Pain on the inside of the elbow
It starts as a dull ache on the inner side of the elbow. Then it catches you when you lift the kettle, carry a heavy bag, wring out a cloth or grip a tool for too long. You may never have played golf in your life. Despite the name, golfer's elbow is mostly a problem of hands and forearms that work hard, whether at a desk, on a building site, in the garden or at the gym.
The good news is that golfer's elbow treatment is usually conservative, and most people improve with the right mix of patience and progressive loading.
What is golfer's elbow?
Golfer's elbow, also called medial epicondylitis or medial elbow tendinopathy, affects the tendons on the inner side of the elbow that you use every time you grip, lift or twist. They join the forearm muscles that bend the wrist and fingers and turn the palm down to the bony bump on the inside of the elbow (Amin et al., 2015).
Despite the "-itis" in its older name, it is not mainly an inflammatory problem. Like other tendinopathies, it is a change in how the tendon is structured and how it copes with load, often after a period when demand outgrew its capacity (Millar et al., 2021).
How common is it?
It is less common than the better-known tennis elbow, which affects the outer side. In a Finnish population study of nearly 5,000 working-age adults, about 0.4% had golfer's elbow at a given time, compared with 1.3% for tennis elbow, and it was most common between the ages of 45 and 54 (Shiri et al., 2006).
What increases the risk?
The same study found that repetitive arm movements and forceful activities were each linked to golfer's elbow, as were smoking and obesity (Shiri et al., 2006). In practice, common triggers include:
- a sudden increase in gripping or lifting at work or at home (DIY, gardening, moving house)
- new or heavier gym work, especially pull-ups, curls and rows
- throwing sports, racket sports and, yes, golf, particularly when technique or volume changes
- long hours using a mouse, tools or a steering wheel with a tight grip
Typical symptoms
- pain and tenderness on the inner bony point of the elbow
- pain when gripping, shaking hands, lifting with the palm up or turning a key
- pain that may spread a little down the inner forearm
- stiffness first thing in the morning that eases as you move
Inner elbow pain is not always the tendon. The ulnar nerve runs just behind that bony bump, and it can be irritated at the same time. Pain can also be referred from the neck. Other structures, such as the ligament on the inside of the elbow in throwing athletes, can cause similar pain (Barco and Antuña, 2017). That is why a proper assessment matters if things are not settling.
Seek advice promptly if you notice: tingling or numbness in the ring and little fingers, weakness or clumsiness of the hand, a hot and swollen elbow, or pain after a fall or a sudden pop.
What helps
Research specific to golfer's elbow is limited compared with tennis elbow, so much of what we know comes from the wider tendinopathy research and from the closely related outer elbow condition (Coombes et al., 2015; Millar et al., 2021). The principles below are consistent across that evidence.
1. Understand the problem
Tendons are not "torn and worn out" in most cases. They have become more sensitive and less tolerant of load. Knowing this helps you keep using the arm sensibly instead of protecting it completely.
2. Adjust the load, do not stop everything
Reduce the activities that clearly provoke the pain for now: very heavy gripping, carrying with straight arms and palm-up lifting. Keep the rest of your life and training going. Complete rest tends to make tendons weaker and less tolerant.
3. Progressive loading of the tendon
Exercise is the core of golfer's elbow treatment. A typical progression looks like this:
- Isometric holds: with the forearm supported, push the palm up into the other hand or a fixed surface and hold for 20 to 45 seconds, a few times, as long as pain stays mild.
- Slow wrist curls: palm up, with a light dumbbell or a water bottle, lowering slowly over three seconds. Build to 3 sets of 15.
- Pronation and supination: holding a hammer near the head, slowly turn the palm down and up.
- Grip strength: squeezing a soft ball or putty, progressing to heavier grips.
- Whole arm strength: rows, presses and shoulder work once the elbow tolerates it.
A useful guide: some discomfort during exercise is fine if it stays mild (around 3 out of 10 or less) and settles by the next morning.
4. Look at technique and set-up
For golfers, a lesson with a coach to check grip pressure and swing changes can help. At work, look at tool handles, mouse position and how long you grip without breaks.
5. Be careful with injections
Steroid injections can reduce pain in the short term, but in the related outer elbow condition they were linked to worse results at six to twelve months and higher recurrence compared with a wait and see approach (Coombes et al., 2010). For many people, they are best avoided or used only after careful discussion with your doctor.
How long does it take?
Tendons adapt slowly. Many people notice a difference within six to twelve weeks of consistent exercise, but full recovery can take several months. Stopping the exercises as soon as pain eases is one of the most common reasons it comes back.
Surgery is rarely needed and is usually considered only after a long period of well-structured conservative care has not helped (Amin et al., 2015).
Frequently asked questions
Is golfer's elbow the same as tennis elbow? No. Golfer's elbow affects the inner side of the elbow, tennis elbow the outer side. The principles of management are similar.
Should I wear a brace? A forearm strap may ease pain during some tasks for some people. It is a helper, not a treatment on its own.
Can I keep playing golf? Often yes, with adjustments to volume, grip and practice routine while you build tendon capacity.
The bottom line
Golfer's elbow is a load problem in the tendons on the inside of the elbow, and it often has nothing to do with golf. Understanding it, adjusting what provokes it and building strength gradually works for most people. Patience is part of the treatment.
If inner elbow pain has been lingering, create an account at bpr.clinic and book an assessment with our therapists. At the assessment we listen to your history, check how your elbow, wrist and neck move, and give you a loading plan you can follow at home and at work.
References
- Amin NH, Kumar NS, Schickendantz MS. Medial epicondylitis: evaluation and management. Journal of the American Academy of Orthopaedic Surgeons. 2015;23(6):348-355. https://doi.org/10.5435/JAAOS-D-14-00145
- Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. American Journal of Epidemiology. 2006;164(11):1065-1074. https://doi.org/10.1093/aje/kwj325
- Barco R, Antuña SA. Medial elbow pain. EFORT Open Reviews. 2017;2(8):362-371. https://doi.org/10.1302/2058-5241.2.160006
- Millar NL, Silbernagel KG, Thorborg K, et al. Tendinopathy. Nature Reviews Disease Primers. 2021;7(1):1. https://doi.org/10.1038/s41572-020-00234-1
- Coombes BK, Bisset L, Vicenzino B. Management of lateral elbow tendinopathy: one size does not fit all. Journal of Orthopaedic and Sports Physical Therapy. 2015;45(11):938-949. https://doi.org/10.2519/jospt.2015.5841
- Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. The Lancet. 2010;376(9754):1751-1767. https://doi.org/10.1016/S0140-6736(10)61160-9
