Golfer’s/Tennis Elbow, “-itis” or “-opathy?”

August 2, 2016

tennis-golf line drawingAn annoying affliction that can happen at this time of year, particularly as we start to engage in more outdoor recreational activities, is the dreaded elbow pain. The classic injuries are Golfer’s elbow (pain on the inside of the elbow) and Tennis elbow (pain on the outside of the elbow). There are several misconceptions about these conditions though.

First, even though the pain is experienced at the elbow, the problem is usually due to motions or positions of the wrist (the elbow is where the muscles of the wrist begin). Secondly, and ironically, these rarely occur because of golf or tennis! If it does, it usually occurs in less accomplished players whose technique is poor than more accomplished players who play frequently or for prolonged periods. More often, it is because of everyday activities (see the article “Ergonomic Fixes for Tennis Elbow” in this issue). Symptoms can range from mild, focal achiness or pain to severe where symptoms are constant and intense and may make it difficult to lift light items such as a magazine! Unfortunately, if symptoms are allowed to get severe, they are very difficult to get rid of, largely because it is difficult to refrain from using our hands in order to let the muscles rest.

One challenge we face as physical therapists is determining the cause of the problem. In young people (those under 30), the overwork most often results in irritation and inflammation (tendon “-itis”) and we may use ice, ultrasound or other modalities to calm the inflammatory reaction. In older people (those over 40), studies often find no evidence of inflammation but actually evidence of cell death (tendon “-opathy”)! The ability for older bodies to heal in this particular area is impaired. In these instances, we actually may try to irritate the area to stimulate the inflammatory/healing response and rebuild the tissue. So, the treatment may be the exact opposite in one instance versus the other. And, what to do for someone in the gray area between 30 and 40 years old? Confusing, right? Welcome to our world. This is why it is so important for us to factor in a variety of factors in determining what is right for you.

By Tom Fontana, PT