For several years, Mr. K and Mr. T. played tennis together almost every Saturday. Their friends, Mr. V. And Mr. H, who preferred golf, scheduled regular tee times. These weekly activities kept them feeling young and fit, until about the time they turned 45 and all developed elbow pain. Tiger Woods and Andre Agassi never seemed to have this problem, they thought. Why did they?

Unfortunately, as we age, we lose muscle strength as well as flexibility which results in decreased wrist flexion and extension. Chronic tendonitis of the elbow is more commonly developed from 40-55-years of age than in younger athletes, and caused by forceful repetitive motion, like with swinging a racket or golf club.

Golfer’s and tennis elbow seem almost endemic in golf and tennis clubs. Even though these conditions are quite similar, tennis elbow is caused by repetitive micro trauma to the extensor tendons of the forearm, while golfer’s elbow affects the flexor tendons.

The two muscle groups that extend from our wrist to our elbow are: the extensor muscle group, which is attached to the lateral epicondyle of the humerus (bony prominence on the outside of the elbow) and the flexor muscle group, attached to the medial epicondyle of the humerus (bony prominence on the inside of the elbow). Generally, repeated forceful contractions of these muscles, initiated by wrist flinging, can produce tendinitis, causing constant localized pain from the elbow down the outer or inner forearm. At times, pain can be so severe that even holding a coffee cup, carrying a bag, or shaking someone’s hand is unbearable.

When you hit a backhand, the racket usually absorbs most of the impact of the ball. However, the forearm muscle, especially when poor technique is used or if in poor physical condition, absorbs most of the impact, straining the extensor tendon of the elbow. For golfers, repetitive wrist and forearm flexion along with improper technique and poor muscle condition when swinging the club strains the flexor tendon of the elbow. In both cases, secondary inflammation may occur and become chronic due to continued overuse or misuse of the extensor and flexor tendons.

Interestingly, many other activities can cause tennis or golfers’ elbow: bowling, excessive writing or wrapping, and repeated throwing, such as baseballs and Frisbees.

Initial treatment for both tennis and golfer’s elbow should include a combination of NSAIDS and physical therapy, along with local hot and cold pack applications, counter braces, and technique instruction. Acute cases can even be resolved after a corticosteroid injection into the affected tendon. Finally, repetitive activity that may aggravate your condition should be, if not avoided, then at least decreased.

You can swing and putt your way back on the court and green. All you need is to do like the pros: warm-up, strengthen and use your muscles wisely. It’s all part of their technique.