Golfer’s elbow – also called pitcher’s elbow – is a repetitive overuse syndrome that manifests as medial epicondylar pain. Golfer’s elbow arises from overuse of the musculature of the wrist and hand whose proximal tendons attach at the elbow. Medial epicondylitis is caused by using repetitive force to flex the wrist forward. It often involves irritation or entrapment of the ulnar nerve where it travels through the cubital tunnel.
Golfer’s elbow can be stubborn to treat due to the low vascularity of elbow tendons and ligaments. In some cases, more than one condition affects the elbow, and they need to be treated simultaneously. Addressing the symptoms of elbow pain is not enough to resolve golfer’s elbow – we need to consider the entire chain of structures from fingers to shoulder. Myofascial connections need to be examined, and mechanical issues that contribute to medial epicondylitis should be corrected.
A recent case study highlights the potential benefits of integrative holistic therapy for golfer’s elbow. Our patient was a 40 year-old male bodybuilder and wrestler complaining of acute pain in the medial elbow. A physical exam followed by ultrasound imaging led to a diagnosis of left medial epicondylitis, with irregular characteristics and increased blood flow. Moderate pain at rest intensified dramatically with movement.
During the previous two years, the patient had received manual deep massage therapy, transcutaneous electrical nerve stimulation, hydrotherapy, and injections of lidocaine and corticosteroids, none of which effectively reduced his pain and disability. Three months prior to dry needling treatment, he had stopped all therapy and physical training except for walking on a treadmill at submaximal intensity.
As a holistic treatment approach, the patient received dry needling on his medial epicondyle and the inner side of his left elbow. Ten needles were inserted vertically and left in place for 20 minutes. Ice was administered after the needles were removed to minimize pain and inflammation
The patient reported no changes in his pain level or range of motion immediately after dry needling, but when he returned two days later for a follow-up exam, he reported improved elbow function and reduced pain. Seven days after the dry needling session, he was able to start exercise training again without pain or limitations.
or
Clinical director & DC RMSK
With over 25 years of experience treating tendinopathies, Dr. Kalika has formulated his own unique approach to diagnosis and treatment. As an expert in diagnostic ultrasonography, he has published multiple scientific publications that have helped to take diagnostic medicine to the next level.
Based on the latest scientific evidence and years of experience treating medial epicondylitis, Dr. Kalika considers not only the wrist and elbow, but also the complexities of the upper arm kinetic chain when diagnosing medial epicondylitis. His expertise in high resolution ultrasonography allows him to visualize the elbow and its associated structures in real time, to identify all factors that contribute to golfer’s elbow.
Dr. Kalika’s expertise in ultrasonography makes him one of the most sought-after specialists in NYC for diagnosing and treating golfer’s elbow.
Diagnosis of medial epicondylitis is often symptoms-based, but that approach can result in mistreatment or undertreatment, prolonging the patient’s pain and increasing medical costs. Dynamic high resolution ultrasound imaging lets us see the big picture in real time, with the elbow in motion.
With diagnostic ultrasound, we can:
Ultrasound imaging takes the guesswork out of diagnosis and ensures that the multiple factors that contribute to golfer’s elbow are identified and treated. Ultrasound imaging takes place on-site, in the comfort of our clinic on your very first visit. Quick and accurate diagnosis means you can begin therapy right away, with no wait time for lab results.
For years, MRI has been considered the gold standard for musculoskeletal imaging, but advancements in technology have catapulted high-resolution diagnostic ultrasonography to the top of the heap.
Why high resolution ultrasound is superior to MRI:
Because golfer’s elbow and tennis elbow are fairly common conditions, many doctors are quick to diagnose elbow epicondylitis based on symptoms alone, without ruling out other potential issues. Consequently, patients often go mistreated or undertreated, prolonging their pain without resolving their condition.
Recent research on elbow epicondylitis was presented at the International Society for Medical Shockwave Treatment (ISMST) Congress:
Without ultrasound imaging, diagnosis of elbow epicondylitis is a hit-or-miss proposition. Misdiagnosis can cause critical conditions to go untreated, costing the patient time and money while prolonging their pain and dysfunction.
Most people take everyday mobility for granted until an injury occurs or pain sets in. Sometimes pain and reduced mobility seem to arise out of nowhere, with no apparent cause of onset. Regardless of whether your pain is caused by trauma or by something less obvious, tensegrity plays a key role.
Tensegrity refers to tensile integrity – a state where a system of individual components is held together under continuous elastic tension. In the human body, tensegrity is created by the myofascial system, the network of muscles and fascia that work together to produce, control, and guide forces, and to hold the body’s various organs and structures in place during movement.
Tensegrity can be disrupted when myofascial tissues are injured or damaged in some way. When that happens, nerves and blood vessels can become entrapped, preventing them from gliding among other structures and producing pain. At the same time, the elastic tension that governs joint alignment and controls movement becomes compromised, creating motor deficits that undermine mobility and stability.
Factors that disrupt myofascial tensegrity include:
Many doctors do not understand the crucial role of the myofascial system in preventing pain syndromes, movement disorders, and disease. In fact, most medical doctors have no idea how to correct myofascial dysfunction or even recognize it as a factor. They simply treat pain symptoms with medications and eventually recommend surgery.
At NYDNRehab, we understand that the body’s systems work together as an integrated whole, and that treating pain is not enough to eliminate its source. We use dynamic high-resolution ultrasound to explore the myofascial system in real time. Ultrasound imaging lets us visualize muscles, fascia, nerves and other structures in motion, to identify places where tensegrity has been disrupted.
Once we identify the problem, we use the most advanced therapeutic approaches to restore myofascial integrity and promote tissue healing.
Identifying and treating underlying issues prior to beginning physical therapy is key to getting fast and effective results. Failure to pre-treat your condition can completely undermine your treatment protocol, and in some cases, your condition may even worsen.
Obstacles to physical therapy success include:
At NYDNRehab, we use a broad range of regenerative technologies and integrative therapeutic approaches to resolve issues that can stand in the way of successful physical therapy. Our staff is certified in a diverse array of holistic treatment methodologies, and our one-on-one treatment sessions are personalized, based on your unique diagnostic profile.
Once we pre-treat your damaged tissues and eliminate compensation patterns, your body will be ready to begin physical therapy.
The human body has its own innate healing mechanisms, but it sometimes needs a nudge to accelerate the healing process. Regenerative technologies help to jump-start healing by stimulating tissue repair at the cellular level. Our outpatient regenerative therapies expedite recovery with minimal discomfort for the patient.
SoftWave is a groundbreaking regenerative mechanotransduction technology that accelerates tissue healing. Its patented electro-hydraulic applicator delivers high-speed soundwaves that can penetrate up to six inches in depth. SoftWave’s defocused and linear focused shockwaves recruit maximum stem cells to the treatment site to promote healing. SoftWave’s wider and deeper penetration using defocused energy is a preferred treatment option for a broad spectrum of conditions, ranging from orthopedic injuries to pelvic health. SoftWave is the only unfocused shockwave technology currently available. According to recent research, SoftWave defocused waves combined with focused and radial shockwaves have maximum regenerative potential.
MyACT is a new type of focused shockwave technology that allows for deeper compression of the focused waves. Its higher frequency allows for precise neuro modulation under ultrasound guidance, with a special linear head for treating myofascial pain. MyACT transforms the mechanical energy of shockwaves into biochemical signals that precisely target damaged tissues. Most injuries involve more than one tissue type. When used together, our advanced shockwave technologies enable us to specifically target multiple tissue types with the most effective shockwave treatment.
Focused ESWT is used as a regenerative treatment for damaged tendon, muscle and bone tissue. This technology produces high frequency sound waves to stimulate the body’s own reparative mechanisms. It is especially effective for chronic degenerative tendon disorders and myofascial pain syndrome.
EMTT transmits high energy magnetic pulses to targeted tissues that synchronize with the body’s own magnetic fields, triggering a regenerative response. EMTT waves can penetrate deep tissues to target difficult-to-reach tendons, muscles, bones and nerves.
EPAT, sometimes called defocused shock wave therapy, is not a true shockwave. It uses mechanical pressure waves to enhance blood circulation, improving oxygen and nutrient delivery to muscle and fascia tissues, but has minimal regenerative properties.The mechanical properties of EPAT make it especially effective for fascial manipulation in combination with focused shockwaves. We combine EPAT with different types of shockwaves for holistic treatment, without additional cost to the patient.
HEIT delivers high-intensity magnetic pulses to peripheral nerve tissues, to stimulate neuroplasticity. We leverage this FDA-approved methodology to treat pain and regenerate nerve fibers, for enhanced motor control.
INDIBA is a form of TECAR therapy that helps to restore the ionic charge of damaged cells, for faster injury healing and rehabilitation.
NESA generates a low-frequency electrical current of intermittent and cyclical stimuli that soothes hypersensitized nerves and restores optimal signaling between the autonomic nervous system and the brain. We leverage this FDA-approved methodology to treat pain and regenerate nerve fibers, to enhance motor control.
PRP therapy uses a sample of the patient’s own whole blood, which is spun in a centrifuge to extract a high concentration of platelets. When injected into damaged tissues, PRP initiates tissue repair by releasing biologically active factors such as growth factors, cytokines, lysosomes and adhesion proteins. The injected solution stimulates the synthesis of new connective tissues and blood vessels. PRP can help to jump-start tendon healing in chronic injuries and accelerate repair in acute injuries.
Alpha 2 macroglobulin (A2M) is a naturally occurring blood plasma protein that acts as a carrier for numerous proteins and growth factors. As a protease inhibitor, A2M reduces inflammation in arthritic joints and helps to deactivate a variety of proteinases that typically degrade cartilage.
Prolotherapy uses a biologically neutral solution to irritate stubborn tissues, triggering the body’s innate healing mechanisms to grow new normal tendon, ligament and muscle fibers.
Running injuries often involve fascial tissue that has become densified and/or formed adhesions, entrapping nerves and blood vessels, causing pain and restricting movement. Hydrodissection is a procedure where a saline solution is injected into densified fascia under ultrasound guidance. The solution works by separating fascial layers and freeing up entrapped nerves and blood vessels. We often use hydrodissection in conjunction with manual fascial manipulation.
SM neuromuscular electrical stimulation (NMES) dynamically interacts with the patient during therapeutic exercises, providing real-time sensory, auditory and visual biofeedback to the patient. This breakthrough technology helps patients to recalibrate muscle actions, to optimize joint function. SMNMES has helped numerous patients to avoid unnecessary shoulder, knee and ankle surgeries, even in complex scenarios.
During PENS treatment, filament-thin needles are inserted through the skin into muscle tissue adjacent to the targeted nerve. A low frequency electrical current is then delivered via the inserted needles to stimulate the dysfunctional nerve. PENS normalizes nerve activity, improves brain plasticity and optimizes muscle recruitment patterns. This therapy is so effective that patients typically need only 4-6 treatment sessions.
At NYDNRehab we use a multifaceted approach to provide our patients with the very best treatment for golfer’s elbow.
Your treatment protocol may include:
Your treatment protocol is customized based on your unique anatomical characteristics and patient profile. We measure and reassess along the way, to ensure your therapy is progressing toward pain-free function.
At NYDNRehab, we treat the whole patient, not just your symptoms. We never use one-size-fits-all rehab protocols or antiquated recovery timelines. We believe that every injury is unique, and treatment should be based on a holistic approach that factors in the patient’s unique profile.
Once we have successfully pre-treated damaged tissues, we can begin one-on-one physical therapy to restore strength and stability, optimize mobility, and re-establish optimal neuromuscular pathways and muscle coordination patterns.
Advancements in technology are changing the game in rehabilitative medicine, enabling us to accelerate healing and restore performance at an unprecedented pace. The clinic at NYDNRehab features some of the most advanced therapeutic equipment currently available, and rarely found in private clinics.
Your tendinopathy therapy may include the use of high-tech equipment:
Golfer’s elbow, sometimes referred to as pitcher’s elbow or thrower’s elbow, refers to medial epicondyle pain. It is an overuse injury that has more to do with the wrist than the elbow, and the majority of people who get golfer’s elbow do not play golf.
Whether your condition arises from sports, occupation or everyday activities, there are several things you can do to reduce your risk: