Differences of Tennis Elbow & Golfer’s Elbow

You don’t have to be Roger Federer or Tiger Woods to suffer from Tennis Elbow. Even if you’ve never played a set of tennis or a round of golf, you can still suffer from Tennis Elbow or Golfer’s Elbow. Tennis Elbow and Golfer’s Elbow are both overuse injuries that are caused activities that requires repetitive motion of the arm and wrist. The difference between the two conditions lies in where the elbow is inflamed.

Here we are going to learn about the causes, symptoms and helpful tips for treating them both. Both Tennis Elbow and Golfer’s Elbow are forms of epicondylitis, an inflammation of tendons that attach to the elbow.

Tennis Elbow affects the lateral, or outside, epicondyle.

Golfer’s Elbow affects the medial, or inside, epicondyle.

What Is Tennis Elbow?

Tennis Elbow, or lateral epicondylitis, is most common in adults between the ages of 30-50. It’s an overuse and muscle strain injury that results in an inflammation of the outside of the elbow and forearm areas.  With repeated use, those muscles are often overworked, becoming inflamed. Plumbers, carpenters and painters are prone to Tennis Elbow due to the repetitive nature of their jobs. Seasonal activities such as raking, gardening and cutting wood can also cause Tennis Elbow.

Symptoms of Tennis Elbow

Pain may radiate from the outside of the elbow to your forearm and wrist.  It can be a constant ache in the elbow area, or you may only feel it while performing activities that involve reaching, grasping or lifting.  It is important to see a doctor to ensure that you receive a correct diagnosis regarding the cause of your pain.

What Is Golfer’s Elbow?

Medial epicondylitis, or Golfer’s Elbow, is an irritation on the inner side of the arm and elbow. This condition can be caused by activities that require repeated twisting or flexing of the wrist. Generally, it’s due to overuse of the forearm muscles. Activities such as gardening, shoveling, playing golf or tennis can cause Golfer’s Elbow. Repeated lifting, especially when your elbow is extended and your palm is facing down, can also cause it. Other causes include racquet sports, baseball or softball, weightlifting, carpentry, painting and other similar activities.

Symptoms of Golfer’s Elbow

Symptoms include pain on the inside of the elbow when lifting the wrist or hand, pain when twisting the forearm, or when making a fist. The area may be slightly swollen or tender to the touch. If the problem has lasted more than a few weeks, additional symptoms can include stiffness in the elbow or weakness in the hands or wrist.

Treatment for Golfer’s Elbow & Tennis Elbow

Immediate Treatment

Give your elbow and wrist a rest. It may take several weeks of resting the elbow and wrist to feel a decrease in pain, and even longer until the symptoms are gone completely. You can help reduce pain and swelling by icing the painful area. Taking anti-inflammatory pain relievers, such as ibuprofen or aspirin can also help. However, it’s important to seek medical attention if the condition does not show improvement.

Helpful Tips for Treating Tennis & Golfer Elbow

Here are a few helpful tips for treating both Tennis & Golfer’s Elbow:

1. For a sports related injury, we can help! After years of working on the european tour and LET we know our elbow injuries pretty well!
2. Consistently do exercises to gradually stretch and strengthen your muscles, especially those in the forearm
3. Your doctor may recommend a cortisone shot
4. Surgery could be an option after a year of unsuccessful treatment
5. Following a full assessment, an elbow brace might be recommneded. The purpose of the brace is to redirect the pressure over your muscles so that the injured area does not take the full force.

For more information on how we can help you, please contact us here.

…. Why understanding the importance of golf biomechanics is key!

The golf swing is a multi-segmented and intricate skill. It requires accurate body awareness and well-coordinated muscular movements. Thankfully the vast array of diagnostic tools such as 3 Dimensional Motion Analysis, Force Plate testing, and Movement assessments strategies now allow for a very precise analysis of the modern day golf swing.

Golf Biomechanics – What is it? 

In essence, golf biomechanics is the analysis of human motion using the principles of physics and physiology.

Whenever a person performs any physical task such as lifting a cup or running, muscles within the body create tension and force across the joints to generate the correct movement. Biomechanics allow us to measure these movements to understand patterns and stress of the joints.

For a golfer wishing to improve their performance, a deeper understanding of golf biomechanics allows for increased performance while decreasing the chance of a possible injury.

Phases / biomechanical movements of the Golf Swing

Biomechanical studies have created a progressive model of the golf swing. To understand the connection between the golf swing, the kinetic chain, anatomy, and the interaction of these three elements we will look at each phase of the golf swing from a biomechanical perspective.

1. Set-up / “address” position

A balanced set up position will provide the correct starting position for the swing.

Recruitment of muscle fibres is low at the set-up stage. The muscles of the body are supporting the body in a specific position and preparing to swing the club. Here however, certain levels of joint mobility, muscular flexibility, and stability are required to hold the correct set-up position. Typically, improper positioning of the body in the set-up stage golf can directly lead to re-routing of the club, poor sequencing, and the development of compensations (and injuries!) in the golf swing. The cause for an improper address position usually comes from poor mobility in specific joints or a lack of stability in certain body parts.

2. Backswing

The backswing starts when the body begins to move the club. At this point the body begins using energy that will be transitioned at the top of the backswing towards the ball and it is the beginning of torque development in the body that will be transitioned into the clubhead at impact. Rotation of the knees, hips, spine, and shoulders continues during the backswing. The important point to remember here is that the entire rotation of these body parts arises around an imaginary axis of the body. The body during this portion of the swing is ´creating´ energy to be released during the downswing phase of the golf swing.

The biomechanical analysis of the backswing suggests that this is the stage of the swing at which speed development begins. Rotation in the lower body, trunk, and shoulders is reliant on joint range of motion, muscular extensibility, stretch reflex, and strength in the lower body, hips, core, and upper back. If your rotation is poor / range of motion suffering, your ability to implement the backswing and develop torque will be weakened.

3. Transition / end of the backswing

This is where the body finishes its backward movement and begins the forward movement.

Again, the transition phase requires a level of joint mobility and stability. Compensations or inefficient movement patterns can arise when a player has limitations in their thoracic spine or hip mobility. Equally a player who cannot stabilize their hips/pelvis will be unable to hold the correct postural position needed to start the downswing phase.

4. Downswing / Double Pendulum

Here torque is generated in the low body, accelerates through the upper body, and then transferred into the club. At this phase of the swing, the bulk of torque is generated by the glutes, hamstrings, quads, and core.

The double pendulum effect: This pendulum consists of an upper and lower pendulum. The shoulders (acting as the fixed pivot), arms and hands (the upper pendulum), and the club shaft and club head (the lower pendulum).

5. Impact

The aim of impact is to hit the ball in the correct direction with the desired amount of force. The club head and ball at impact are in contact for approximately half a millisecond, so any error in timing, body positioning, swing sequence, or positioning of the clubface will quickly affect the impact position, ball flight, speed, and direction!

Low handicap players will reach their maximum club head speed at the impact position. Players with biomechanical inefficiencies / physical limitations will lose speed before impact causing a loss of distance and poor ball flight direction.

The impact position includes the release of the hands with precise timing for the transfer of speed to the club head. Clearly physical limitations, poor mechanics, or improper equipment will have an impact.

6. Follow-through

In essence this is the deceleration of the body after contact with the ball and where the sequence of the swing ends.

This stage requires activation of the subscapularis, latissimus dorsi, and pectoralis major. To allow for the dissipation of energy and slowing down of the body also requires a high level of eccentric and stabilization strength of the muscular system. Poor conditioning of the body and limited flexibility may limit the capability of a golfer to carry out this phase of the golf swing well.

How we can help you!

To improve your game, firstly start to understand the principles of golf biomechanics. Secondly, appreciate the differing structures and movements of your golf swing. I.e. recognizing the optimal shoulder and wrist movements will allow you to have consistency with successful chip shots.

As explained it is easy to see how poor conditioning of the body and limited flexibility will affect your game and that is where we at Elite Performance Therapy can help!

We work with both amateurs and professionals and are here to take you to the next level … and it doesn´t need to take long!

Whether it is assisting you with an effective warm up, build strength in a specific part of the body, improve general flexibility or simply to enjoy golf without pain, we can help 😊

If you want to be skilled at golf, you will at least need desire, determination, hand-eye coordination, …and some talent 😊

For the game itself, you´ll need to develop sound fundamentals, shot-making skills, course management, a keen understanding of the mental aspect of golf, equipment, and physical conditioning. Sounds like we´ve described the perfect modern-day golfer, right?!

Today’s technology means there are endless possibilities to improve your game – from video analysis, Doppler radar, SkyTrack Launch Monitor to an expensive moveable weighted driver –  however, there is one piece of equipment that still gets all too often neglected: your body.

Many golfers feel the psychological component of golf is their greatest challenge, yet completely undervalue the biomechanics and conditioning that is required to play the game well.

To demonstrate this Isy and Sarah at Elite Performance Therapy took on the ultimate challenge: take an already highly skilled golfer and make them even better!

 The Process: How we did it!

Golf instructors can teach you about every aspect of the swing, but what happens when you physically cannot get into those positions? Besides frustration, injury becomes increasingly likely.

To understand what the body can and cannot do, the key starting point is a physical screen to assess a golfer.

The Golf Screen

This is a physical evaluation that brings to the forefront any issues a golfer may encounter. In essence it is a musculoskeletal assessment of the body to identify and isolate physical limitations, which may lead to poor performance and possible injury. Along with a Selective Functional Movement Assessment (SFMA), the major components of the kinetic chain involved in the golf swing (the pelvis, thorax and arms) are individually assessed to determine if there is an optimal transfer of load from the ground to the ball. It is also important to include fundamental movements, looking at speed, power, and agility.

Here at Elite Performance Therapy, we have developed our own unique and proven screening process which allows us to consistently track, measure, and develop a player´s golfing performance.

Case Study: John Walker

Aim: To improve his Golf Performance

Full Orthopaedic and Neurological Assessment

We assessed John´s active range of motion (the motion John has when he initiates the movement) and a full passive check of movement (the motion achieved when a practitioner moves the body).

This active versus passive movement gives us an indication of muscle tone and whether there is a structural reason (joint) for lack of movement or a functional reason, such as tight muscles. We did this throughout John´s body which included the neck, shoulders, thoracic, lumbar, hips, knees, ankles, and toes, noting passive and active ranges.

In John´s case, he has had previous hip surgery with bilateral hip resurfaces so we expected to find a significant reduction in hip rotation and restrictions in his squat pattern. However, John actually was able to squat through a full range (better than most) largely due to an excellent outcome from his hip surgery and good ankle flexibility.

What we did find was reduced thoracic mobility, reduced hip rotation (although still a good range), and restricted pelvic rotation. He also had some chronic neck stiffness and upper thoracic stiffness.

The next stage of our assessment was a neurological assessment:

The golf swing requires the power of the arms, but maybe – and surprisingly to some, to hit the ball further and with power a strong core and strong hips are essential. This is the powerhouse for your swing.

Using specific muscle testing we found that John has an inhibited (weak) left glute. The hamstrings fired up well, but they also fatigued quickly.

So, what does this mean?

Power and endurance of power is important to maintain strength throughout your game of golf. In John´s case, a glute that isn´t firing will have significantly affected his power as the glute is an extensor of the hip. Paramount for your golf swing!

To recap: to have the optimum performance you need a range of motion and power!

Treatment Process

Many professional golfers use clinical massage and Chiropractic and there’s a good reason: It works!

Tiger Woods is unarguably an amazing golfer with natural abilities and skills. However, even with his natural high level of skill, he relies on clinical massage and chiropractic care to keep him in good golf shape. He considers regular treatment essential to his game, saying, “I’ve been going to a chiropractor for as long as I can remember, it is as important as the practice of my swing.”

….Back to the Case Study!

As muscles and joint experts, we use a range of techniques including soft tissue massage, myofascial release, trigger points, joint mobilisation, joint manipulation, medical acupuncture, cupping therapy, and IASTM… to name but a few!

To help John improve his golf performance our focus was to improve hip rotation, increase thoracic mobility, and manipulate through his low back to help the nerve input to his glutes.

We used a combination approach of specific soft tissue release to those areas of muscular restriction and thoracic mobilisation and manipulation to increase thoracic rotation. We included needling to help stubborn areas of muscular tightness, manipulation to the low back where specific joint restrictions were identified. This increases the afferent nerve input to his hip muscles so creating increased power output.

After just one treatment John had a significant increase in power to both hamstrings and glutes. He had better thoracic range and felt more flexible through his hips.

Identification of muscle imbalance was discussed we prescribed John specific mobility and strengthening exercises to support our findings.

On return for John´s second treatment he still had some signs of the limited hip range and pelvic stiffness we had originally identified; however this glute and hamstrings were still firing well.

Did we succeed in our challenge?

Sports performance – in this case, golf – is our speciality and we love what we do! The challenge of working with an already good golf player and taking their game to another level -higher than their perceived expectations- is how we get our fix!

John did more than excel himself and the results speak for themselves:

Whether you are a golfer in your teenage years, 20s, 30s, or 40s, you are going to need to know about fitness to add power and golf-specific conditioning to your game. At Elite Performance Therapy we understand you would like that extra 15 yards on your irons and want to be comfortable taking repetitive swings without body aches and pains during or after a day of golf.

Perhaps you a golfer in your 50s, 60s, 70s, and worried about being able to continue your passion? We understand you want to give yourself the best opportunity to extend your game beyond most individual’s limits and perform at a high level.

​You’ve worked hard on the mechanics of your game, your swing, and your approach. But we come back to the original challenge: Have you worked hard on the motor behind it all?!

Here at Elite Performance Therapy, we work with both amateurs and professionals. We are here to take you to the next level … and it doesn´t need to take long! Whether it is to win your next bounce game, lower your handicap, secure the club championship, progress through the various professional tours or simply to enjoy golf without pain, we can help 😊

There’s soreness, and then there’s pain. It’s important to not confuse the two!

To active people in general and athletes at all levels, the inability to recognize the differences between muscle soreness and pain can mean pushing your body – your muscles and joints – to the point of injury. It’s the difference between healthy progress and unnecessary, long-term risk.

Post-workout soreness can start anywhere from later that day until a few days after the workout … with a peak usually around the 36-hour mark. However if the soreness lasts longer than the normal couple of days or so, or has an impact on how you function, it is probably some sort of injury.

Ignoring it can do long-term damage to your body.

In contrast, soreness – often referred to as delayed onset muscle soreness (DOMS) – is a side effect of the repair process that follows the microscopic muscle damage from a typical, rigorous workout. Activities likely to cause DOMS include strength training, walking / running down hills, jogging, step aerobics and jumping.

So how can you tell soreness from pain?

The answer can be a simple as listening to your body.

Here are some of the signs that you’re experiencing pain – not simply soreness — and should stop and seek the advice :

Sharp Pain: Sharp, intense pain that you experience when exercising and at rest can be classified as pain. In contrast, sore muscles tend to feel tight and achy when at rest. During exercise, sore muscles will feel “burning” and fatigued. But if the burning later turns to swelling and inflammation, get advice.

Pain in the Joints: Soreness is a muscular thing. Though muscle discomfort can also cross the line into pain, discomfort in the joints is less ambiguous. If, say, getting up from a chair or walking up the stairs becomes a struggle, it may be time to seek professional advice.

Warm-Up Discomfort: If the discomfort you feel doesn’t go away after you’ve warmed up for your workout or event, you’ve potentially crossed the line into pain. General soreness should improve through use, so if discomfort lingers on without improvement, you’re likely dealing with pain.

P.R.I.C.E. Fails: If soreness persists and seems to linger, apply P.R.I.C.E., a popular acronym that takes you through the steps of Pressure, Rest, Ice, Compression and Elevation. Then re-evaluate the way you feel. If the hurt doesn’t improve or subside, you may be experiencing pain.

If you’re experiencing pain, or if you’re just not sure, seeking advice is your best option.

Here at Elite Performance Therapy we will assist in your recovery including; initial pain management, identify and address all factors that may have contributed to your injury to prevent further problems, and provide specific recommendations regarding reintegration into exercise, as appropriate.

Quarantine Golf with Elite Performance Therapy & Mike Browne – the ONLY pro golfer on one leg !

In light of lock-down we have been working with Mike Browne – the ONLY pro golfer on one leg (!) to put together some ways to keep you entertained, injury free and improve your golf swing!

Please note that this is exclusively for our clients at one of our prestigious golf society’s :

• Sandgrown’uns
• Golf the Costa (GtC)
• Nomads
• Golf in the Sun (G.I.T.S)

A Bit about Mike

From beginner to Pro in 2.5 years; Mike has made fast progress since taking up golf as an Army amputee. His advice will make you a better golfer, while his story cannot fail to inspire you. Imagine I told you about a man who didn’t pick up a golf club until he was 36 years old. Imagine that, within a year, his handicap had plummeted from 28 to eight. Within three years of taking up the game, he’d turned professional and won events in multiple continents, beat Ian Woosnam, nearly qualified for the Open, shot rounds in the low 60s and recently impressed 19 PGA Tour winner Matt Kuchar during a round together at The Renaissance Club…

Mike made his professional debut in Spain on The Gecko Tour in October 2016 and now splits his time between golf’s satellite tours and the European Disabled Golf Association. He won the 2018 South African Disabled Golf Open by an astonishing 12 shots and successfully defended his title this year. He’s currently ranked third in the world for golfers with disabilities, and he’s on course to take the top spot soon. He represented Great Britain in the Simpson Cup at Oakhill, the equivalent of the Ryder Cup for wounded and sick veterans.

Over the coming weeks we will be putting together some demonstration videos with Mike to include :

• Warm up / Swing / Putting at home drills
• On the tee exercises
• Stretching correctly
• Rotation & Flexibility
• Speed work
• Upper body / core / trunk / low body exercises

Injuries – Online Consultations

Please also note that through this time Elite Performance Therapy will be providing online consultations, prescriptive home exercise as well as self-massage/release techniques – we understand that prolonged sitting can aggravate many underlining back and joint injuries!

To Receive further information and demonstration videos

If you are interested in receiving these complimentary videos and further information please click here or email us directly at info@elite-performance-therapy.com. Be sure to include your membership number!

All the best and keep safe.

Isy & Mike