Podcast 29 - Golfer's Elbow

Golfer's Elbow


Dr. Chad Edwards: This is Dr. Chad Edwards and you’re listening to podcast 29 of Against the Grain. Are you tired and fatigued? Are you frustrated with doctors because they just don’t seem to listen? Do you want to fix your pain without surgery? If you answered ‘yes’ to any of these questions, then we are the clinic for you. We offer prolotherapy, PRP or platelet-rich plasma therapy and stem-cell injections, IV nutrition therapies, bioidentical hormone replacement therapy and functional medicine to get you back on track to optimal health. Call our clinic at 918-935-3636 or visit our website at www.revolutionhealth.org to schedule your appointment today.
Speaker: Welcome to Against the Grain podcast with Dr. Chad Edwards. Where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field with real stories from real patients to help you on your way to a healthy lifestyle. Get ready, because we are about to go against the grain.
Marshall Morris: Hello, welcome. My name is Marshall Morris and today I am joined by Dr. Chad Edwards who believes that 80% of medical recommendations are crap, technically speaking there. He is the author of Revolutionize your Health with Customized Supplements and he’s served in the US Army for 23 years as both as an enlisted soldier and as an officer, as a physician. He graduated from medical school at Oklahoma State University and he is the founder of www.revolutionhealth.org and the Against the Grain podcast. Dr. Edwards, welcome.
Dr. Edwards: Thank you so much, Marshall. I appreciate you being here to help me through all this stuff.
Marshall: I wish that my beauty can match yours [laughs].
Dr. Edwards: Beauty is in the eyes of the beholder. What can I say.
Marshall: [laughs] Dr. Edwards, what are we talking about today, for all of our listeners?
Dr. Edwards: One of my passions is prolotherapy, and we talked about that last week, in last podcast, we talked about a shoulder injury called a slap lesion, and there are so many different injuries that we can talk about. And I thought we’d focus a little bit on Golfer’s elbow.
Marshal: Do you golf?
Dr. Edwards: No.
Marshall: I don’t golf either.
Dr. Edwards: People say, “Do you play golf?” And I say, “No, golf plays me.”
Marshall: Yes.
Dr. Edwards: I’m a shooter, so I call competitive shooting my golf.
Marshall: There you go. Okay. We’re talking about Golfer’s elbow and something that you’ve seen patients coming to your clinic with?
Dr. Edwards: Absolutely, it’s not uncommon. In fact, I bought some land and put a big barn up on it, and I hired some other guys to help. But built this gigantic pole barn by myself. I’m out doing framing work, and I’ve got a hammer, and it’s a big size, large, heavy framing hammer that you can drive a nail in with a couple of swings. We are doing all this stuff, and I started getting this pain right on the inside of my arm. In fact, I still have a little bit of it, but– right there where the muscles attach to your elbow on the inside. Tennis elbow is on the outside. We’ll talk about that some other time. But the Golfer’s elbow is the one in the inside. The other name for it is Medial Epicondylitis.
Marshall: Wow.
Dr. Edwards: Yes, exactly. All the muscles that make your fingers curl, like you’re making a fist, and the ones that make your wrist flex, like you’re doing wrist curls, all of those muscles come up and attach to this medial epicondyle that’s on your humerus, on the upper arm bone. All those things are attached in one place, and if you’re doing lots of swinging, gripping, flexing, those kinds of things, you can irritate that area. I figured that would be a good thing to talk about.
Marshal: Okay, so it’s called Golfer’s elbow because so frequently, golfers will go out to play around, maybe, every day for a week and build– this pain will manifest itself in their elbow, or what’s the deal?
Dr. Edwards: Yes. I don’t know if they were just jealous that tennis elbow had a name-
Marshall: [laughs].
Dr. Edwards: -and they needed something. But on the swing, on a golf’s swing, the way you bring that on the rear hand, I don’t know what you call it-
Marshall: Sure.
Dr Edwards: -the driving hand maybe? I don’t know what you call it, the one on the back, or the high one, when the golf club is up. That one, there’s a lot of flexion associated with that one, and as you’re going through to hit the ball, and with doing that repetitively, you can irritate that same area because of that flexion of the wrist, and so you will often see that in golfers. Now, interestingly, I’ve seen Golfer’s elbow in tennis players and I’ve seen Tennis elbow in golfers. It doesn’t always follow the same thing, but we can pretty easily address that with prolotherapy.
Marshal: What do most people do when they have this Golfer’s elbow and how long does it really stay around being a nuisance there in their elbow in terms of pain, just nagging them?
Dr. Edwards: I think that most things in the body should heal on their own. I often, I’m a ‘hands off, let it do its thing, let’s see what happens, let’s see if this thing will heal on its own.’ And I usually recommend giving a six to eight weeks, because most things, if they’re going to heal themselves, they’re going to heal within that period of time. The ones that don’t, now we need to do something about that. How do we treat that?
There’s lots of things that– traditionally, we will treat, some intervention that we can do. There’s things like physical therapy, you can use ice. The standard sports medicine dogma is RICE: rest, ice, compress, elevate. As we’ve talked about in the past about how I got into prolotherapy, when the guy came up and did his in-service exam talking about Tulsa prolotherapy and said, “Don’t use ice after an injury.” I was just like that– pretty sure that’s heresy. I think he might go to hell for that. As I started looking at the research, there wasn’t good evidence to support the use of ice after an injury, so I thought, “Maybe he’s onto something.”
And when you look at the way the body heals, inflammation is a healthy process in the acute phase, a couple of weeks after an injury, that kind of phase. But that ‘rest, ice, compress, elevate’– obviously, ice, we’ve got some straps that we can use and put it around there and then put some compression on that thing, obviously resting and don’t do things that irritate that area, and then elevate holding it above the level of the heart and try and reduce that inflammation, all those things. That’s kind of a standard sports medicine dogma. You can do ice massage that goes along with the ice, but certainly there is some massage components associated with it. But as we’ve talked about in previous podcast on Tulsa prolotherapy, these ligaments and tendons, specifically this one is a tendon, they just don’t heal well. Either it heals or it doesn’t, and, of course, I don’t see the ones that heal on their own, they don’t come and see me-
Marshall: Sure.
Dr. Edwards: -and I understand that. From my perspective, all of them have to be fixed because none of them get better, but there’s definitely a selection bias associated with that. With any injury, avoid– as far as therapy across the board -avoid anti-inflammatories, those kinds of things. We’ll talk a little bit more about that in a minute but that’s standard sports medicine dogma of RICE, that’s how most people would treat it. Before I started doing Tulsa prolotherapy, it’s certainly what I would do – recommending that ‘rest, ice, compress, elevate’.
And there is definitely other options. Certainly, we might send them to physical therapy, occupational therapy. They may or may not get better, and some of this things — I think it’s important to understand the way the body heals. In the first 72 hours or so after an injury is called the inflammatory phase, and then for six weeks, we have what’s called the proliferative phase, where we’re proliferating new collagen based on that inflammation. And then for 18 months after the injury, we have what is called the re-modelling phase. You stimulated the inflammatory response one time, and you get inflammation, proliferation, and re-modelling all from that one stimuli. So up to 18 months after an injury, we can see added benefit. I’m sure a lot of people will see that they just slowly get better over time. I’d had injuries like that. And if we don’t do anything, don’t do anything to make it worse, lots of these things will improve over time.
But most of the healing is going to occur in that first few weeks. If you have zero improvement at six weeks, it’s unlikely that it’s going to completely resolve at 18 months.
Marshall: Okay, so most golfers or anybody that has this pain on the inside of their arm, at the elbow, the common way to heal it or encourage healing is to reduce the inflammation. But the inflammation is actually the body’s reaction to healing, is what most people might not understand. What would you say is the alternative to that or why is that better? Why is there a better solution to that?
Dr. Edwards: You’re going back to that RICE approach, the standard sports medicine dogma, you’ve got to rest it. Don’t continue to do the things that are making it mad. If you got a scab, or if you have a cut, and you continually pick on that scab, it don’t heal. You never give it the appropriate environment to heal. If you get Golfer’s elbow, whether it’s because of golf, or because you’re building a barn on your land or because of whatever, if you continue to do the same things that caused it, it’s unlikely that it’s going to get better on its own. If you’re continuing to do those same activities.
We get into an area where– like with golf, if you’re on your swing, you’re developing Golfer’s elbow or you’re building your barn, or filling in the blanks, whatever it is that you’re doing, you’re getting an injury, you’re getting a pain because of that, the standard dogma is – you got to stop doing that. Let that digest for a second. You’ve got a golfer that loves to golf and I’ve got a long-term family friend that has gone pro a couple of times and he’s a big golfer, and he’s in his late 60s if not early 70s, and he’s very proud of the fact that he golfs at his age. He’s a pretty good golfer. But if I told him, “You’ve got a tendinopathy in there, you’ve got medial epicondylitis, you’re going to have to stop playing golf” [laughs], the only way that’s going to end is with him saying, ” I don’t think so.”
Marshall: [laughs].
Dr. Edwards: And he’ll just deal with the pain. When I was in the army, we talked about, either, I don’t remember, it was earlier in this podcast or a previous podcast, people trying to hide their injuries and with my guys, my special operators that I worked with, if I told them, “You just got to not run, you can’t do this, you got to stop doing that”, it’s unacceptable, that doesn’t work. And if I tell them that’s the only way they’re going to get better, they are just going to quit coming to see me. And the bad thing is, one time they may really need something that I can offer them and they won’t come to see me because I’ve lost them, I’ve lost their respect. It’s unreasonable to say, “Just stop doing that.” My runners don’t quit running, my weight lifters don’t quit weight lifting, my cross fitters don’t quit cross fitting, my golfers don’t quit golfing.
So why am I going to tell them that? And then, when they come back, I’m going to ask them, “How are you doing with that rest?”, and they’re either going to tell me the truth and– we know that whatever I recommend they’re not going to do, or they’re going to just lie to me and say, “It’s going great”, and I’m going to be the idiot that thinks I’m helping them a lot by telling them to rest. Again, sometimes they get better on their own, but Tulsa prolotherapy is an option where we can do an injection, they can generally continue their activity, but, we talked about anti-inflammatories, so anti-inflammatories, especially if you consider golf– they want to continue playing golf but it hurts, so you do something that makes it not hurt. And so medications can be beneficial for making it not hurt, but that inflammation, as you mentioned earlier, is part of the healing process and taking anti-inflammatory medications inhibits that healing.
Marshall: Okay, we’re going to talk, when we come back from the break, about the application, the Tulsa prolotherapy procedure and how that can help the healing process of Golfer’s elbow.
Chad: Absolutely.
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Marshall: Okay, we are back with Dr. Chad Edwards and we’re talking about Golfer’s elbow. The pain on the inside of the elbow, golfers develop it, maybe you’re out swinging a hammer, producing a lot of flexion on that part of the arm. Prolotherapy as an alternative – how does prolotherapy help and why is it a good alternative?
Dr. Edwards: Yes, first of all, Tulsa prolotherapy does nothing other than stimulate your body to heal itself. It’s an injection that we inject into the tender areas, stimulating the inflammatory response and when we repeat that inflammation in a focused area, your body can often heal itself. It’s got a great track record, it’s been around for a long time and it’s got a greater than 85% success rate.
The other cool thing is that most of the time you don’t have to stop doing what you’re doing. You’re still getting the benefit of that inflammation without having to stop, completely at least. Sometimes we’ll curtail it, but it is– I’ve been in prolotherapy nearly eight years and it is extremely rare, I’m thinking maybe four or five times have I told someone, “You really need to back off the activity that you’re doing.” It’s extremely rare, most of the time they can continue doing what they’re doing.
Marshall: Okay, you can continue doing what you’re doing. How would you classify it, minimally invasive or– it’s not even invasive, it’s an injection, right?
Dr. Edwards: Right. Anything that we’re intruding into the body I would consider invasive. I agree with your statement, it is minimally invasive. It’s something that we can do in the in the clinic, most the time it just takes a couple of minutes, you might need to do an exam and you’ll have a little bit of a discussion, but the procedure itself takes a minute or so, and it is extremely rare that we get one that we don’t get better. I’ve got police officers and SWAT team members and certainly Special Operations in the military, and housewives, and the full spectrum of people that come in with this specific injury and most of the time we get them better and get them back on their feet. It’s a process, doesn’t cure overnight, it doesn’t heal overnight, it doesn’t fix itself overnight, but with the average patient in between three and six rounds or treatments, our success rate is very, very good.
Marshall: What do you recommend in terms of time between rounds?
Dr. Edwards: Generally, I would say about four weeks. There’s two components to the healing process: one is stimulating the inflammatory response, and the second is time. It just takes time for some of the stuff to heal. But my goal– because sometimes, it’s human nature, we want to be fixed yesterday. It’s human nature that we want it healed as quickly as possible and sometimes some people will say, “I just got to get this fixed” and they’ll consider something like surgery.
I would argue for medial condolytis, in fact I’m not aware of a surgery for that, nor do I think it would really fix it, but we want to get better yesterday. With prolotherapy, my goal is that, a year from now we don’t have this conversation. That it’s done, it’s behind you and the animal studies, they did prolotherapy on, I think it was rabbits– and they looked at the ligaments after they had done several rounds of prolotherapy, and the ligaments were 40 percent thicker and 50 percent stronger than the control group. In other words, we can make the ligament thicker and stronger than it was before you injured it.
Marshall: Can you do prolotherapy over my whole body?
Dr. Edwards: Yes, I wouldn’t recommend that at the same time-
Marshall: [laughs].
Dr. Edwards: -and the way you said it sounded a little bit perverted, but-
Marshall: Okay-
Dr. Edwards: [laughs].
Marshall: -that’s fair, but prolotherapy can prevent further pain, on down the road. If you’re planning on golfing, or if you are planning on building multiple barns on your land-
Dr. Edwards: [laughs].
Marshall: -then you could actually strengthen the ligaments in your arms, so that maybe the pain doesn’t come back in the future.
Dr. Edwards: That’s correct. Whatever caused it to begin with, may very well not cause it again.
Marshall: That’s awesome. Prolotherapy – awesome, awesome alternative, where do they go to find out some more information about this?
Dr. Edwards: You can certainly go to our website www.revolutionhealth.org. Give us a call 918-935-3636, schedule your appointment, it doesn’t matter where you’re coming from, you can come from out of town, we get patients that come out of state all the time. Tulsa International Airport, right down the road, you can fly in to see us.
Marshall: The birthplace of tourism, Tulsa, Oklahoma.
Dr. Edwards: That’s exactly right. It’s a very easy procedure, easy to get done and we can get you back on track probably quicker than most things.
Marshall: That’s awesome. Dr. Edwards, thank you so much for joining us today to talk about Golfer’s elbow and prolotherapy.
Dr. Edwards: Awesome, thanks, Marshall, I appreciate you.
Speaker: Thanks for listening to this week’s podcast with Dr. Chad Edwards. Tune in next week, where we’ll be going against the grain.
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