Golfer’s Elbow: (Medial Epicondylitis / Medial Elbow Tendinopathy)
A common elbow pain pattern, though less that its cousin tennis elbow — rarely caused by golf, and not always inflammatory
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Golfer’s elbow — medically known as medial epicondylitis — is a condition that causes pain on the inside of the elbow, where the forearm muscles attach to the bone. It develops when the tendons responsible for gripping and bending the wrist are exposed to more load than they can comfortably tolerate.
Despite its name, most people who develop golfer’s elbow do not play golf. It is commonly linked to repetitive gripping, lifting, manual work, gym training, or racquet sports.
This article explains what golfer’s elbow is, why it develops, how it is diagnosed, and the most effective ways to manage it:
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The Elbow Joint
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Soft Tissues of the Elbow
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Tendon Structure, Tendinitis and Tendinosis
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Reactive Tendon vs Chronic Tendinosis
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When It Is Actually Acute?
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Who Is Most at Risk?
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Why Perimenopause and Menopause Can Influence Tendon Pain
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What Does Golfers Elbow Feel Like?
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How Is Golfers Elbow Diagnosed?
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The Natural History – Does It Settle on Its Own?
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Treatment Options for Golfers Elbow
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Summary
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Golfers Elbow FAQ's
The Elbow Joint
To fully understand golfers elbow, it's essential to grasp the complex anatomy of the elbow joint. The elbow is a hinge joint formed by the articulation of three bones, which work together to facilitate a wide range of movements.
Bones of the Elbow Joint
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Humerus:
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The humerus is the upper arm bone that extends from the shoulder to the elbow. The lower end of the humerus features two prominent bony protrusions called the medial and lateral epicondyles. These epicondyles serve as crucial attachment points for muscles and tendons. The lateral epicondyle, located on the outer side of the elbow, is particularly relevant to tennis elbow as it is the site where the tendons of the forearm muscles attach.
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Radius:
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The radius is one of the two forearm bones and is situated on the thumb side of the forearm. It is the smaller of the two bones and plays a vital role in the rotational movement of the forearm. The top end of the radius, known as the radial head, forms part of the elbow joint and allows the radius to rotate around the ulna, enabling motions like pronation and supination (turning the palm up and down).
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Ulna:
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The ulna is the larger and longer bone of the forearm, located on the pinky side. It forms the main structure of the forearm and, together with the humerus, creates the hinge of the elbow joint. The upper end of the ulna features a prominent curved shape that fits snugly into the humerus, allowing for the bending and straightening of the arm.
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Soft Tissues of the Elbow
The elbow joint's stability and functionality are maintained by various structures, including muscles, tendons, and ligaments. These structures work in harmony to support and move the joint.
Muscles:
Theforearm muscles — including the pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis and flexor carpi ulnaris — converge into a common tendon known as the common flexor tendon. This tendon anchors to the medial epicondyle and transmits the forces from these muscles across the elbow as you grip, bend the wrist, turn the hand and lift objects.
Tendons:
Tendons are tough, fibrous tissues that connect muscles to bones. In the case of golfers elbow, the tendons attaching the forearm muscles to the medial epicondyle become inflamed due to repetitive strain. This inflammation leads to pain and tenderness on the inner elbow.
Ligaments:
Ligaments are strong bands of tissue that connect bones to other bones, providing stability to the joint.
The medial and lateral collateral ligaments are the primary stabilizing ligaments of the elbow. The annular ligament encircles the head of the radius, holding it in place and allowing smooth rotation around the ulna.
Tendon Structure, Tendinitis and Tendinosis
On the inside of the elbow sits the medial epicondyle — a prominent bony attachment point on the humerus. This is where the common flexor tendon anchors, giving rise to several forearm muscles responsible for wrist flexion, finger flexion, and forearm pronation.
These muscles are active during gripping, lifting, carrying, turning objects, typing, weight training, and racquet or club sports. In most daily tasks, they work quietly in the background to stabilise the wrist so the hand can generate force efficiently.
When loading is appropriate and recovery is sufficient, the tendon responds positively. Collagen fibres organise themselves along the direction of stress, tensile strength improves, and the tissue becomes more resilient to demand.
However, when repeated loading, particularly forceful gripping combined with wrist flexion or forearm rotation, exceeds the tendon’s capacity, adaptive processes can begin to falter.
Instead of maintaining organised collagen structure, the tendon may develop:
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Disruption of normal collagen alignment
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Increased ground substance within the matrix
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Areas of microscopic fibre breakdown
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Reduced tensile integrity
This pattern is commonly referred to as tendinosis — a degenerative or maladaptive tendon response rather than a purely inflammatory one.
Although the term medial epicondylitis suggests inflammation, research examining chronic cases shows relatively limited inflammatory cell presence. The dominant features are structural disorganisation and altered tendon biology rather than classic acute inflammation.
Understanding this distinction is important, because treatment aimed solely at reducing inflammation may not address the underlying issue in persistent cases.
Reactive Tendon vs Chronic Tendinosis
Golfer’s elbow does not present in exactly the same way in every individual. Tendon pathology exists along a continuum, and the stage of presentation influences both symptoms and management.
In some cases, symptoms develop shortly after a noticeable increase in activity — for example, a return to golf after a break, a weekend of heavy DIY, or a new gym programme involving repeated gripping. In these more acute situations, the tendon can enter a reactive phase.
During a reactive phase, the tendon becomes temporarily more sensitive. It may thicken slightly, fluid content can increase within the tendon matrix, and pain can feel sharper or more easily aggravated. Although this stage is not a classic inflammatory injury in the way a sprained ankle might be, inflammatory mediators can play a short-term role in irritability.
At this stage, the tendon is not structurally “degenerate,” but it is overloaded and temporarily intolerant to high demand.
If excessive load continues over time — or if the reactive stage is not allowed to settle — the tendon can progress into a more persistent tendinopathy pattern. In this stage, structural disorganisation becomes more prominent. Collagen fibres lose alignment, tensile strength reduces, and the tendon becomes less efficient at transmitting force.
Pain in established tendinopathy is often less acutely sharp but more stubborn. Symptoms may fluctuate with activity rather than resolving quickly with short-term rest.
Importantly, duration alone does not always determine stage. Someone may present early with underlying degenerative change, while another may present later but primarily be experiencing a reactive flare on top of a previously quiet tendon.
This is why assessment matters.
Management differs subtly between these stages. A highly reactive tendon may benefit from short-term load reduction and careful reintroduction of activity. A more degenerative tendon requires progressive strengthening to rebuild capacity and restore resilience.
Both presentations sit on the same continuum — but understanding where the tendon currently sits helps guide effective treatment.
When It Is Actually Acute?
Although many cases of golfer’s elbow develop gradually over time, not every presentation is long-standing or degenerative.
Occasionally, symptoms appear quite suddenly after a noticeable increase in activity — for example, an intense weekend of golf practice, a return to the gym involving heavy pulling exercises, prolonged DIY, or repetitive gripping tasks that the forearm is not used to tolerating.
In these situations, the common flexor tendon can enter a reactive phase. The tendon may become temporarily more sensitive and irritable. There can be increased fluid within the tendon matrix, heightened pain sensitivity, and short-term thickening of the tissue. While this is not a classic inflammatory injury in the same way as a ligament sprain, inflammatory mediators may contribute to short-term irritability.
When a tendon is in this reactive state, an aggressive strengthening approach is often not appropriate initially. A brief period of relative load reduction, sensible activity modification, and symptom control may allow irritability to settle before progressive rehabilitation begins. This is where clinical reasoning becomes important.
Why Stage of Presentation Matters
Distinguishing between:
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A highly reactive, recently overloaded tendon
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A more established degenerative tendinopathy
is not always straightforward.
Time alone does not define the stage. Someone may present within a few weeks of symptom onset but already have underlying tendon degeneration. Another individual may present months later yet primarily be experiencing a reactive flare triggered by a sudden increase in demand.
Assessment therefore considers:
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Symptom irritability
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Pain behaviour during and after activity
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Tolerance to loading
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Functional limitation
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Recent changes in workload
Management is then adjusted accordingly.
Introducing heavy strengthening too early in a highly reactive tendon can aggravate symptoms. Equally, advising prolonged rest in an established tendinopathy may delay recovery and reduce overall tendon capacity.
Effective treatment depends on recognising where the tendon currently sits along this continuum.
Why Complete Rest Is Rarely the Solution
It is natural to want to stop using the arm when pain develops. However, tendons adapt to mechanical load. Removing load entirely for extended periods does not restore strength or resilience.
In fact, prolonged unloading can reduce tendon capacity further, making recurrence more likely when activity resumes.
The aim is not to avoid using the arm altogether. Instead, the goal is controlled, progressive reloading — gradually rebuilding tolerance so the tendon can handle everyday demands without recurring symptoms.
This reflects modern tendinopathy principles: long-term resilience is achieved by restoring capacity, not simply suppressing pain.
Who Is Most at Risk?
Golfer’s elbow most commonly affects adults in midlife, particularly between around 35 and 60 years of age. As with many tendon conditions, this age pattern reflects a combination of biological and lifestyle factors. Tendon recovery and collagen turnover gradually change over time, while occupational and recreational demands often remain high — lifting, gripping, carrying, gym training, manual work, and repetitive forearm tasks.
Unlike tennis elbow, which is more strongly associated with repetitive wrist extension, golfer’s elbow is typically linked to repeated wrist flexion and forceful gripping. People who regularly perform pulling movements, use tools requiring sustained grip, lift with the wrist bent, or engage in repetitive forearm pronation may be at greater risk. Manual trades, gym-based pulling exercises (rows, deadlifts, pull-ups), racquet sports, and golf itself are common contributors.
The dominant arm is more frequently affected, largely because it performs more repetitive and forceful tasks.
Sex differences are less consistently reported than in tennis elbow, but clinically, medial elbow pain is commonly seen in individuals with sustained gripping demands or high-load pulling activity. As with other tendinopathies, midlife women may report changes in tendon tolerance around the perimenopausal transition. Oestrogen influences collagen metabolism and connective tissue behaviour, and some women notice that activities previously tolerated without issue begin to provoke tendon pain during this period.
It would be inaccurate to suggest that menopause directly causes golfer’s elbow. However, hormonal changes may alter load tolerance in some individuals, meaning that the same mechanical demand can become symptomatic.
Metabolic factors may also play a role. Conditions affecting glucose regulation and systemic inflammation have been associated with tendon disorders more broadly, although mechanical loading remains the primary driver in most cases.
Smoking is often discussed in relation to tendon health because of its effect on circulation and collagen integrity. While not a direct cause, it may influence recovery capacity.
The key point is that golfer’s elbow is rarely just a “golf injury.” It is usually a load-related tendon condition shaped by everyday work, training habits, and cumulative mechanical demand rather than a single dramatic event.
Why Perimenopause and Menopause Can Influence Tendon Pain
Many women notice new or worsening tendon pain during perimenopause and the years following menopause. This does not mean that menopause directly causes tennis elbow, but hormonal changes can influence how tendons respond to load.
Oestrogen plays a role in collagen metabolism, tendon structure and tissue turnover. As oestrogen levels fluctuate and decline, tendon tissue may become slightly less resilient to sudden changes in load. In practical terms, this can mean that activities which previously felt manageable — lifting shopping, gardening, increased computer use, returning to exercise — begin to provoke symptoms.
This does not mean tendons are “weak” or damaged beyond recovery. It means their load tolerance may temporarily shift.
During this life stage, recovery may require:
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More gradual progression of strengthening
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More attention to load management
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Longer adaptation timeframes
It is also important to recognise that midlife often brings changes in sleep, stress, work demands and physical activity patterns — all of which influence tissue recovery.
With appropriate progressive strengthening and sensible load progression, most women recover well. The key is recognising that the tendon may need time and structured loading rather than complete rest.
What Does Golfers Elbow Feel Like?
When people search for “what does golfer’s elbow feel like?” they are usually trying to understand a very specific pattern of inner elbow pain.
The defining symptom is discomfort on the inside of the elbow, typically centred around the medial epicondyle — the bony prominence on the inner aspect of the joint. This pain often develops gradually rather than after a single traumatic incident. Many individuals cannot identify one specific injury. Instead, they notice increasing irritation over days or weeks, particularly during gripping or lifting tasks.
Inner elbow pain with gripping is one of the earliest and most common complaints. Activities such as carrying shopping bags, lifting a kettle, shaking hands, holding a heavy pan, or performing gym pulling exercises can suddenly become uncomfortable.
Pain often increases when bending the wrist toward the palm under load — for example:
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Lifting weights during curls or rows
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Carrying objects with the wrist flexed
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Using tools that require sustained grip
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Swinging a golf club
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Turning or twisting movements under tension
Unlike tennis elbow, which is aggravated by wrist extension, golfer’s elbow pain is typically provoked by wrist flexion and forceful gripping.
Pain Pattern and Radiation
In some cases, discomfort may spread slightly down the inner forearm. This does not usually indicate nerve damage. It reflects the shared involvement of the flexor muscle group and their common tendon.
Pain is usually mechanical in nature. It increases during activity and settles with rest. Persistent severe pain at complete rest is uncommon and may suggest an alternative diagnosis.
Grip Weakness and Functional Limitation
Many individuals report that their grip feels weaker. Common descriptions include:
“It hurts when I carry shopping.”
“I struggle to hold onto the bar at the gym.”
“My arm feels weak even though I can move it normally.”
This weakness is typically pain-related rather than true muscle loss. When gripping provokes pain, the nervous system reduces muscle output to protect the area. As pain decreases and tendon tolerance improves, grip strength usually returns.
Elbow movement itself is often preserved. You can usually bend and straighten the elbow fully, but tasks requiring sustained grip or pulling become uncomfortable.
Local Tenderness
Pressing directly over the medial epicondyle is usually tender. Many people can pinpoint the painful spot precisely.
Loading the wrist flexors — particularly gripping with the wrist bent toward the palm — often reproduces symptoms quickly.
Because the ulnar nerve runs close to the medial epicondyle, some people may worry about nerve involvement. True nerve symptoms, such as tingling or numbness into the ring and little finger, are not typical of simple golfer’s elbow and should be assessed separately.
How It Differs from Other Inner Elbow Pain
Golfer’s elbow pain is generally:
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Localised to the inner elbow
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Aggravated by gripping and wrist flexion
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Reproduced by resisted wrist flexion
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Tender over the medial epicondyle
If symptoms include significant numbness, persistent tingling, or weakness unrelated to pain, conditions such as ulnar nerve irritation should be considered.
Recognising this characteristic pattern helps guide accurate diagnosis and appropriate management.
How Is Golfers Elbow Diagnosed?
Golfer’s elbow is primarily a clinical diagnosis. This means it is identified through a detailed history and physical examination rather than relying on scans.
When someone presents with pain on the inside of the elbow, the first step is understanding how the symptoms began. In many cases, the onset is gradual. There is rarely a single traumatic injury. Instead, people describe increasing inner elbow discomfort over weeks, often following changes in workload, training intensity, gripping tasks, or gym activity.
The location of pain is typically precise. Many individuals can point directly to the medial epicondyle — the bony prominence on the inside of the elbow. This focal tenderness is a key feature of medial elbow tendinopathy.
During examination, symptoms are usually reproduced when the wrist flexors are loaded. Pain may be provoked during:
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Resisted wrist flexion
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Resisted forearm pronation
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Sustained gripping
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Pulling movements under load
These movements increase tension through the common flexor tendon at its attachment to the medial epicondyle.
Elbow joint movement itself is usually preserved. The elbow bends and straightens normally. Pain is typically load-dependent rather than movement-restricted.
Why Imaging Is Rarely Required
It is common for people to assume that ultrasound or MRI scanning is necessary to confirm golfer’s elbow. In most cases, imaging is not required.
Tendon changes seen on scans do not always correlate with pain. Structural alterations can be present in individuals who have no symptoms, while significant pain can occur with only minor imaging findings.
Imaging is generally considered when:
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Symptoms are unusual or severe
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Pain does not clearly relate to tendon loading
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There is joint locking, instability, or marked swelling
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Neurological symptoms are present
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Symptoms fail to improve despite structured rehabilitation
Diagnosis is usually based on recognising a characteristic clinical pattern rather than radiological confirmation.
Conditions That Can Mimic Golfer’s Elbow
Medial elbow pain is not always caused by tendon overload. Other conditions that may resemble golfer’s elbow include:
Ulnar nerve irritation (cubital tunnel syndrome):
Because the ulnar nerve runs close to the medial epicondyle, irritation can cause inner elbow pain. This is often accompanied by tingling or numbness into the ring and little finger, or weakness in hand function.
Cervical spine referral:
Irritation of nerves in the neck can refer pain into the medial elbow region, sometimes with altered sensation or weakness.
Medial collateral ligament injury:
More common in throwing athletes, this may produce instability or pain with valgus stress.
Elbow joint pathology:
Less common, but mechanical symptoms such as catching or locking may suggest intra-articular involvement.
A careful assessment differentiates these conditions by evaluating neurological signs, joint stability, pain behaviour, and response to tendon loading tests.
The defining feature of golfer’s elbow is activity-related inner elbow pain provoked by loading the wrist flexors, without significant neurological deficit or joint restriction.
The Natural History – Does It Settle on Its Own?
Many cases of golfer’s elbow improve over time, particularly when load is adjusted appropriately.
However, medial elbow tendinopathy can sometimes be slower to settle than its lateral counterpart. The inner elbow flexor tendon is involved in almost every gripping and pulling activity, which means it is difficult to fully “rest” in daily life. Even routine tasks such as carrying shopping or lifting objects can continue to load the tendon.
In early reactive presentations, symptoms may settle within several weeks if aggravating activities are modified and load is reintroduced gradually. In more established tendinopathy, recovery typically takes longer. It is common for meaningful improvement to occur over 3–6 months, with continued gains beyond that as tendon capacity increases, that can take >12 months.
Symptoms often fluctuate. It is normal to experience temporary flare-ups if activity exceeds current tolerance. These flare-ups do not necessarily indicate worsening structural damage; they usually reflect a temporary load-capacity imbalance.
Unlike acute muscle strains, tendon recovery is rarely linear. Improvement tends to occur gradually, with periods of stability interrupted by minor setbacks.
Factors That Influence Recovery
Several factors can influence how quickly golfer’s elbow improves:
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Ongoing occupational or sporting load
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Ability to modify aggravating tasks
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Overall conditioning and strength
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Sleep and recovery quality
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Smoking
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Metabolic health
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Hormonal influences in midlife
Because the ulnar nerve runs close to the medial epicondyle, nerve sensitivity can occasionally complicate recovery. True nerve involvement is uncommon in simple tendinopathy but may prolong symptoms if present.
Does Golfer’s Elbow Go Away on Its Own?
Some individuals experience gradual improvement without formal intervention. However, waiting alone does not increase tendon capacity.
Without progressive strengthening and appropriate load management, symptoms may settle temporarily only to return when activity increases again.
The aim of treatment is not simply symptom suppression. It is restoring the tendon’s ability to tolerate normal mechanical demand. The long-term outlook is generally very good. Most individuals return to full activity without surgery. Durable recovery depends on rebuilding load tolerance rather than avoiding use indefinitely.
Treatment Options for Golfers Elbow
Management of golfer’s elbow is usually conservative. Surgery is rarely required, and most individuals improve with structured non-operative care.
The aim of treatment is not simply to reduce pain in the short term. The goal is to restore tendon capacity so the common flexor tendon can tolerate everyday gripping, lifting, and pulling demands without recurring flare-ups.
Because golfer’s elbow is typically a load-related tendinopathy rather than a purely inflammatory injury, management centres on education, load modification, and progressive strengthening.
1. Education and Load Adjustment
Understanding what aggravates symptoms is the foundation of recovery.
Golfer’s elbow is commonly aggravated by:
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Forceful or sustained gripping
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Pulling movements under load
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Wrist flexion under tension
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Repetitive forearm rotation
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Gym-based pulling exercises
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Tool use or manual work
Complete rest is rarely helpful beyond a short initial period in highly reactive cases. Tendons require mechanical load to adapt. However, repeatedly exceeding the tendon’s current tolerance can prolong symptoms.
Early management focuses on temporarily modifying aggravating activities while introducing controlled loading.
This may involve:
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Adjusting grip position
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Reducing pulling intensity
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Modifying gym technique
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Using straps temporarily during high-load tasks
The objective is not elimination of use, but smarter use.
2. Exercise-Based Rehabilitation
Exercise remains the most consistently supported treatment for medial elbow tendinopathy.
Because the underlying issue is reduced load tolerance, rehabilitation focuses on progressively rebuilding tendon capacity.
Early Phase – Pain-Modulated Loading
In reactive presentations, isometric exercises for wrist flexion can reduce pain sensitivity while maintaining muscle activation.
Load is introduced cautiously and progressed according to symptom response.
Progressive Strengthening Phase
As irritability settles, strengthening becomes more structured. This may include:
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Controlled wrist flexion exercises
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Progressive resistance loading
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Grip endurance training
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Forearm pronation strengthening
Emphasis is placed on slow, controlled movement rather than high-speed repetition.
Functional Reintegration
Later stages incorporate task-specific loading. This might include:
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Gradual return to gym pulling exercises
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Sport-specific drills
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Simulated occupational tasks
Tendon adaptation is gradual. Progression over weeks and months is more important than intensity in the early stages.
3. Manual Therapy
Manual therapy techniques — including joint mobilisation of the elbow and wrist, soft tissue work to the forearm flexors, and neural mobility techniques where appropriate — can provide short-term symptom reduction.
In medial elbow tendinopathy, mobilisation of the humeroulnar joint or proximal radioulnar joint may temporarily improve pain-free grip strength. The proposed mechanisms are likely neurophysiological rather than structural — altered pain modulation, improved motor output, and reduced protective muscle inhibition.
However, it is important to understand what manual therapy does not do.
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It does not reorganise collagen fibres.
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It does not reverse tendinosis.
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It does not rebuild tensile strength within the common flexor tendon.
Its value lies in facilitating participation in active rehabilitation. If manual therapy reduces pain sufficiently to allow progressive loading to begin, it can be useful. On its own, it is unlikely to provide durable improvement.
In cases where ulnar nerve sensitivity coexists, gentle neural mobilisation may be indicated — but this must be differentiated carefully from pure tendinopathy.
4. Bracing and Counterforce Supports
Counterforce straps are commonly used for medial elbow pain. These braces apply pressure just distal to the medial epicondyle and are thought to alter force transmission through the common flexor tendon. Some individuals report meaningful short-term relief, particularly during work or sport.
Mechanically, the brace may reduce peak strain at the tendon origin. Neurologically, it may alter pain perception through sensory input. However, bracing does not increase tendon capacity.
It may reduce symptoms during activity, but once removed, the underlying load tolerance remains unchanged. For this reason, bracing can be useful as a temporary adjunct — particularly in reactive or highly irritable presentations — but should not replace progressive strengthening.
Long-term reliance on bracing without rehabilitation risks perpetuating tendon deconditioning.
5. Medication
Simple analgesics can help manage pain, particularly in the early phase. Short courses of non-steroidal anti-inflammatory drugs (NSAIDs) may reduce discomfort in reactive presentations where inflammatory mediators are contributing to short-term irritability. Any medication use MUST be led by your treating practitioner of pharmacist.
However, in established tendinosis, inflammation is not the dominant driver. Suppressing pain chemically does not restore tendon structure or load tolerance.
Medication may help reduce symptom intensity, but it does not change the biology of the tendon. For this reason, it should be viewed as supportive — not curative.
6. Corticosteroid Injections
Corticosteroid injections are sometimes offered for persistent golfer’s elbow, particularly when pain is severe or function is significantly limited. They can provide rapid symptom relief, often within days to weeks. However, longer-term outcomes are less encouraging.
Across elbow tendinopathies, research suggests that while steroid injections may improve short-term pain, medium- and long-term outcomes (6–12 months and beyond) are often no better than placebo or exercise-based rehabilitation. In some studies, recurrence rates are higher following steroid injection.
Why might this occur?
Corticosteroids reduce inflammation and pain sensitivity, but they do not rebuild tendon capacity. In degenerative tendinosis, collagen structure remains disorganised. If activity resumes quickly during the window of reduced pain, the tendon may again be exposed to loads it cannot tolerate.
There is also evidence that repeated corticosteroid exposure may negatively influence tendon cell activity and collagen synthesis.
This does not mean injections have no role. In selected cases — particularly highly reactive presentations where pain is preventing any meaningful loading — an injection may allow symptoms to settle enough for structured rehabilitation to begin.
But it should not be seen as a standalone solution.
7. Biologic Injections (PRP and Similar Treatments)
Platelet-rich plasma (PRP) and other biologic injections aim to stimulate a healing response by introducing growth factors into the degenerative tendon. The rationale is appealing. However, current evidence remains mixed.
Some studies suggest modest improvement compared with placebo. Others show no clear superiority over structured exercise. Variability in preparation techniques, dosing protocols, and patient selection makes firm conclusions difficult.
At present, biologic injections cannot be considered a universally supported first-line treatment for medial elbow tendinopathy.
They may be considered in persistent cases after structured rehabilitation has been attempted.
8. Shockwave Therapy
Extracorporeal shockwave therapy has been used in chronic tendinopathy with the aim of stimulating a biological response and modulating pain.
Evidence for medial elbow tendinopathy is variable. Some individuals report improvement, particularly in long-standing cases, but outcomes are not consistently predictable.
Shockwave may be considered when progressive loading has been implemented appropriately yet symptoms persist.
It should not replace rehabilitation — it may complement it.
9. Surgery
Surgical management of golfer’s elbow is uncommon. It is typically reserved for individuals with persistent, function-limiting symptoms that have not improved after at least 6–12 months of comprehensive conservative management.
Procedures usually involve debridement of degenerative tendon tissue and, in some cases, addressing associated pathology.
The majority of individuals recover without surgical intervention.
What Actually Changes Long-Term Outcomes?
The strongest evidence across tendinopathy research consistently supports:
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Education
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Intelligent load management
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Progressive strengthening
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Patience and graded return to activity
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Passive interventions may reduce symptoms temporarily. Durable recovery depends on restoring tensile capacity within the tendon.
Golfer’s elbow improves when tendon capacity once again meets or exceeds mechanical demand.
Summary
Golfer’s elbow is a load-related tendon condition affecting the inside of the elbow, where the common flexor tendon attaches to the medial epicondyle.
Although often labelled “medial epicondylitis,” most persistent cases are not driven by ongoing inflammation. Instead, they reflect a tendon that has been exposed to more mechanical demand than it can currently tolerate. Over time, this can lead to structural disorganisation within the tendon and reduced load capacity.
Not every presentation is the same. Some individuals develop a reactive, irritable flare following a sudden increase in activity. Others present with a more established degenerative tendinopathy pattern. Recognising where the tendon sits along this continuum helps guide appropriate management.
Short-term symptom control may have a role in selected cases. However, durable recovery depends on restoring tendon capacity through progressive, structured loading rather than prolonged rest or repeated pain suppression alone.
The long-term outlook is generally very good. Most people return to normal activity without surgery. The key lies in understanding the condition properly and addressing the underlying load–capacity imbalance rather than focusing solely on pain.
Educational Notice
This content is intended for educational guidance only and reflects current evidence and clinical reasoning at the time of publication. It does not replace individual assessment, diagnosis, or treatment provided by your healthcare practitioner. Management decisions should always be based on personalised clinical evaluation.
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Frequently Asked Questions About Golfers Elbow
1. What is golfer’s elbow and how is it different from tennis elbow?
Golfer’s elbow is a tendon condition affecting the inside of the elbow (medial side), where the common flexor tendon attaches. It is also known as medial epicondylitis or medial elbow tendinopathy.
Tennis elbow affects the outside of the elbow (lateral side) and involves a different tendon group. While both are load-related tendinopathies, golfer’s elbow is typically aggravated by wrist flexion and gripping, whereas tennis elbow is aggravated by wrist extension.
2. What causes inner elbow pain in golfer’s elbow?
Golfer’s elbow develops when repetitive gripping, pulling, or wrist flexion exceeds the tendon’s current load capacity.
Common triggers include gym pulling exercises, racquet sports, golf, manual work, tool use, and lifting tasks. It is usually a gradual overload problem rather than a single traumatic injury.
3. How long does golfer’s elbow take to heal?
Recovery time varies depending on severity, tendon stage, and load management.
Mild reactive cases may improve within several weeks. More established tendinopathy often requires 3–6 months of progressive rehabilitation. and can take >12 months to completely resolve. Improvement is usually gradual rather than immediate.
4. Can golfer’s elbow go away on its own?
Some cases improve over time, particularly if aggravating activities are reduced.
However, complete rest alone does not rebuild tendon strength. Without progressive loading, symptoms may settle temporarily but return when activity increases again.
5. What exercises help golfer’s elbow?
Exercises that gradually strengthen the wrist flexor muscles and improve grip endurance are most effective.
Rehabilitation often begins with pain-modulated isometric loading, progresses to controlled strengthening, and eventually includes functional tasks specific to sport or work. The key is gradual progression within symptom tolerance.
6. Should I rest my arm completely if I have golfer’s elbow?
Complete rest is rarely recommended beyond a short initial period in highly reactive cases.
Tendons require mechanical loading to adapt. The goal is usually controlled load modification rather than total avoidance of use.
7. Are steroid injections effective for golfer’s elbow?
Corticosteroid injections may reduce pain in the short term. However, longer-term outcomes are often no better than structured rehabilitation, and recurrence risk may be higher if activity resumes too quickly.
Injections may be appropriate in selected cases but are not considered a long-term solution.
8. Can golfer’s elbow cause numbness or tingling?
Simple golfer’s elbow typically causes pain but not numbness.
If symptoms include tingling or numbness into the ring and little finger, this may indicate ulnar nerve irritation rather than isolated tendon overload and should be assessed.
9. Is golfer’s elbow only caused by playing golf?
No. Most people who develop golfer’s elbow do not play golf.
The condition is more commonly linked to repetitive gripping, pulling exercises, gym training, tool use, or manual work.
10. Can golfer’s elbow come back after recovery?
Yes, if tendon load again exceeds capacity.
Recurrence risk is reduced by maintaining forearm strength, increasing activity gradually, avoiding sudden workload spikes, and allowing adequate recovery between high-demand tasks.
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With 25+ years of hands-on physiotherapy experience, I’ve built a trusted reputation for clinical excellence and evidence-based care. My approach combines proven techniques with the latest research, so you can feel confident you’re in safe, skilled hands.
Longer Appointments for Better Results
No two people—or injuries—are the same. That’s why I offer 60-minute one-to-one sessions, giving us time to:
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Thoroughly assess your condition
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Provide focused, effective treatment
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Explain what’s really going on in a clear, simple way
Your treatment plan is tailored specifically to you, aiming for long-term results, not just temporary relief.
Honest Advice & Support You Can Trust
I’ll always tell you what’s best for you—even if that means you need fewer sessions, not more. My goal is your recovery and wellbeing, not keeping you coming back unnecessarily. I have low overheads nowadays and I do not have pre-set management targets to maximise patient 'average session per condition' (yes it does happen commonly and I hate it with a passion - read my article here)
Helping You Take Control of Your Recovery
I believe the best outcomes happen when you understand your body. I’ll explain your condition clearly, give you practical tools for self-management, and step in with expert hands-on treatment when it’s genuinely needed.
Looking for a physiotherapist who values honesty, expertise, and your long-term health?
Book an appointment today and take the first step towards feeling better.
Contact Info
On a Monday and Tuesday I work as a advance musculoskeletal specialist in primary care but I can still be contacted for enquiries. You are welcome to call but it is often faster for me to reply via an email or watsapp message, simply as my phone will be on silent in clinic. Either way, I will reply as soon as possible, which in the week, is almost always on the same day at the latest.
Clinic Opening Hours
** Please note that online sessions and Aquatic sessions be arranged outside of normal clinical hours on request.**
Sat -Sun
Closed
0900 - 1430
Closed - FCP
Weds - Fri
Mon - Tues