Golfer's Elbow and the Kinetic Chain

Golfer’s Elbow (Medial Epicondylitis)

Let’s ease our way into things with a simple question. What in the world is golfer’s elbow? More than likely you’ve heard of tennis elbow, but golfer’s elbow? That’s a new one. Golfer’s elbow (also called medial epicondylitis) is defined as an overuse and overload syndrome causing inflammation of the flexor-pronator mass at the medial epicondyle. In the most basic of terms, it’s pain on the inside of your elbow and forearm. 

Ok great, so where does the name “golfer’s elbow” come from? That’s a pretty simple question to answer, too. A lot of golfers have pain or have had pain on the inside of their elbows, so we call it golfer’s elbow. Easy as that. Moving on.

Here’s another question that you might not be asking yourself, but I’ll answer for you anyway: How does it happen? Let’s go back to that fancy definition. Golfer’s elbow is defined as an overuse and overload syndrome causing inflammation of the flexor-pronator mass at the medial epicondyle. Key words here are overuse and overload. Microtraumas to the muscles on the inside of your elbow happen when those muscles are used too often or under too much load, which eventually can lead to inflammation and pain. And it makes sense why so many golfers have pain or have had elbow pain when you think about it. An average golfer will hit close to 96 (for a male) or 108 (for a female) shots in an 18-hole round of golf in a span of 4 or 5 hours. If you take out putts, but add in warm up swings, you are likely taking 100+ swings that make contact with the ball, the ground, or ideally both! All that force from hitting the ground and/or ball is transferred up the club to your wrist and elbows. Every. Single. Swing. 

Kinetic Chain

Time to get technical. Let’s talk a bit about the kinetic chain. If you think of pretty much any sport played on dry land, how do the most elite athletes generate all that force? It’s all about an efficient transfer of energy that starts from the ground and works its way up towards the hands. Take a golf swing, for example. The energy starts in the ground and works its way up through the kinetic chain – feet, legs, hips, back, shoulders, elbows, hands, and into your club – eventually transferring all that power directly into the golf ball so that you can hit the ball far (at least most of the time) and straight (hopefully). The kinetic chain: an efficient transfer of energy through each body segment to exert a force on some object to accomplish a specific goal. Incredible. Hashtag physics.

But what happens if and when this kinetic chain inevitably breaks down?

Tug-of-War

Ok, bear with me for a moment, it’s analogy time. Imagine of a tug-of-war match between two mostly equally matched teams. What happens when one member of a team isn’t as strong or as fit as the others? The other team members have to pick up the slack and work harder to win the battle. Now when this happens over and over, the team members pulling the extra weight get irritated, fatigued, and generally pissed off, right? 

We can use that same idea to describe what happens to your body during a golf swing. If one part of the body is weak or unstable (I’m looking at you, hips and shoulders), other body parts have to work harder to compensate for this weakness. It’s exactly this inefficient transfer of energy (remember that kinetic chain thing we just talked about?) that causes things to get irritated, inflamed, and painful and we end up with injuries like golfer’s elbow. 

Great, So Now What?

So, you have golfer’s elbow. What do you actually do about it? In general, when treating an injury like golfer’s elbow, it’s important to consider two strategies: load management and active rest.

The idea of load management is to properly construct training and activity in a way that maximizes the body’s ability to adapt and perform at a high level while reducing the risk of injury. With this in mind, giving your body time to rest and recover is just as important as staying active. Reducing or eliminating load gives a structure time to repair itself and ultimately become stronger, increasing the load that that structure can handle. 

On the other hand, active rest involves decreasing the intensity or organization of your normal activity. But didn’t I just say that rest and recovery is important for healing? Absolutely! But load management and active rest aren’t mutually exclusive.  Just because your elbow is hurt doesn’t mean you can’t exercise your legs, core, or even shoulders. In fact, using load management and active rest strategies together can prevent recurrence of injuries like golfer’s elbow.

Let’s go back to our kinetic chain discussion. If your hips, core, or shoulders are weak or unstable, your elbow will have to compensate for those deficits, resulting in injury. So when managing a golfer’s elbow injury, we can allow the elbow time to rest and recover (load management), while training other parts of the body like the hips, core, and shoulder (active rest). Managing any injury with these strategies in mind will improve recovery times and prevent recurrence of injuries. 

Dr. Riley Kerr, PT, DPT, ATC

Physical Therapist, Doctor of Physical Therapy

Titleist Performance Institute Medical Level 2 Provider