"But this is an overuse injury!"
I get this question all the time when it comes to tendon issues like tennis elbow and golfer’s elbow. And honestly, for good reason! Because until you really dive in, it makes no sense!
For decades, there’s been a misconception that if you have an overuse injury, resting is the best way to fix it. And while RICE (rest, ice, compression, elevation) certainly has its uses, it is not the end-all be-all of pain reduction.
I mean, the guy who came up with the RICE protocol has basically recanted at this point…
With overuse injuries like tendonitis, we’re tempted to lay off and let it sort itself out.
But eventually you’re going to have to use it again, and if it’s not more robust than when you started… You’re going to find yourself right back in the same spot soon.
AS ALWAYS, A QUICK ANATOMY LESSON:
Tendons connect our muscles to our bones, and their job is to transmit force from the muscles to the bones to create movement. They’re made of strong, flexible fibers. You’ll see the white area at the end of the muscle in this picture… that’s the tendon.
A stronger muscle tends to have a stronger tendon because they build together. If you’re actually strong, you will feel like you’re barely gripping the club… but if you’re weak, you’ll have to work a lot harder and will be more likely to develop tendon issues.
IS MY GOLF GAME TO BLAME?
Golfer’s elbow usually happens on your trail arm, and may be related to the following issues:
Hitting off a mat too often
Casting the club (or losing your lag)
Tennis elbow usually happens on your lead arm, and may be related to the following issue:
Scooping or chicken winging the club
Over the top swing plane
Either can be due to:
Clubs that are too heavy
Grips that are too small
Single traumatic instance like hitting a root or rock
Poor low point control causing you to hit the ground first (due to any number of swing issues).
TREATMENT OPTIONS:
Physical (or occupational) therapy: You’ll work to load the tendon at an appropriate level to help it get more tolerant to load, but not so much that it continues to worsen. There are often other treatments included to stimulate healing like cross-friction massage, dry needling, laser therapy, shockwave therapy… you name it.
Medical intervention: Steroid injections may help short term, but that not only weakens the tendons and can result in a tear if done too often, and it doesn’t address the reason why you’re having that pain in the first place.
If it turns into a tear, then we run the risk of needing surgery, which turns a few weeks of work into months of recovery.
Self-treatment options: Rest, ice, and a brace or “counterforce strap” like this that helps take stress off the tendon during activity. I’ll often use a counterforce strap for patients while we’re rehabbing!
Relative rest: Hire someone to do your yardwork and home improvement stuff so you get to take a break.
OKAY, SO LET’S TALK ABOUT LOADING
All this information is great, but if we don’t understand why we load, then it really doesn’t help explain why therapists do what they do in your sessions. So, here’s the part we’ve all been waiting for!
How proper loading affects tendons:
Proper loading calms the irritation by…
Pulling the inflammation out, which then…
Reduces pain, and leads to…
Everything moving better, and then you can…
Strengthen the tendon and muscle so you…
Return to play without pain!
Proper loading involves making the tendon work without overworking it, which is how we got here in the first place. Teaching the tendon, and all the muscles around it, to accept and tolerate bigger and bigger loads means when you play, the whole joint will be ready to do its job.
A protocol involves more than I can put into writing here, but keep an eye on my social media spaces for an upcoming video on how you’ll put this into practice.
PUTTING IT ALL TOGETHER…
Short term fixes don’t help you long term unless they’re combined with something that’s been proven to work
For the long term, you need strength.
If you want to keep playing right now, here’s how you can proceed:
Get with someone you trust and start loading appropriately.
Use a counterforce strap to help avoid more irritation during your round.
Wrap a towel around your club to alleviate some of the grip stress (a bigger grip means less torque on your muscles and tendons)
Get this right, and in time you’ll feel just as sharp on hole 18 as you did during warm ups!
Here at MyPhysio, we’re not about can’t or don’t. We’re about improving strength, motion, and skill to help you play your best game. If you need help figuring out why you're hurting or what to do about it, set up your free call and let's sort it out together!
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