A man in his 40s from Minato Mirai came to the clinic with right elbow pain that had been bothering him for about half a year.

After participating in a golf competition six months ago, the patient began experiencing pain on the inner side of his right elbow.

Each time he practiced golf thereafter, the pain worsened, prompting him to consult an orthopedic clinic. The physician diagnosed him with “golfer’s elbow,” but no specific treatment was provided at that time, other than prescribing painkillers and anti-inflammatory patches. During subsequent visits, he was instructed to perform stretching exercises and was later advised, “If the condition does not improve, we will proceed with a steroid injection next time. The pain will disappear immediately.” He recalled during his consultation at my clinic that he had thought, “If that’s the case, I wish they had given me the injection from the beginning.”

Although the steroid injection temporarily relieved the pain, it recurred once he resumed playing golf, leading to a cycle of repeated injections. This made him question whether there was a more fundamental approach to resolving the issue. As a result, while continuing his treatment, he decided to visit my chiropractic clinic—conveniently located near his home in Minato Mirai—for additional care.

[Initial Symptoms]

Interview:

In addition to golf, he occasionally experienced pain during daily activities—for example, when lifting objects or when rising from a chair—at the very moment his arm exerted force.

Visual Inspection:

On visual inspection, no abnormalities were observed.

Static Palpation:

Compared to the left side, there is overall increased tension in the muscle group attached to the medial epicondyle of the right elbow (pronator teres, flexor carpi radialis, palmaris longus, and flexor digitorum superficialis).

Motion Palpation:

No remarkable findings were observed on dynamic palpation; however, discomfort was noted at the medial epicondyle (ulnar side of the elbow) during supination (twist outward).

Orthopedic Tests:

Golfer’s Elbow Test: Positive.
(This test evaluates for medial epicondylitis by having the patient flex the elbow to 90°, then applying resisted extension force. The test is considered positive if pain is elicited at the medial epicondyle.)

Muscle Strength Examination:

The muscle group attached to the medial aspect of the elbow (as noted in the static palpation section) was assessed as weakened due to pain.

[Initial Treatment Plan]

In order to observe whether symptomatic improvement could be achieved solely at the affected site without addressing other regions, the initial treatment session was limited to the following interventions at the elbow:

  • Improving flexibility of the flexor-pronator muscle group attached to the medial side of the elbow
  • Correction of the range of motion and alignment of the radius and ulna comprising the elbow joint
  • Ultrasound therapy applied to the medial epicondyle of the elbow

The patient was asked to return one week later.

[Prognosis]

2nd Visit:
The patient reported slight improvement in daily pain, describing the discomfort as “still present, but lighter than before.” Within the week, he practiced once at the driving range, but due to pain, he could swing with only about half his usual strength, the same as before treatment.
Treatment was focused on the elbow as in the previous session, followed by alignment work on the upper arm muscles (biceps/triceps), wrist, and shoulder joints.

3rd Visit:
One week later, the patient reported no longer experiencing pain during daily activities. Pain still appeared during golf over the weekend, but the intensity was lower than before, and the duration of discomfort was shorter compared with prior to treatment.

4th Visit:
As the previous session had shown good results, the same treatment approach was continued.

5th Visit:
The results plateaued compared with the 3rd visit. Pain during daily activities had disappeared, but discomfort still occurred during golf, though with reduced intensity. Considering that the swing mechanics might be contributing to the problem, treatment was extended to include alignment adjustments of the lumbar spine, pelvis, knees, and ankles to help distribute the load during the swing.

6th Visit:
This broader approach brought dramatic results. Pain during golf was almost completely gone. Despite spacing sessions two weeks apart, the patient played golf four times within that period and experienced only minimal discomfort. On a scale where the initial pain was “10,” the pain had reduced to about “2–3.”

7th Visit and Onwards:
Treatment has since transitioned to maintenance care. The patient now continues care not only for the elbow but also for prevention of general musculoskeletal issues such as shoulder stiffness and lower back pain.

[Practitioner’s Opinion]

This patient presented with a classic case of golfer’s elbow (medial epicondylitis). The elbow joint is anatomically designed for flexion and extension, but it is not well suited for rotational movements.

Sports such as golf and tennis often involve torsional forces on the elbow, and the use of centrifugal force places additional instantaneous stretching stress on the tendon, which can contribute to inflammation.

This particular case was no exception—the condition developed as a result of repetitive stress on the medial tendon of the elbow.

During treatment, the improvement was limited when addressing only the elbow. Transitioning to an approach that focused on adjusting the body’s core alignment produced better results.

By improving the mechanics of the golf swing, the patient was able to utilize the lumbar spine, pelvis, and hips more effectively, thereby distributing the load and reducing stress on the elbow.

As is true in many cases, symptoms should not be assessed solely at the affected site but rather within the context of the entire body.

That said, considering time constraints, the initial session focused on the local area of pain, with progress observed over time. In this case, it took some time before I determined that a more comprehensive, whole-body approach would be necessary.

Since symptoms improved to a certain degree with local treatment alone, deciding whether to continue focusing on the elbow or to broaden the scope of care was challenging.

Currently, the patient has recovered well and is able to enjoy playing golf again, requiring only monthly maintenance visits, which marks a positive outcome for this case.

At Spine Chiropractic, I address a wide range of musculoskeletal conditions directly impacting daily life, not merely as a form of relaxation therapy. Conveniently located within a one-minute walk from Bashamichi Station, an eight-minute walk from Nihon-Odori Station, a seven-minute walk from JR Kannai Station, and a 12-minute walk from JR Sakuragicho Station, my clinic is well-suited for residents and workers in the Yokohama area.

If you are experiencing similar symptoms, please feel free to visit Spine Chiropractic. I am committed to providing care with sincerity and professionalism.