วันศุกร์ที่ 13 พฤษภาคม พ.ศ. 2565

Physiotherapy with 11 ways to stretch the golfer's elbow.

Have you stretched your hand while typing? What pose do you stretch? I guessed it could be a forehand stretch which releases hand tension.  

Ref: https://www.avera.org/

11 ways to stretch the golfer's elbow. 

Exercise #1: Golfer’s elbow stretch with hand open: Direction to stretch the all five muscles is wrist extension with ulnar deviation with supination with straight fingers. 



Exercise #2: Golfer’s elbow stretch with hand closed: Direction to stretch Pronator teres and Flexor carpi radialis is wrist extension with ulnar deviation with supination



Exercise #3: Standard forehand supinate with hand open stretch




Exercise #4: Standard forehand supinate with hand closed stretch 



Exercise #5: Arm prayer stretch



Exercise #6: Standard forehand pronate with hand open stretch 



Exercise #7: Standard forehand pronate with hand closed stretch



Exercise #8: Table forehand pronate with hand open stretch



Exercise #9: Table forehand supinate with hand open stretch


Exercise #10: Floor forehand pronate with hand open stretch



Exercise #11: Floor forehand supinate with hand open stretch 




According to forehand muscle anatomy originates from the medial epicondyle of the humerus. From the radial to the ulnar aspects of the forearm, the musculature includes the pronator teres, the flexor carpi radialis, the palmaris longus, the flexor digitorum superficialis, and the flexor carpi ulnaris. The pronator teres and flexor carpi radialis both attach to the anterior aspect of the medial epicondyle. They are known as flexor - pronator muscles of the forearm.

The tendon of these five muscles concur at the common flexor tendon where is approximately 3 cm long and, in most elbows, crosses the ulnohumeral joint medially. 

Wrist flexor muscles anatomy
(Ref: https://www.flickr.com/photos/nickbrazel/136518076)


One of the elbow pain is epicondylitis. It is one of the most common elbow problems in adults that occurs both laterally and medially. The number of medial epicondylitis is much less frequently than lateral epicondylitis seven to ten times more often, approximately.

The majority of the disorder’s primary etiology is a repetitive stress or overuse of the flexor-pronator musculature. Excessive repetitive stress on the tendon eventually results in microtrauma and degeneration. Histopathologic examination has revealed a staged process of pathologic tendon change. Initially, repetitive trauma results in peritendinous inflammation. Continued injury results in angiofibroblastic hyperplasia, an invasion of vascular and fibroblastic elements into the tendon. Eventually, replacement of the normal tendon with angiofibroblastic hyperplasia results in structural breakdown and irreparable fibrosis or calcification. Activity causing such pathology to the common flexor tendon can eventually transfer forces deeper to the Ulnar Collateral Ligament, which mirrors Common Flexor Tendon fiber orientation and histologic anatomy.

 Degenerative changes in the musculotendonous region of the medial epicondyle are the result of chronic repetitive concentric and eccentric contractile loading of the flexor-pronator group. Most often such changes are seen in the pronator teres and the flexor carpi radialis muscles, although larger diffuse tears can occur in the palmaris longus, flexor digitorum superficialis, and flexor carpi ulnaris. Although repetitive overuse has been identified as the primary etiology, a single traumatic event, such as a direct blow or a sudden, extreme eccentric contraction, may result in the development of epicondylitis. Medial epicondylitis has been associated with activities involving repetitive forearm pronation and wrist flexion.

Ref: https://www.washingtonpost.com/


All activities, both sports and non - sports,  which require repetitive forearm, wrist, and hand motions. Sports activities; include,  golf, tennis, bowling, racquetball, football, archery, weightlifting, javelin throwing, and  baseball pitchers, resulting from intense valgus forces on the medial elbow during the late cocking and acceleration phases of throwing. For non - sports are  associated with occupations such as carpentry, plumbing, meat cutting, etc.

Ref: https://www.istockphoto.com/


The majority of the disorder’s primary etiology is a repetitive stress or overuse of the flexor-pronator musculature. Excessive repetitive stress on the tendon eventually results in microtrauma and degeneration. Degenerative changes in the musculotendonous region of the medial epicondyle are the result of chronic repetitive concentric and eccentric contractile loading of the flexor-pronator group. 

Activity causing such pathology to the common flexor tendon can eventually transfer forces deeper to the ulnar collateral ligament, which mirrors common flexor tendon fiber orientation and histologic anatomy. Most often such changes are seen in the pronator teres and the flexor carpi radialis muscles, although larger diffuse tears can occur in the palmaris longus, flexor digitorum superficialis, and flexor carpi ulnaris. Although repetitive overuse has been identified as the primary etiology, a single traumatic event, such as a direct blow or a sudden, extreme eccentric contraction, may result in the development of epicondylitis. 

 Histopathologic examination has revealed a staged process of pathologic tendon change. Initially, repetitive trauma results in peritendinous inflammation. Continued injury results in angiofibroblastic hyperplasia, an invasion of vascular and fibroblastic elements into the tendon. Eventually, replacement of the normal tendon with angiofibroblastic hyperplasia results in structural breakdown and irreparable fibrosis or calcification. Activity causing such pathology to the common flexor tendon can eventually transfer forces deeper to the ulnar collateral ligament, which mirrors common flexor tendon fiber orientation and histologic anatomy.

The inflammatory of musculotendinous origin at the medial epicondyle of the elbow is medial epicondylitis that is commonly referred to as “golfer’s elbow”. 

Ref: https://capitalchirodsm.com/tennis-elbow-versus-golf-elbow/


Although, stretching before performance may impact on some types of injuries but not impact on other injuries. Stretching benefits consist of increased flexibility, decrease pain, physiotherapy treatment process, injury prevention, basically. A plausible theory of injury prevention; include, (1) stretching makes the muscle–tendon unit more compliant, (2) increased compliance shifts the angle–torque relationship to allow greater relative force production at longer muscle length, and (3) subsequently the enhanced ability to resist excessive muscle elongation may decrease the susceptibility to a muscle strain injury.

 This theoretical rationale for why pre-participation muscle stretching might decrease the risk of subsequent muscle strain injuries is a testable hypothesis that has not been adequately addressed in the literature. Indeed, a counter hypothesis could be that enhanced contractile force production when a muscle is in a lengthened position could increase the likelihood of injury. Importantly, this rationale does not apply to the risk of other injuries such as ligament injuries, fractures or overuse injuries, such as tendinopathies.

Insertion of forearm flexor tendons in golfer’s elbow consist of wrist joint and fingers joint. Referring to anatomy, the way to stretch can be done with hand open and with hand closed. However, there are various poses to stretch the golfer’s elbow that are more advanced than hand closed. 

Conclusion, I would like to recommend stretching often to prevent injury because it affects the muscle - tendon unit which is the most common pathologic changed degeneration. The stretching principle is very simple: stretch to the point where “tightness without pain” or “noticeable tension without pain” will hold at the point for 30 seconds of 3 - 4 repetitions in one muscle as VIDEO demonstraion.


Reference:

https://journals.lww.com/jaaos/fulltext/2015/06000/medial_epicondylitis__evaluation_and_management.4.aspx


https://www.researchgate.net/publication/8474346_Stretching_and_injury_prevention_-_An_obscure_relationship/link/02bfe50f46bf7022d9000000/download


https://www.researchgate.net/publication/40766291_To_stretch_or_not_to_stretch_The_role_of_stretching_in_injury_prevention_and_performance/link/59ddfbc80f7e9bec3bae07b6/download 


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