Golfer’s elbow, medically referred to as medial epicondylitis and more accurately described as medial epicondylalgia, is a common cause of pain on the inside of the elbow. While it is often compared to tennis elbow, which affects the outside of the elbow, golfer’s elbow involves the tendons that attach to the medial epicondyle, the bony prominence on the inner side of the elbow.
Despite the term epicondylitis, golfer’s elbow is not primarily an inflammatory condition. Current evidence shows it is more accurately classified as a tendinopathy, where repetitive or excessive loading leads to tendon degeneration, scar tissue formation, and reduced load tolerance. The affected tendons connect the wrist and finger flexor muscles to the elbow and play a critical role in gripping, wrist flexion, and forearm rotation.
Physiotherapy for golfer’s elbow focuses on identifying and modifying the loads contributing to tendon overload, restoring tendon capacity through progressive strengthening, and addressing contributing factors such as technique, posture, and work demands. With early and appropriate physiotherapy management, most people experience a good recovery and return to normal activity.
Key Facts
- Around 90–95% of people with golfer’s elbow are not golfers or competitive athletes.
- Tendon degeneration rather than inflammation is the predominant pathological finding in chronic medial epicondylalgia.
- Conservative management, including physiotherapy, is effective for the majority of cases.
Risk Factors
- Repetitive manual or occupational tasks
- High gripping demands
- Sudden increase in activity or training volume
- Poor technique in sport or lifting
- Smoking
- Obesity
- Type 2 diabetes
- Inadequate warm-up or conditioning
Symptoms
- Pain on the inside of the elbow
- Pain that may radiate down the forearm toward the wrist and hand
- Pain with gripping, lifting, or resisted wrist flexion
- Weak grip strength
- Tenderness over the medial epicondyle
- Tightness through the wrist flexor muscles
- Pins and needles or tingling extending toward the ring and little fingers in some cases
Aggravating Factors
- Repetitive gripping or wrist flexion
- Manual work involving tools or sustained hand use
- Lifting objects with poor wrist control
- Racquet sports, golf, rowing, weightlifting, baseball, or cricket
- Sudden increases in activity or DIY projects
Causes
Golfer’s elbow develops when the wrist and finger flexor tendons are subjected to repetitive or excessive load that exceeds their capacity to recover. Over time, this load results in microtears within the tendon, leading to structural changes such as fibrosis, tendon thickening, and reduced tensile strength.
The muscles involved are responsible for wrist flexion, finger flexion, gripping, and forearm pronation. Activities that involve sustained or forceful gripping place repeated strain on these tendons. Common examples include trades work, cooking, tool use, and racquet or bat sports.
Contributing factors may include poor technique, inadequate conditioning, sudden increases in activity volume, and insufficient recovery time. Cervical spine referral, particularly from the C6/7 region, or median or ulnar nerve irritation can mimic or coexist with golfer’s elbow, which is why a comprehensive physiotherapy assessment is essential.
How Is It Diagnosed?
Diagnosis of golfer’s elbow is primarily clinical and is commonly performed by a physiotherapist or medical practitioner. Assessment begins with a detailed subjective history, including symptom onset, occupational demands, sporting activity, and aggravating movements.
Physical examination typically reveals tenderness over the medial epicondyle and pain with resisted wrist flexion or forearm pronation. Passive wrist extension with the elbow straight often reproduces symptoms. Physiotherapists will also assess shoulder, cervical spine, and neural mobility to rule out referred pain or nerve involvement. In most cases, imaging is not required to confirm the diagnosis.
Investigations & Imaging
- Ultrasound
- May demonstrate tendon thickening or degenerative changes but is not always required.
- MRI
- Used in persistent or severe cases to assess tendon integrity or exclude other pathology.
Physiotherapy Management
Exercise
Exercise is a major component of physiotherapy for golfer’s elbow. Rehabilitation focuses on progressively loading the wrist flexor tendons to restore strength and load tolerance. Isometric exercises are often used early to reduce pain while maintaining muscle activation. Programs then progress to eccentric and concentric strengthening and functional gripping tasks relevant to work or sport demands.
Activity Modification
Physiotherapy management includes modifying aggravating activities rather than complete rest. This may involve reducing gripping force, altering lifting technique, pacing workloads, or modifying sports participation. The goal is to maintain activity while allowing the tendon to adapt safely.
Manual Therapy
Manual therapy techniques such as joint mobilisation and soft tissue techniques may be used to reduce pain and improve movement. Cross-fibre friction massage may be applied to address tendon sensitivity and scar tissue, though it can be uncomfortable initially.
Postural Retraining
Upper limb and shoulder posture can influence elbow load, particularly during desk-based or manual work. Physiotherapy may address postural habits that increase strain on the medial elbow.
Bracing & Taping
Counterforce braces or taping may be used to temporarily offload the tendon during aggravating activities. These strategies support symptom management but do not replace strengthening.
Dry Needling
Dry needling may be used to address muscle tension and trigger points in the wrist flexor muscles contributing to pain.
Shockwave
Shockwave therapy may be used as an adjunct treatment for golfer’s elbow when symptoms persist despite appropriate physiotherapy and load management. In medial epicondylalgia, shockwave is applied to the affected tendon at the inner elbow and is thought to stimulate biological responses within the tendon that can help reduce pain and improve tolerance to loading. It is typically delivered over a short course of sessions and is used to support, not replace, progressive strengthening and rehabilitation. Shockwave therapy is considered low risk, though discomfort during treatment is common and short-lived.
Ultrasound
Therapeutic ultrasound may be used as an adjunct for symptom relief, although evidence supporting its effectiveness is mixed.
Education
Education is essential in golfer’s elbow rehab. Physiotherapists explain tendon pain, recovery timelines, and the importance of progressive loading. Understanding that pain does not necessarily indicate damage helps reduce fear and improve outcomes.
Other Treatments
Pain relief options such as paracetamol or non-steroidal anti-inflammatory drugs may assist with short-term symptom relief but do not address tendon pathology. Corticosteroid injections may provide short-term pain reduction but are associated with poorer long-term outcomes compared to physiotherapy-led management.
Surgery
Surgery is rarely required for golfer’s elbow and is considered only when prolonged conservative management fails. Procedures may involve debridement of degenerative tendon tissue. Post-operative physiotherapy is essential to restore strength and function.
Prognosis & Return to Activity
Golfer’s elbow can be slow to resolve, particularly if symptoms have been present for some time before treatment. Many cases improve within months with appropriate physiotherapy and load management. Early intervention improves outcomes and reduces the risk of chronic pain. Return to activity is guided by pain levels, strength, and functional capacity rather than time alone.
Complications
- Chronic medial elbow pain
- Persistent grip weakness
- Reduced work or sporting capacity
- Recurrent symptom flare-ups
Preventing Recurrence
- Gradually increase load in work and sport
- Strengthen forearm muscles regularly
- Use correct technique during lifting and sport
- Warm up adequately before activity
- Allow sufficient recovery between repetitive tasks
When to See a Physio
- Elbow pain lasting longer than a week
- Weak grip affecting work or daily activities
- Pain worsening despite activity modification
- Tingling or nerve-related symptoms in the hand