the club through with the left arm and trunk (core). Other examples include: improper pulling within the backstroke of swimming (swimmer’s elbow), poor swinging mechanics/loose wrists when batting, or even the “cocking-back” phase of a tennis serve, which places a tremendous amount of stress on the medial aspect of the elbow.

Inside Scoop

For those who think they may be suffering from medial or lateral epicondylitis, there are plenty of non-surgical and surgical treatment options that a patient can consider. There are  other ways in which epicondylitis can be avoided, the most logical method would be to take some time from competitive play, break-down and evaluate your mechanics during play, and consider a technique or mechanics alteration. Seek out the Pro at the local course, or spend that extra money (that you would use for a copay at the Dr.’s office) and schedule a trainer for a few hours, and practice proper mechanics. Other options would be to cut-back or limit the amount of play, decrease intensity of play, or even discontinue the playing of that sport/activity in its entirety. The end result does not have to be that drastic, but it all depends on how much time and effort the person would like to dedicate, and how healthy they would like to be, after treatment.

In the video below we demonstrate how to use the Theraband Flexbar to treat both tennis elbow and golfer’s elbow.