Hi, I’m Dr. Eric Cobb with Z-Health Performance. We are back, discussing dealing with golfer’s elbow. We started this series last week, so if you have not watched video number one, please go check it out because it lays some foundational information about dealing with golfer’s elbow and about the thoracic spine in its relationship to elbow issues.
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Alright, so golfer’s elbow, we’ve already discussed what’s called medial epicondylitis. We mentioned the idea that many people develop this issue not because they’re golfers, yes it can happen in golf but it can happen in almost any activity particularly, sporting activity where we’re putting the elbow under high load. In the first video, we said there are two kinds of major things we have to deal with: we have to deal with improving the local tissue capacity and that may involve strengthening exercises, mobility exercises, working with the nerve (we’re going to cover all that stuff later because the), second issue we talked about is improving kinetic chain function and generally speaking this is where we start with a lot of people because whenever we go back and look at how people develop golfer’s elbow, it usually as I said, shows up in technical problems and there’s a lot of new research that’s coming out about this. So as an example, if I’m an overhead athlete, I’m a pitcher right and I’m throwing a baseball, I’m a volleyball player and I’m hitting or serving, I’m a tennis player and I’m hitting a forehand; when we look at people doing this and, particularly those that develop golfer’s elbow or medial epicondylitis, there is a consistent pattern that shows up in the opposite hip.
Alright, so if I have problems on my right elbow this entire video is going to be focused on improving the opposite hip. So as an example, what they have found is that people that develop golfer’s elbow tend to lack internal rotation of the hip during the sporting activity. So if I’m a tennis player, I’m right-handed, and I’m stepping in to hit a forehand; if you watch this hip and my pelvis as I drive through this leg is planted and you can see that my pelvis is rotating over this fixed hip. That’s called internal rotation of the hip. When that is lacking, let’s say I need to be able to get to here to complete the stroke but I can’t. I get stuck here. We then tend to overuse the wrist which generates additional stress on the medial elbow. That same thing shows up if I’m throwing or performing some kind of overhead activity.
So when we’re working with the kinetic chain, one of the first things that we have to do is improve internal rotation on the hip opposite the side you’re experiencing the pain. There are a lot of different exercises out there for working on internal hip rotation. But I like to be very specific with this, because in most cases we need that internal rotation to occur when we are swinging the golf club, when we’re hitting the tennis ball, when we’re throwing the baseball, whatever it is. So here’s the basic progression I like to have people go through; I’m going to step back just a little bit so that you can see what we’re going to do is, we’re going to stand in a neutral stance, we’re going to bend our knees, our feet are facing directly forward to begin with. From here, I’m going to shift my weight onto my left side. Remember, I’m working my left hip and I’m going to straighten that leg. And I’m now going to rotate my pelvis up toward that side, so in this case, I would be doing left pelvic rotation. This is causing internal rotation of this hip. So again, I’m going to slide, straighten, rotate, slide, straighten, rotate. That’s it. Now, I’m going to repeat that, only this time, I’m going to preset that leg into internal rotation. So, I’m lifting my toes, putting my weight on my heel, thinking about this area, and turning it in. And now I repeat that same exercise; where I’m going to shift, straighten, rotate. It’s going to feel pretty tight if this is one of your issues. Shift, straighten, rotate.
After we’ve done that, we’re then going to start adding some more positional specificity to it. So, I’m now going to take that leg and I’m going to step forward. Alright, I’m going to begin by straightening that knee. And I’m then going to just rotate to that side. Alright, so straighten, rotate. If I’m feeling comfortable with the amount of stretch I have, I’m going to straighten, shift and rotate. Straighten, shift and rotate. And then I’m going to repeat that same process with different degrees of knee bending. So I’ll do a small amount of knee bend, rotate. Test that shift, rotate and then a deeper knee bend. And again shift and rotate as you do this with different degrees of knee flexion. You’re going to feel different areas of tension in the hip, which is why we like to kind of floss through those different knee positions. Knee straight, slightly bent, more fully bent now. That was again all done with my foot facing forward. I would then repeat that same process again, beginning with an internally rotated hip. So, I’m here I’m thinking about my hip, I’m turning it in and then I’m straightening my leg. Shifting and turning my pelvis that direction and I will do that again with my three degrees or three different positions of a knee bend. Usually three to five repetitions in each one of those positions. That hip is going to begin to feel much more free during that. You can also always go back, palpate the medial elbow. See if it’s painful. Try your grip or even try swinging your club, bracket, or whatever. Once you’ve gone through that, the next evolution is to add a weight. Shift to it so now I’m going to go back to my foot facing directly forward. I’m going to going to begin with my weight to my back leg. Now from here, what I’m going to do is I’m going to shift into that front. I’m going to shift my weight forward into that front leg. As I do that, I’m going to go into that slight knee bend and I’m going to rotate. Shift slight, Bend and rotate again forward rotate. You can again add some shifting of the pelvis to that side, as well. So now as I’m coming forward, I’m shifting my body bending the knee and rotating my pelvis that direction. So, now we’re really trying to work on the motor pattern of weight transfer leading to internal rotation. I would then repeat that again with my hip internally rotated. This is one of my favorite little progressions to get people working on. If you have medial epicondylitis and you do play a sport that requires a lot of this rotation, this may be one of those exercises that you put into your day, in the morning, when you’re after morning break, during lunch, afternoon break, etc., because the more we can get the body to understand that this is a motion and a movement that we need to have available, and we can start to work on those tissues. To make sure they’re accepting of the movement. The more quickly this will then translate into whatever it is that you’re doing technically in your sport. Which should help take some pressure off that medial elbow.
So, this is the second kind of major area of the kinetic chain that we’re interested in. Thoracic spine and hip. Now, eventually if you want to take this a step further, as you’re working on all this, you can also add in spinal rotation. So, it’s not just pelvis, but we’re now adding in a little additional spinal rotation. Thinking about if I was hitting a tennis ball, maybe I would be here and I would be driving through. So, I may need to do a forward drive with a counter rotation of the spine while my pelvis is going toward that leg. So you’re going to play with a lot of different possibilities that are more closely related to whatever store it is that you’re participating in.
Alright, so give this a shot! Hopefully you find this really effective and helpful. We’ll be back next week with some more info for you on dealing with golfer’s elbow.
