Medial Elbow Tendinopathy (Golfers Elbow)
Medial elbow tendinopathy (commonly referred to as “Golfer’s elbow”) refers to pain on the inside of your elbow. Often, people with medial elbow tendinopathy will experience pain or difficulty with daily activities including gripping a coffee cup, lifting a bag, using tools, exercising, or swinging a golf club. Despite its name, you don't have to play golf to develop it. Medial elbow tendinopathy can affect anyone who regularly engages in activities involving gripping, repetitive wrist movements, lifting or repetitive use of the forearm. The good news is that most people improve with appropriate rehabilitation, particularly when started early and the activities contributing to the problem are addressed.
This blog will discuss the symptoms, causes and treatment options for medial elbow tendinopathy.
This blog will cover the following topics on Golfer's Elbow:
- What Is Golfer's Elbow?
- What Causes Golfer's Elbow?
- What Does Golfer's Elbow Feel Like?
- How is Golfer's Elbow Diagnosed?
- How is Golfer's Elbow Treated?
- How Long Does Golfer's Elbow Take to Recover?
- When Should You See a Physiotherapist?
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What is golfer’s elbow?
Medial elbow tendinopathy is a condition affecting the common flexor tendon – the tendon that attaches the forearm flexors and pronator muscles to the inside of the elbow. The prevalence of medial elbow tendinopathy has been reported to be as high as 4% in the working population and often affects people between 40-60 years of age (Kheiran, Pandey & Pandey, 2021).
The flexor and pronator muscles help you bend your wrist and fingers and rotate your forearm and are heavily involved in activities such as gripping, lifting, throwing and swinging a golf club. When these tissues are repeatedly exposed to loads that exceed their current capacity, the common flexor tendon can become painful and less tolerant of further load. Over time, changes can occur within the tendon, including disruption of its normal collagen structure and reduced capacity to tolerate physical strain (Kheiran et al., 2021).
Medial elbow tendinopathy can be aggravated by activities such as gripping, lifting, using tools, exercising, or repetitive wrist movements. Because pain on the inside of the elbow can also involve nearby structures such as the ulnar nerve, an accurate assessment is important.
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What causes golfer’s elbow?
The underlying cause is usually repetitive loading of the forearm muscles and tendons. The pain often develops gradually, particularly when there is a sudden increase in training, work or recreational activity. Importantly, the issue isn't necessarily that you are doing a particular activity "wrong". Often, the amount of load has simply increased faster than the tendon could adapt to it. Less frequently, medial elbow tendinopathy can also occur due to a more obvious injury or unusually heavy workload.
As the name suggests, golf is a common trigger, particularly when there are changes in playing volume, technique or equipment. However, as mentioned above, many people with medial elbow tendinopathy don't play golf at all. Other activities that may lead to medial elbow tendinopathy include:
- Activities requiring repetitive gripping
- Weight/resistance training
- Racquet, throwing and climbing sports
- Manual work/labour
- Frequent use of tools or machinery
- Repetitive lifting
What does golfer’s elbow feel like?
The most common symptom is pain on the inside of the elbow. You may notice pain around the bony prominence on the inside of the elbow, sometimes extending a short distance down the forearm. Symptoms are often worse during activities that require gripping, lifting or using the wrist.
Common symptoms include:
Pain
Aching or sharp pain on the inside of the elbow. Specifically, it can be felt over the bony prominence (head of the ulnar bone), just below it on the common flexor tendon and sometimes it may travel down the inner forearm.
These are common tasks that may be painful with medial elbow tendinopathy (Golfer's elbow):
- Gripping objects
- Lifting weights
- Any task that is repetitive – e.g. using secateurs or scissors
Weakened grip strength
Some people may notice they have reduced grip strength and find it difficult to hold heavy objects, make a fist or perform small tasks such as handwriting.
Reduced range of motion
Some may notice that their elbow feels stiff to move when trying to bend and straighten to the elbow, due to stiffness or pain. This might be particularly noticeable after activity where the elbow is being worked hard, or when first moving after periods of resting the elbow.
Swelling
Sometimes there may be localised swelling on the inside of the elbow, although this is a rarer symptom.
For some people, symptoms are relatively mild at first and only appear during certain activities. Without appropriate management, however, the pain can become more persistent and start interfering with work, sport or everyday activities.
How is golfer’s elbow diagnosed?
A diagnosis can usually be made through a clinical assessment by a physiotherapist. Your physiotherapist will typically ask about: when your symptoms started, what activities aggravate them, any changes in your workload, and how the pain affects your daily life. Once your physiotherapist has asked all the questions they need, they will then move on to conduct a physical assessment. Some things your physiotherapist may assess include:
- The location of your pain and tenderness
- Elbow and wrist movement
- Grip and forearm strength
- Pain during resisted wrist and finger movements
- Sensitivity in your ulnar nerve
- Wrist and elbow stability
A clinical diagnosis of medial elbow tendinopathy by a physiotherapist is important, as pain on the inside is not always medial elbow tendinopathy. Up to 60% of those experiencing medial elbow tendinopathy also have ulnar nerve pathology due to its close proximity to the common flexor tendon (DeLuca, Cage, Stokey & Ebraheim, 2023). Therefore, a thorough and accurate clinical diagnosis is important to not only treat the right injury but to rule out any other problems in nearby structures including the ulnar nerve, ulnar collateral ligament or the elbow joint. If the diagnosis isn’t certain, your physiotherapist might refer for further imaging via MRI or ultrasound.
Experiencing pain on the inside of your elbow? Finding gripping, lifting, using tools, exercising, or repetitive wrist movements uncomfortable?
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Helping you move better and get back to the activities you love.
How is medial elbow tendinopathy treated?
Conservative treatment is the most common treatment method with success rates of 60-90% (Zellner, Van Hattem, Touet & Cucchi, 2026). Surgery is generally reserved for persistent cases that have not responded to an appropriate rehabilitation program. Each case of elbow pain needs to be treated individually, though your physiotherapist may incorporate some of the below strategies for injury management:
- Modify aggravating activities – your physiotherapist may suggest specific modifications to the activity that is causing your pain
- Progressive strengthening – Beginning a strength and conditioning program that gradually builds the load placed on the forearm muscles and tendons
- Address contributing factors – Your rehabilitation should also consider why the problem developed in the first place. For example, this might include reviewing your golf swing, lifting technique, training program etc.
- Pain management - Ice, manual therapy, taping/bracing and other treatments may be used to help manage symptoms, depending on the individual presentation.
How long does golfer’s elbow take to recover?
Recovery time varies considerably between individuals. For some, recovery can be swift after modifying the aggravating activity and beginning an appropriate exercise program. However, others may experience symptoms for several months. This can happen when symptoms have been present for a long time or the aggravating activity cannot easily be avoided.
It is important to recognise that rehabilitation is a gradual process and as such, pain level may vary throughout the process. The goal isn't only to make the elbow pain-free, it is also to gradually restore the strength and capacity required for your normal work, exercise and sporting activities.
When should you see a physiotherapist?
If you have been struggling with any of the symptoms mentioned above for several weeks, it's a good idea to book into a physiotherapist to get a management plan in place. Don't leave the symptoms too long though - the more quickly you get help, the more quickly we can get you on the road to recovery!
Summary
Golfer's elbow is not just a problem for golfers. Medial elbow tendinopathy can affect anyone exposed to repetitive gripping, lifting, wrist flexion or forearm rotation.
If inner-elbow pain is stopping you from working, exercising or enjoying your sport, book an appointment with one of our friendly physiotherapists at PhysioTec Physiotherapy. Our experienced team of physiotherapists are able to conduct a thorough examination and provide you with a management plan for your elbow pain.
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Author
This blog was written by Dr. Molly Connolly, one of our Sports Physiotherapists and Pilates Instructors. Molly's undergraduate degree was in Exercise and Sports science and she completed a PhD of the title: A multidisciplinary approach to understanding low back pain in elite adolescent tennis athletes. She also has a love of triathlon! Molly completed a post-graduate Masters in Physiotherapy at the University of South Australia.
You can read more about Molly here.
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References:
- DeLuca, M. K., Cage, E., Stokey, P. J., & Ebraheim, N. A. (2023). Medial epicondylitis: current diagnosis and treatment options. Journal of Orthopaedic Reports, 2(3), 100172.
- Kheiran, A., Pandey, A., & Pandey, R. (2021). Common tendinopathies around the elbow; what does current evidence say?. Journal of clinical orthopaedics and trauma, 19, 216-223.
- Zellner, A. A., Van Hattem, S., Touet, A., & Cucchi, D. (2026). Medial Elbow Epicondylitis. In Orthopaedic Sports Medicine: An Encyclopedic Review of Diagnosis, Prevention, and Management (pp. 1-16). Cham: Springer Nature Switzerland.