All about Golfer's Elbow: Symptoms, Prevention and Management

You might have heard the term "golfer's elbow" and wondered if it's exclusive to those who frequent the greens. 

In truth, golfer's elbow, medically known as medial epicondylitis, isn't even limited to golfers. It refers to the pain and inflammation experienced in the tendons connecting your forearm to the inner side of your elbow. 

This discomfort arises when the tendons and muscles in your forearm are strained due to repetitive motions or excessive force. Though the name might suggest otherwise, you don't have to be a golfer to suffer from this condition. 

Any activity that involves repetitive wrist flexion or gripping, even tasks like gardening, lifting weights, or using certain hand tools, can contribute to its onset. When you have golfer's elbow, you'll likely feel pain on the inner side of your elbow, which may extend along the inner side of your forearm. 

The pain can be exacerbated when you're gripping objects, turning a doorknob, or flexing your wrist. You might also notice stiffness in the elbow, weakness in your hands or wrists, and sometimes even numbness or tingling radiating into one or more fingers, usually the ring and little fingers. 

Recognizing these symptoms early on and seeking appropriate treatment and interventions can help you manage the condition more effectively.

In this blog post, we take a deep dive into what the symptoms of the condition look like, and your best bets to prevent and treat the condition if it's already there.

Symptoms Of Golfer’s Elbow

Pain and Tenderness

Pain and tenderness are often the primary symptoms associated with golfer's elbow. This discomfort originates from where the tendons of the forearm muscles attach to the bony bump on the inside of the elbow. 

Overuse or strain can cause small tears in the tendons, leading to inflammation and discomfort. As a result, the area becomes sensitive to touch or pressure. Activities that involve gripping, lifting, or flexing the wrist can exacerbate this pain. 

It may range from mild discomfort to sharp, severe pain depending on the extent of damage or inflammation. Often, individuals suffering from golfer's elbow notice this pain intensifying during the specific aforementioned actions. 

Stiffness

Stiffness refers to the reduced ability to move the elbow joint freely. This limited range of motion can be a result of inflammation in the tendons of the forearm muscles. 

Overuse of these tendons, through activities such as golfing or even repetitive tasks, can cause tiny tears. These micro tears lead to inflammation and thickening of the tendons, which then restrict the natural movement of the elbow.

Stiffness might manifest as difficulty in fully extending or flexing the arm. A person experiencing stiffness might also find it challenging to perform routine activities, such as gripping objects, turning door handles, or even shaking hands. 

It's also noteworthy that stiffness can be worse after periods of inactivity, like upon waking up in the morning. Effective treatment, ranging from rest and physiotherapy to medications and supplements, can help alleviate this stiffness and restore the elbow's range of motion.

Weakness

Weakness associated with golfer's elbow primarily impacts the muscles of the inner forearm, manifesting as a notable reduction in grip strength. This condition originates from inflammation or micro-tears in the tendons that attach the forearm muscles to the medial epicondyle, the bony bump on the inner elbow. 

Such tendon damage can lead to challenges in gripping or lifting the golf club, affecting swing mechanics and potentially influencing shot accuracy and distance. 

This weakness is often accompanied by a sharp or nagging pain, further restricting the ability to exert force with the affected muscles during a golf game.

It's paramount for golfers to recognize this weakness early in its onset. Proper identification followed by tailored physical therapy and strengthening exercises can halt the progression of golfer's elbow, helping players return to their optimal performance on the golf course.

Regular conditioning and attention to swing technique can further prevent the recurrence or aggravation of this condition.

Tingling and Numbness

Numbness or tingling, medically referred to as "paresthesia," can be an unsettling sensation often described as pins and needles, prickling, or a lack of sensation in a specific area. 

When it comes to golfer’s elbow,  these symptoms can manifest in the fingers, particularly the ring and little fingers. 

This occurs due to the irritation of the ulnar nerve, which passes near the inner part of the elbow, precisely where inflammation or damage from golfer's elbow is present.

The ulnar nerve is responsible for sensation in the half of the ring finger closest to the little finger and the little finger itself. When the nerve is compressed or irritated, it can result in these sensations. 

This can be particularly concerning as a firm grip is vital for control and power during swings. If not addressed, prolonged nerve compression can lead to more severe complications, including motor deficits or chronic numbness. It's vital to seek medical advice and intervention to prevent long-term issues.

Swelling

Swelling refers to the accumulation of fluid in the tissues surrounding the inner bony bump of the elbow. This response typically arises when the tendons connecting the forearm muscles to the elbow experience micro-tears or are overloaded due to repetitive stress, such as the repeated action of swinging a golf club. When the body detects this tissue damage, it dispatches white blood cells and releases proteins, leading to visible and palpable swelling. 

For golfers, swelling can be a sign that the tissues are aggravated and need rest. It can result in restricted movement and discomfort, and, when combined with the pain of golfer's elbow, can significantly impair grip strength and overall performance on the golf course. 

Proper care, which may include cold compresses, elevation, and anti-inflammatory medications, is essential to reduce swelling and alleviate associated symptoms..

Intensified Pain

Pain intensification upon specific movements is a hallmark of this condition. When you flex the wrist towards your forearm or grip something tightly, the discomfort can sharply increase. Even straightforward actions like making a fist or turning the wrist can amplify the pain. 

It's during the swing, especially with an improper technique or repetitive motion, that you might feel a pronounced sting. The tendons, having undergone repetitive strain, become inflamed. 

So, each time you execute a movement involving these tendons, the sensation of pain becomes particularly noticeable. It's like a constant reminder from your body to pay attention. 

Recognizing which actions elevate the discomfort and making necessary adjustments, whether in your daily activities or in your swing, becomes essential for effective management and healing.

How To Prevent Golfer’s Elbow

Utilize Proper Swing Technique

Proper swing technique is the bedrock for both optimal performance and injury prevention. Starting with stance and posture, a golfer should position their feet shoulder-width apart to ensure a stable base. 

This stability is complemented by a slight bend at the hips, a straight back, and an elevated chin, guaranteeing flexibility, rotation, and a clear line of sight to the ball. 

The grip on the club plays a pivotal role in the swing's effectiveness. It should be firm yet relaxed, with hands naturally molding around the club, thumbs pointing downwards, and fingers wrapped securely but without excessive tension. This relaxed grip minimizes strain on the forearms, a common site of injury.

The backswing, initiated by a tandem turn of the shoulders and hips, is a crucial phase where energy gets stored, preparing for the downswing. Keeping the lead arm straight and pulling the club back smoothly sets the stage for a forceful downswing. 

As the downswing commences, the hips lead the movement, followed by the shoulders. By the point of contact, the clubface should squarely meet the ball. A successful swing culminates in a fluid follow-through, with the club naturally ending over the opposite shoulder.

Throughout this intricate dance of movements, maintaining a consistent balance and rhythm is essential. Any rush or uneven application of force can not only affect the shot's accuracy but also increase the risk of injury and predispose you to the dreaded elbow injury.

Choose the Right Club

Choosing the right golf club is for more than just optimizing performance; it's also a preventive measure against injuries like golfer's elbow. The right club can significantly reduce the stress exerted on the tendons and muscles of the forearm, which are implicated in golfer's elbow.

Firstly, the weight of the club plays a significant role. Heavier clubs can increase the strain on the forearm, especially during the downswing and at the point of impact. 

A club that's too heavy for the golfer can cause them to overcompensate in their swing, leading to undue stress on the medial tendons of the elbow.

The shaft's flexibility is another crucial factor. A shaft that's too stiff for the golfer's swing speed may not flex adequately during the swing. This lack of flex can result in greater shock being transmitted to the arm upon ball impact, a potential risk for golfer's elbow.

Additionally, the grip size of the club is paramount. Grips that are either too large or too small for the hand can lead to excessive grip pressure, causing the forearm muscles to work harder. This additional strain, especially if repeated over multiple swings, increases the risk of overuse injuries.

Lastly, the material of the club, particularly the shaft, matters. Graphite shafts, for instance, are known to transmit fewer vibrations than steel shafts, potentially reducing the risk of injuries resulting from repetitive shock.

Strengthen Forearm Muscles

Strengthening the forearm muscles is pivotal not only for enhancing athletic performance in activities that demand wrist and grip strength but also for preventing injuries such as golfer's elbow. 

The forearm comprises several muscles responsible for a range of movements, from wrist flexion and extension to pronation and supination of the hand.

To fortify these muscles, incorporating targeted exercises into your routine is crucial. Wrist flexor and extensor exercises, using light weights or resistance bands, can effectively build strength.

For instance, holding a dumbbell with the palm facing upwards and flexing the wrist upwards challenges the flexor muscles. Conversely, with the palm facing downwards and extending the wrist, the extensor muscles are worked.

Another essential exercise is wrist pronation and supination. Holding a dumbbell vertically by one end, rotate the wrist to turn the weight from side to side. This movement engages the muscles responsible for rotating the forearm.

Hand grippers or even squeezing a tennis ball can enhance grip strength, further bolstering the forearm muscles. Beyond these targeted exercises, climbing, rowing, or any activity that demands repetitive gripping can naturally develop these muscles.

While building strength, it's equally vital to ensure flexibility. Regularly stretching the forearms post-exercise can aid in maintaining a balance between strength and flexibility, fostering muscle health and reducing injury risk.

Avoid Overuse

Avoiding overuse is another cornerstone principle in injury prevention across various sports and physical activities, including golf. Overuse injuries result from repetitive strain without allowing adequate time for the body to recover. Golfer's elbow, which is a form of tendinitis, is caused by consistently applying strain to the tendons in the forearm without appropriate rest.

Overuse is often manifested in individuals who frequently play or practice without breaks, especially those trying to master a specific skill or correct a flaw in their technique. It's not merely the act of playing multiple rounds in succession, but also spending prolonged hours at the driving range, hitting ball after ball.

To sidestep overuse, it's a good idea to heed several strategies. Scheduled rest days are paramount, allowing muscles and tendons the time they need to repair and strengthen. Listening to your body is equally critical. At the onset of discomfort or pain, it's essential to pause and evaluate rather than pushing through, which can exacerbate potential injuries.

In addition, diversifying activities can help offset overuse. Instead of solely focusing on golf, incorporating other forms of exercise can help distribute physical stress across different muscle groups. 

This approach, known as cross-training, can also enhance overall physical conditioning, making you less prone to injuries associated with repetitive motions.

Wear A Brace If Needed

Most people believe that wearing a brace is only necessary if you’re already injured. However, wearing a brace or support, especially in sports and activities that exert repetitive strain on specific body parts, can be instrumental in both the prevention and management of injuries. In the context of golfer's elbow, a condition that affects the tendons on the inner side of the forearm, a brace can provide crucial relief and protection.

Such braces, commonly referred to as counterforce braces, are designed to redistribute the force exerted on the tendon, thereby decreasing tension and alleviating pain. Positioned just below the elbow on the forearm, these braces work by compressing the upper part of the forearm, which reduces the muscle's pull on the affected tendon.

Beyond pain management, a brace can also serve a preventive role. For individuals who are prone to golfer's elbow, wearing a support during activities that involve repetitive wrist and forearm motions can minimize the risk of aggravating or re-injuring the tendon.

However, while braces offer valuable support, they should be used judiciously. Relying excessively on a brace without addressing the underlying causes, like improper technique or muscle imbalances, can be counterproductive in the long run. 

It's also essential to ensure the right fit; a brace that's too tight might impede blood flow, while one that's too loose may not provide the desired support.

Warm up and Stretch

Warming up and stretching form the twin pillars of any effective physical activity preparation, be it recreational endeavors or professional athletics. 

The essence of warming up revolves around gently awakening the body, incrementally elevating the heart rate, and enhancing circulation. Engaging in activities such as brisk walking, light jogging, or even easy swings with a golf club fosters improved blood flow to the muscles. 

This not only makes them more pliable and responsive but also reduces their susceptibility to injury. The increased blood flow also ensures muscles are well-oxygenated, crucial for their efficient functioning.

Following the warm-up, the focus shifts to stretching, a process that further primes the muscles for impending exertion. There are primarily two stretching modalities. 

Static stretching involves sustaining a stretch for a specific timeframe, usually between 15 to 30 seconds. While it's often recommended post-activity to aid recovery and promote flexibility, it can be integrated pre-activity, granted the muscles have been sufficiently warmed up. 

On the other hand, dynamic stretching, better suited as a precursor to physical activity, emphasizes active movement. By employing exercises such as leg swings, arm circles, or torso twists, you can elevate your functional range of motion, mirroring many motions inherent to your specific sport or activity.

For avid golfers, pinpointed stretches that cater to the shoulders, torso, hips, and forearms can be invaluable. These routines not only amplify the golf swing's flexibility but also establish a broader range of motion, thereby mitigating risks associated with strains or repetitive injuries, such as golfer's elbow.

Treatment Approaches

Rest and Activity Modification

Rest and activity modification form the foundational steps in managing many overuse injuries, including golfer's elbow. Their primary purpose is to halt the cycle of damage and allow the body's natural healing processes to take precedence. 

When discussing "rest" it doesn't merely mean abstaining from the activity causing discomfort. It signifies providing the affected tendons and muscles a reprieve from all forms of strenuous or repetitive actions. 

While it might seem straightforward, the true challenge lies in striking a balance. Prolonged rest can lead to muscle weakness or stiffness, which could exacerbate the problem when one returns to activity. Hence, it's essential to find a middle ground: sufficient rest to facilitate healing without allowing the muscles to deteriorate.

Activity modification, on the other hand, encompasses a broader spectrum of strategies. It involves identifying and temporarily eliminating or adjusting the specific motions leading to strain on the injured tendons. For golfers, this might mean tweaking the swing technique, altering grip strength, or changing the frequency of play. 

Outside of golf, this could translate to altering daily routines, switching to ergonomic tools, or using assistive devices to minimize strain on the affected area. The essence of activity modification is adaptability—finding alternative methods to accomplish tasks without placing undue stress on the injured region.

Patiently following these steps is often challenging for avid enthusiasts or professional athletes. However, understanding that this phase is a temporary detour rather than a complete halt can make the journey more palatable. It's an investment in long-term health, ensuring that when you do return to your passion, you do so with vigor and without lingering pain.

Hot and Cold Therapy

Cold and hot therapies have been time-honored treatments, especially for musculoskeletal concerns. Each has its unique mechanisms and ideal application scenarios. 

Cold therapy, or cryotherapy, centers around the application of cold to specific body areas, often using tools like ice packs, cold sprays, or cold water immersion. The primary advantages of this approach include vasoconstriction, which is the narrowing of blood vessels. 

This reduced blood flow can effectively curb inflammation and swelling. Additionally, cold therapy possesses an inherent numbing effect, offering pain relief, especially after an acute injury, by decelerating nerve pain signal transmission. 

Plus, by diminishing cellular metabolism in the affected zone, it can contain post-injury damage. It's essential, however, to ensure that ice doesn't directly touch the skin to prevent potential ice burns or frostbite.

On the flip side, hot therapy, or thermotherapy, utilizes heat, often through hot water bottles, warm towels, or heated pads. The warmth induces vasodilation, expanding blood vessels and thereby promoting blood flow to the targeted region. 

This elevated blood flow can speed up healing by ferrying essential nutrients and oxygen crucial for tissue repair. The penetrating warmth from hot therapy can also relax muscles, making it a suitable remedy for muscle spasms or lingering muscular tension. 

Besides, just as with cold therapy, heat offers pain relief by targeting deep-seated muscles or joints, enhancing their elasticity and mitigating stiffness. However, while hot therapy is often the go-to for chronic issues like arthritis, it's vital to avoid using it on fresh injuries, as it can intensify swelling.

Supplementation

Well-timed supplementation plays an important part in recuperation from a niggling injury. Try the following:

• Omega-3 Fatty Acids: Found primarily in fish oils, omega-3s have anti-inflammatory properties that can help reduce swelling and pain. Regular supplementation can potentially offer relief from inflammatory conditions.
• Turmeric (Curcumin): Curcumin, the active ingredient in turmeric, has been widely recognized for its potent anti-inflammatory and antioxidant properties. It may help reduce pain and inflammation in conditions like golfer's elbow.
• Glucosamine and Chondroitin: Often used together, these supplements are popular for joint health and conditions like osteoarthritis. They can promote joint lubrication, potentially aiding in pain relief and tendon health.
• Collagen: Collagen plays a crucial role in the health and strength of tendons, ligaments, and other connective tissues. Supplements with Radiance Collagen Peptides can support tendon recovery and strengthen connective tissues, which might be beneficial in conditions like golfer's elbow.

Massage and Physical Therapy

Massage therapy and physical therapy are integral modalities in the realm of therapeutic interventions, each offering unique benefits and approaches to physical well-being. Massage therapy is primarily centered around the hands-on manipulation of the body's soft tissues, such as muscles, tendons, ligaments, and skin. 

Through techniques involving varied pressure and movement, it provides numerous benefits, from muscle relaxation and improved circulation to stress reduction and enhanced flexibility. 

By kneading and applying targeted pressure, massage not only alleviates muscular pain but also boosts blood flow, ensuring efficient delivery of oxygen and nutrients to cells. This enhances healing and diminishes muscle soreness. Moreover, the soothing nature of massage offers a profound sense of relaxation, significantly reducing stress levels.

On the other hand, physical therapy, often referred to as physiotherapy, adopts a more comprehensive approach to the physical well-being of individuals. 

Its main focus is the diagnosis, treatment, and prevention of physical impairments, often resulting from injuries or illnesses. Physical therapists utilize a diverse array of techniques. 

They might design personalized exercise regimes tailored to bolster weak regions, enhance mobility, or accelerate recovery. 

Techniques like joint mobilization, where therapists manually move joints to restore movement, are common. Furthermore, they often resort to various tools and modalities, ranging from ultrasound machines to electrical stimulation, to combat pain and inflammation. 

A cornerstone of physical therapy is patient education. Therapists invest time in enlightening patients about their specific conditions, teaching self-management strategies, and guiding them in injury prevention techniques. 

While massage therapy largely focuses on relaxation and immediate relief, physical therapy delves into the underlying causes of pain or mobility challenges, presenting a structured pathway to long-term rehabilitation and recovery. Together, both fields contribute significantly to a comprehensive approach to health and wellness.

Extracorporeal Shock Wave Therapy

Extracorporeal Shock Wave Therapy (ESWT) has emerged as a non-invasive therapeutic intervention particularly useful in addressing musculoskeletal conditions, including golfer's elbow and associated cases of tendinitis.

At the heart of ESWT is the application of high-energy acoustic waves, or shock waves, to the afflicted region. These shock waves are not just random bursts of energy; they play several pivotal roles in alleviating symptoms and promoting recovery. 

Firstly, ESWT introduces microtrauma to the affected area. While this might sound counterintuitive, this microtrauma is instrumental in sparking the body's innate healing mechanisms. It promotes the secretion of vital growth factors and boosts blood circulation, thereby ferrying essential nutrients that are indispensable for tissue repair.

Additionally, a standout effect of ESWT is neovascularization, the genesis of new blood vessels. This not only augments blood flow but also aids in rejuvenating and healing the inflamed or injured tendons typical of golfer's elbow. 

Pain alleviation is another noteworthy benefit. The shock waves curtail the production of pain mediators while simultaneously stimulating the secretion of analgesic substances, granting much-needed relief.

In some cases, golfer's elbow might be accompanied by tendon calcifications. ESWT proves beneficial here too, as it assists in disintegrating these calcium build-ups, allowing the body to absorb and eventually discard them. 

The therapy also positively modulates fibroblast activity, cells vital for the repair and regeneration of connective tissues like tendons. Thus, ESWT not only offers symptomatic relief but also targets the root causes of the condition. 

However, it's essential to underline that while promising, ESWT's effectiveness can differ among individuals, and it's often viewed as an option when traditional treatments fall short. As always, a thorough consultation with a healthcare expert is crucial before choosing ESWT as a treatment path.

OTC And Prescription Anti-Inflammatory Medication

Anti-inflammatory medications, commonly known as nonsteroidal anti-inflammatory drugs (NSAIDs), play a significant role in managing the symptoms of golfer's elbow. 

NSAIDs, which include over-the-counter options like ibuprofen and naproxen, act by targeting and reducing the body's inflammatory response, a key contributor to the pain and discomfort associated with golfer's elbow. 

By inhibiting enzymes responsible for producing prostaglandins—chemicals that promote inflammation, pain, and fever—these medications directly address the swelling and tenderness present in the affected area.

In addition, by curtailing inflammation, NSAIDs can potentially expedite the healing process. Inflamed tendons, if left unchecked, can lead to prolonged discomfort and potentially cause further tissue damage. By reducing inflammation, these medications create an environment conducive to tissue repair and regeneration.

The pain-relieving properties of NSAIDs may also provide immediate symptomatic relief to individuals, enabling them to perform daily activities with reduced discomfort. This relief can also be instrumental in facilitating physiotherapeutic interventions, allowing patients to engage more effectively in rehabilitative exercises without being hindered by pain.

While NSAIDs are undoubtedly beneficial, it's imperative for users to be aware of potential side effects, especially when used over extended periods. These can range from stomach upset to more serious concerns like gastrointestinal bleeding.

Even though many are OTC, they should be used judiciously or after consulting your pharmacist or physician.

Alternative Treatments

While conventional treatments, such as medications and physical therapy, are common, many individuals turn to alternative treatments in search of relief and healing. One popular alternative is acupuncture, an ancient Chinese technique where thin needles are inserted at specific points to balance the body's energy and stimulate natural healing. 

Acupuncture can help reduce pain and inflammation associated with golfer's elbow by increasing blood flow and releasing endorphins, the body's natural painkillers.

Topical applications of arnica, a herb renowned for its pain-relieving properties, might also assist in reducing pain and swelling.

Then there are some individuals who gravitate towards chiropractic care. Chiropractors can employ manipulative techniques to realign joints and alleviate undue pressure on the elbow's tendons. By doing so, they can help restore proper biomechanics and decrease pain.

Lastly, yoga and tai chi are holistic practices that emphasize controlled movements, balance, and breathing. Incorporating these exercises can help stretch and strengthen the forearm muscles, reduce tendon strain, and improve overall joint flexibility. 

The meditative components of these practices might also offer mental relaxation and stress reduction, which can indirectly aid in the healing process of golfer's elbow. It's vital, however, for anyone considering alternative treatments to consult with a healthcare professional to ensure safety and appropriateness for their specific condition.

Bracing

Bracing is a common recommendation when you're dealing with conditions like golfer's elbow. The pain can even sometimes spread into your forearm and wrist. So, how can a brace help you manage this condition?

Firstly, wearing a brace, especially a counterforce brace, around your forearm can help distribute pressure across the arm, ensuring that the entire load isn't borne by the tendons of your elbow. 

By doing this, you're reducing the strain on the tendons, which can aid in alleviating pain and discomfort. When you wear a brace, you'll often find that you can perform certain movements that would otherwise cause pain, with significantly more ease.

Furthermore, a brace acts as a constant reminder for you to avoid overusing the affected arm. When engaging in activities that require repetitive hand, wrist, or forearm movements, it's easy to forget the condition and unintentionally exacerbate it. However, with a brace snugly wrapped around your forearm, it serves as a tactile cue, subtly nudging you to be cautious.

The compression provided by the brace can help reduce inflammation and swelling as well, two primary culprits behind the pain of golfer's elbow. By compressing the affected area, you're promoting better blood flow, which can facilitate quicker healing. And, while the brace aids in alleviating symptoms, it simultaneously provides support to the muscles and tendons, ensuring they heal correctly without further strain or injury.

Remember, while bracing can be beneficial, it's crucial for you to pair it with other treatments such as physical therapy or exercises to effectively address golfer's elbow.

Surgery

When you're grappling with the persistent pain of golfer's elbow, and have exhausted all non-surgical interventions, surgery might be presented to you as a potential solution. 

The persistent inflammation and pain in the tendons connecting your forearm to the elbow can be debilitating, especially if it hampers your daily activities or passion for sports. Surgery, though considered a last resort, can provide you with relief when other treatments fail.

In the surgical approach, your surgeon would typically focus on removing damaged tissues from your tendon, promoting an environment for healthier tissue growth. By making a small incision on the inner side of your elbow, the surgeon can access the damaged tendon, excise the degenerated tissue, and, if necessary, reattach healthy portions of the tendon to the bone. This procedure aims to relieve pain by addressing the root cause—damaged or degenerated tendon tissues.

Post-surgery, you'll likely engage in a structured rehabilitation program, guided by a physical therapist, to restore strength and flexibility in your elbow and forearm. This period of rehabilitation is crucial, ensuring that you not only recover from the surgical procedure but also regain or even enhance your elbow's functional capability.

Remember, while surgery can be highly effective, it's not without risks. Potential complications, albeit rare, can include infection, nerve damage, or issues related to anesthesia. 

Final Words

Golfer’s elbow can feel like the end of the world for you, but oftentimes, only if you allow it to get too far. Well-timed rest, along with good nutrition and knowing when to seek help can make a huge difference and prevent the worst outcomes.