Body Repair

Head-to-Toe Injury Advice from the Pros
New Methods to Conquer a Painful Golfer’s Elbow

Golfer’s Elbow commonly referred to as medial epicondylitis is a painful and frustrating injury for golfers because of its tendency to heal slowly and re-occur often. Golfer’s elbow is most often attributed to an incorrect golf swing, in which the club is “thrown” from the apex of the backswing down toward the ball. Appropriately termed “hitting from the top,” this incorrect technique creates similar valgus forces upon the medial epicondyle of the dominant arm, leading to the same tension overload pattern. The body produces an inflammatory response due to the repetitive stress on the flexor-pronator muscle groups. Later stages of epicondylitis is characterized by microtearing and tendon degeneration with or without calcifications. If you’ve had medial elbow pain for the past 3 months and have tried the typical conservative treatment outlined in classic cures with no luck and want some relief before you hit the golf greens this coming spring, ask your doctor about these innovative procedures.
Nutritional Supplementation

There are a number of key nutrients that can significantly help in reducing inflammation in addition to accelerate the body’s natural healing capacity for the traumatize tendons.
Arginine – soft tissue injuries significantly increase the need for the amino acid arginine, which is essential for a variety of metabolic functions. Supplementing the diet with arginine can significantly increase the amount of reparative collagen at the site of injury.

Vitamin A – increases white blood cells at the injured area in addition to promoting collagen cross-links which improves the tensile strength of connective tissue like tendons.

Copper – has been shown to promote biosynthesis of bone and other connective tissues. It works along with Vitamin C to create strong collagen which cross-links with another key protein elastin which improve the tensile strength and enhances healing.  

Zinc – appears to play little role in the initial inflammatory stages of repair but a greater role during tissue regeneration.

EPA – everyone has heard of the benefits of fish oil and I agree. Eicosapentaenoic acid (EPA) found in Omega 3 fish oils have been shown to have a positive effect on collagen synthesis and healing.

Bromelain – is found in pineapple and contains a proteolytic enzyme which breaks down scar tissue which can build up on injured tissues and reduce their elasticity.

Curcumin – is an extract of the spice tumeric and displays anti-inflammatory properties in addition to speeding up the healing process by changing the arrival time and concentration of cytokines which regulate cell growth.

For the acute stages in which medial epicondylitis displays the hallmarks of inflammation and synovitis the following modalities and therapeutic:

Low Level Laser

Method – is increasing in popularity however the exact mechanism of action has not been fully determined. It is thought the therapeutic nature of low level laser is attributed to the alteration of the resonant frequencies inside connective tissue which triggers physiological processes such as growth and injury repair.

Result – has been shown by numerous studies to enhance the body’s regenerative capacity after injury. LLL increases procollagen synthesis, reduces swelling, activates macrophages, increases DNA and ATP synthesis, etc all of which improves the overall healing capacity of damaged tissue.

Acupuncture Therapy

Method – has been in existence in China for more than 2000 years and has been increasing in popularity amongst North Americans. Acupuncture involves a needle puncturing the surface of the body, a phenomenon known as needle grasp in which the connective tissue literally grasps the needle and any rotation and pistoning of the needle will cause a deformation of the extracellular matrix leading to downstream effects.

Topical Therapy

There are a new set of therapeutic topicals (IGNITE® and XCCELERATE®) which been formulated to target the biochemical processes associated with connective tissue trauma: degeneration, inflammation, regeneration and fibrosis. These topicals are crucial in increasing nitric oxide and collagen synthesis which is a key step in supporting the healing of tendons. In addition these topicals will help mitigate inflammation, reduce local oxidative stress and pain. For a more detailed explanation of these topicals, visit www.zanagen.com.

Myofacial/Active Release Therapy®

Method – is a manual soft tissue therapy that decreases the tension in the fibrous bands of connective tissue that surrounds the body. Often after an injury to the connective tissue, fibrous adhesions known as scar tissue builds up which can be a common source of pain and impede range of motion. ART when performed by a certified practitioner combines the use of precisely directed tension along with very specific body movements to free restrictions in the traumatized tissue.

In cases where medial epicondylitis is characterized by evidence micro-tearing of the tendon origin at the epicondyle, scar tissue build-up and/or calcifications the following therapeutic treatments can be explored:

Sclerosing Injections/ Prolotherapy

Aprotinin

Method – is a serine protease inhibitor which inhibits the breakdown of collagen by enzymes known as matrix metalloproteinases (MMPs) which are at highly elevated levels during tendinopathy.

Result – investigations using Aprotinin injections have shown they are superior to both corticosteroid and saline injections in patellar tendinopathy.

Platelet-Rich Plasma

Method – involves blood being drawn and spun using a centrifuge into concentrated platelets that are then injected into the injured area. When the platelets degranulate they release growth factors in physiologic proportions which stimulate the regeneration of tissue.

Result – recent studies investigating the effect of various growth factors such as GDF-5, IGF-1 and PDGF-2 on tendons and ligaments have shown to play positive roles in healing.

Classic Cures

Traditional Approach for treating Golfer’s Elbow

  1. Apply Ice three to four times daily to the affected elbow
  2. NSAIDs are taken for 10-14 days

If the patient does not respond to the above measures the next steps are taken:

  1. Night splinting
  2. Local corticosteroid injections 

I hope that some of the suggestions in this article have been informative. Still the most important step is prevention and overcoming flaws in your golf swing is the key step if you don’t want to be re-injured – even the best golfers in the world have a swing coach.