Why do I have RSI?Jan 13
Repetitive strain injury (RSI) is the term used to describe a range of painful conditions of the muscles, tendons and other soft tissues. It is mainly caused by repetitive use of part of the body, usually related to a task or occupation. Leisure activities can also be a cause, especially sports of a repetitive nature, however RSI does not necessarily involve repetition of the same movement.
Unlike a normal strain following a sudden impact and/or injury, the symptoms of RSI can persist well beyond the time it would take symptoms of a normal strain to ease.
There are many forms of RSI ranging from tendonitis to carpel tunnel syndrome, the one we are going to focus on is golfers elbow.
What is golfers elbow?
The symptoms of golfers elbow present with pain on the inside of the elbow, this is especially true when gripping. The pain is caused through wear and tare of the tendons attaching the forearm flexor muscles to the medial elbow (medial epicondyle).
Why do I have golfers elbow?
Well despite what people think its not usually the elbow or tendon its self that is at fault but something else in the chain that is either tight or shut down, it is rarely where the pain is that is the cause of the issue.
Remember the old children’s song , your thigh bone is connected to your hip bone well it turns out they weren’t lying to you with this one, every part of the body affects every other part of the body. I won’t go into much detail here but have you ever noticed that if you have a sore knee or leg that you end up limping or walking slightly different to avoid the pain. If you have ever done this for long enough then you may have noticed that you start to get pain in your hips or lower back, most people will only notice the pain going up as high as the lower back, but if a change in gait (walking) is left unchecked for an extended period of time it can actually cause pain or mechanical changes in the thoracic spine (mid back) and into the shoulders. This mechanical change will eventually manifest as pain in the shoulders or elbows or wrists depending on where the weak point is or the point that is under most stress. Most people would see this as an issue with the area that is presenting pain, however the actual problem is from somewhere else in the body.
So with the very simple explanation above in mind lets look how the average weekend golfer (or untrained golfer) can develop golfers elbow. Most if not all club golfers do not train their body so they can be strong enough to avoid injury, so the vast majorities have bad posture especially when you add to this their desk job, which involves sitting for hour after hour day after day.
The combination of being weak and tight in all the wrong areas, and spending excessive hours sitting a week does 2 main things. This is, tighten the hip flexors and round the thoracic spine. Lets first look at the hip flexors, in a seated position the hip flexors are constantly in a shortened position (as shown below), as the femur is closer to the lumbar spine which leaves the psoas in a shortened and therefore tight position.
If the hip flexors get tight this causes the lower back to arch excessively, which causes the thoracic spine to round forwards (this is also a common cause of tight hamstrings).
The second main area a seated position affects is the thoracic spine, not only is the thoracic spine forced to round due to tight hip flexors, but adding to that the seated position forces the thoracic spine to round as well, which reinforces the problem. The constant rounding of the thoracic spine will lead to poor mobility of the area in which the ability to extend the spine out of flexion will be reduced, it will also lead to the tightening of the Pecs, Lats , and upper rectus abdominus, whilst simultaneously lengthening and weakening the lower traps, rhomboids, and accessory shoulder retractor muscles. Even if you constantly think about keeping a straight back gravity will force you into a rounded position sooner or later, the vast majority of people do not have the strength to fight against gravity in a seated position, the upper body rounds and slumps into a hunch back of Notradaime esque position.
All of which leads to poor shoulder mechanics, poor spinal alignment and a risk of injury.
How exactly does this cause golfers elbow?
Let me put it this way, I have witnessed my Dad put his back out on 2 separate occasions through the extreme activities of, brushing his teeth and the second time putting on his socks. As hilarious as it is to make out that he can not pick up a tooth brush and has the worlds heaviest socks, it is clearly not the activity that caused his back to go, it was in fact the years preceding the incidents of failing to stretch tight muscles and to spend time strengthening muscles that support good posture and a strong back. (Indecently this caused him to miss out on golf for a number of months, and have to start stretching and exercising to become pain free and start golf again)
Whether you want to admit it or not golf is a sport if you are weak and have poor postural alignment you are going to get injured sooner or later.
Lets look at how it happens, if you have poor posture with rounded shoulders and a rounded thoracic spine, then you will have poor mobility in the shoulders and a lack of rotation through the torso. You then place a golf club in your hands and try and hit the ball as far as possible with all your effort. When trying to do this with poor mobility and flexibility the outcome is usually to let the front foot lift to gain extra rotation, this actually puts the body in a weaker position as there is no grounding or coil through the body and thus you lose the power from your body and its rotation. The only way you can then create power is through the limited uncoil of your torso, but mainly through the extension or your elbow. As you swing down, the body will uncoil much faster than the elbow extends due to the bodies limited rotation, this will cause the elbow to be in a disadvantageous position putting excess stress through it. As well as the elbow being is a poor position it will get added wear and tear, due to the inertia of the club pulling the elbow into extension and away from the body (this would not usually be a problem as the shoulder would have the ability to take some of the force and reduce the tension on the elbow, however the poor shoulder mobility of most people stops it from helping).
This will inevitably lead to injury as your body is not designed to put such force through a single joint, it is designed to generate and absorb force through multiple joints thus dissipates forces evenly through the body to minimize wear and tear.
How do I fix it?
Well the good news is, it is not as difficult as you think to start fixing it, the bad news is it takes a fair amount of consistent dedication to fix.
What you need to do is dedicated you time to the following stretches and trigger points.
- Hip flexors
- Lat stretch
- Chest stretch
- Horizontal foam roller
Alternatively you can follow through level 1 of golf’s missing link, which will also add in the exercises to start strengthening your weak muscles as well.