Treating My Golfer's Elbow and Tennis Elbow

I’ve had both golfer’s elbow (medial epicondylitis) and tennis elbow (lateral epicondylitis). Of the two, golfer’s was the worse for me, it was more painful, lasted longer, impeded more activities, and was more difficult to treat.  I was taking Advil for months for the golfer’s elbow. However, both maladies are nasty.  Also, in my case, the pain was not from gripping (as it is with many people) but with elbow flexion and extension.  With golfer’s elbow, I had the most pain from activities that entailed lifting weight, exerting force with the palm up (e.g., curling a weight); with tennis elbow, the major pain was with extending the elbow as in a dumbbell triceps curl.  In my case I think both golfer’s and tennis elbow was principally localized on the muscle-tendon units along the ring finger axis, from ring finger to elbow.

Current thought suggests the initial problem is a tendinitis which over time can evolve into a long-lasting tendonosis, involving damage and degeneration to the elbow tendons, with golfer’s involving flexor tendons (e.g., palm up wrist curl) and tennis involving the extensor tendons (e.g., palm down wrist curl).  The initiating event is likely a small tear or multiple tears in the tendon. However, in my experience I believe an important component is tightness, particularly for golfer’s, while tightness and weakness is a problem for tennis. So, stretching can be important, but, in my opinion and experience, for golfer’s elbow, the classic “extend your arm palm up and push your hand down” stretch made the problem worse. However, slow stretching as part of the eccentric part of an exercise, as those explained below, helped to elongate the tendon-muscle unit under weight, which helped. While I see the stretching under weight as important, the literature suggests that eccentric exercises stimulate the tendon to remodel itself, synthesize healthy tissue, etc. Just resting is not enough. Once the initial tendinitis part of the problem with inflammation, etc. is done (at that early point, rest and ice may be useful), work needs to be done to stimulate tendon remodeling and to relieve the stress on the injured point by the stretching of the area.

What is eccentric?   Eccentric is the lowering part of a muscle movement, while concentric is the lifting part. For a barbell curl, concentric is lifting the bar up, curling it up, while eccentric is lowering it back down to the starting position. And when I talk about “therapy” here I mean doing the exercises when you have an active case of golfer’s/tennis elbow; “maintenance” is doing preventive exercises when you are feeling better.

Note that I do the following regularly now, as preventive maintenance. I consider my elbow problems currently 95% better, in the sense that usually it is fine, but with too much work (like too much barbell curls), I can get some flare-ups (so far minor).  When that happens I increase the therapeutic exercises described below, and go easy on the aggravating activities for a while.

Golfer’s elbow plan:

I did the following for golfer’s elbow. During this time I avoided weight-lifting exercises that aggravated the condition (normal palm-up curls) and instead did alternatives like hammer curls (palms facing toward body).

I would divide the work I did into the three most important (major) exercises and two auxiliary (minor) exercises which are still important.

Major:

1. See this. Load up a dumbbell rod or a broomstick with weights at the end and go to it. I would do sets of 20 reps. For maintenance I only do I set each arm. When you have the problem, do more than one set. It will take time. I saw progress when I got up to five pounds at a hand-weight distance of five inches.  Today, I use 7.5 pounds with the left arm at around 4-5 inches and the right 5-9 inches.

This is a great exercise. I believe it both stimulates tendon remodeling AND slowly stretches the tendon-muscle unit, so the area is less tight, so that the muscle is not constantly “tugging” at the painful area. Try and do 20 reps per set. One set twice per day 4-5 days per week for maintenance; do at least two sets twice per day for therapy. Start light and work up the weight and distance.

2. Use the Flextend glove. This is a great tool. Again, be patient, it takes time. I started seeing improvement once I got to two strands used at a time for each hand.  The massage did not help, and the stretching I think made me worse. But the actual exercise is great, and the fellow in the video really explains well the double action of stretching and strengthening. The utility of these exercises underscores the importance of tightness in the development of golfer’s elbow, and how dynamic stretching – stretching against resistance (weights or bands) can be helpful.  Do this twice per day, 4-5 days per week. Try and get to 20 reps per set, do as in video.

3. Eccentric dumbbell wrist curls. Start light, work up the weight. I use 20 lbs. now.  Put dumbbell in hand of affected arm, palm up, arm on leg, dumbbell over knee. Use the other hand (of unaffected arm) to lift the dumbbell to the up position (don’t do the concentric lift with the affected arm).  Then, using the affected arm only, slowly lower the dumbbell all the way down to the full down position, with wrist fully bent downward. Then use the unaffected hand/arm to life the weight up and repeat. Do 20 reps per set, once per day, 4-5 days per week.  One set for maintenance. Multiple sets (up to three) for therapy, or you can sometimes try one long set (up to 50 reps). You can also do it twice per day for therapy.

Minor.

4. Expand Your Hand Bands. Twice per week, once per day, three sets of 25 reps. Build up to increasing intensity of the bands; I use the red ones now. Try and open your hands wide and get a good stretch.

5. Eccentric dumbbell curls. With the same dumbbell you use for the eccentric wrist curls, do this exercise, one set once per week.  Standing, hold dumbbell at arm’s length, palm up in hand of affected arm. Using the unaffected hand, raise the dumbbell up to the top, fully curled position. Very slowly lower – the same principle as the eccentric wrist curl, but here you are stretching the entire arm, all the flexors. This also acclimates your arm to accept the stress of doing curls again. Do 4-10 reps, depending on the weight and how you feel. Probably 6-8 reps would be best.

Tennis elbow plan:

Some of the exercises outlined above for golfer’s elbow can work for tennis elbow, if suitably modified. For example, the Flextend glove has a tennis elbow program.

The Expand Your Hand Bands are helpful here as well.  The exercise with the weighted rod used for golfer’s elbow (# 1, above) can be adapted for tennis elbow, just lower in the opposite direction (I do a couple of sets per week of that for tennis elbow prevention now).

Many people are very happy with results from the Flexbar for tennis elbow. I believe it can be effective for most people; I have one myself which I sometimes use for maintenance to prevent future tennis elbow, or to use when I feel some twinges there. The exercise can also be used in reverse fashion for golfer’s elbow, but I am less optimistic about that based on my own experience – the range of motion for me is much more limited for medial elbow Flexbar exercises. But for lateral elbow problems – tennis elbow – Flexbar can be a very effective addition to your therapy regimen.

But I had tennis elbow long before I heard of that, and I cured it with exercises of my own invention, coupled with stretching. Yes, the sort of stretching I did not find helpful for golfer’s elbow. The interesting thing is, you can find people saying online that the sort of “pull one hand with the other” type stretching is good for golfer’s but not tennis, but I found the opposite for myself – this is what worked for me, specifically.

So, I did the following for tennis elbow therapy:

1. Find a relatively light dumbbell (or even a heavy soup can).  Do a few (palm down) reverse wrist curls to warm up.  Then do this: standing up, hold the weight at arm’s length in the hand of the affected arm, palm down.  Then bend your arm at the elbow (and only the elbow, try and keep the shoulder straight), until the arm is completely bent and the weight is next to your chin. If necessary, you can support that arm with your other arm to prevent stress to the shoulder supporting the weight (you don’t want to cause shoulder problems while treating tennis elbow! Anyway, start with a light weight and support the arm as indicated if that is easier and more comfortable). Then, with your arm bent in that position, do reverse wrist curls with the weight under your chin. Go slow and get a good stretch. With ALL of the exercise listed in this post, if it is too painful, during or after, you can go to a lighter weight. However, in my case, I did feel discomfort at the beginning (I used a three pound dumbbell for 20+ reps; today for maintenance I have worked up to an eight pound dumbbell for 20 or so reps), not extremely bad, but with your elbow in that stretched position, you are putting stress on the painful tendon and then doing exercises. My idea was to strengthen the area in its position of maximal weakness, so that if I worked it to a point where I could do high reps in that position with no pain (eventually) then I was getting better. This exercise I think stretches the area under dynamic stress and may stimulate tendon remodeling (?). Note though that this is NOT a strictly eccentric exercise, I was doing the full reverse wrist curl, concentric (up) as well as eccentric (down).

2. Then after one or multiple sets of the exercise above, I would put the hand of the affected arm against a wall, palm against wall and fingers up, and slowly lower myself to the wall, essentially doing the eccentric phase of a one-handed push-up against the wall. Body weight would be on the bent arm (note: I was someone what had been doing years of weight training, for others, they may need to at least partially support themselves with the other arm as well). This too causes some discomfort, but my opinion was, again, if I could acclimate my arm to this stress, and if I could eventually do this without pain, then I would be getting better.

3. I immediately followed the above exercises with the standard tennis elbow stretch, affected arm straight out, palm down, and then pulling the hand down with the other hand and holding for 20-30 seconds.  After than I would sometimes just move my arm up and down (with no weight) in a reverse curl motion, to loosen things up and I would sometimes feel a faint “rubber band snapping” in the extensors of the forearm, and sometimes would feel as if the pain was moving from an intense pain at the lateral epicondyle to a fainter soreness in the muscles. It felt almost as if the pain was being "pulled" off the joint into the muscles and lessening. I suspect that by stretching the entire region, the tight pulling on the tendon was decreased, allowing for healing.

I can imagine some medical professional may disapprove of my tennis elbow exercises because of the significant stress on the elbow. If your doctors, nurses, therapists, etc. disapprove, then you should of course listen to them. Alternatively, they may say give it a chance, but, always listen to the medical experts. In my case, the therapists I went to were useless, and I decided I needed more intensive work. But what was useful to me may not be for you (and vice versa).

For maintenance to prevent future tennis elbow, I do the bent arm reverse wrist curl several times per week, and also do the weighed rod exercise for tennis elbow, as well as for golfer’s elbow, several times per week.

So, that is what worked for me. As always, if you are interested, consult your medical professional. These things take time. While my tennis elbow responded relatively quickly to the therapy routine (and I mean by “relatively quickly” 3-4 months), the golfer’s elbow took about six months to show significant improvement and longer to get to the point it is today.  But I had waited a long time before doing these routines. For me, rest was useless; in my case, it had likely already progressed to tendonosis – tendon damage – and the only way to reverse it was to actively engage in therapy. Keep in mind my conditions were relatively severe; in the case of the golfer’s elbow, even closing a car door or washing my hair hurt. With the tennis elbow, tooth brushing and flossing hurt. And yet, I’ve been able to get to the 95% better condition, with regular function at 100% and only the occasional mild flare-up to deal with so far. So, in my case, these routines worked, and still work as prevention.