Golfer's Elbow: Causes, Symptoms, Treatment and How to Get Back to Sports

Kathy Ryan-Ceisel, PT MHS | Algonquin Sports PT

Overhead Throwing Expert-Athletic Edge and Wellness

Golfer's elbow isn't just a golf injury.

It can affect golfers, baseball players, softball players, tennis players, climbers, weightlifters, throwing athletes, and people whose jobs require repetitive gripping and wrist movements. The medical term is medial elbow tendinopathy, and it affects the common flexor-pronator tendon origin on the inside of the elbow.

Like tennis elbow, golfer's elbow is generally better understood as a tendon overload problem rather than simply inflammation. The good news? Most people can improve without surgery when the condition is identified early and treated appropriately.

📢What Is Golfer's Elbow?

Golfer's elbow involves the common flexor-pronator tendon origin near the medial epicondyle, the bony prominence on the inside of the elbow.

The flexor-pronator muscles help:

• Flex the wrist

• Grip

• Pronate the forearm

• Stabilize the elbow

• Transfer force through the arm

When repetitive loading exceeds the tendon’s ability to recover and adapt, symptoms can develop. Golfer's elbow is therefore not necessarily caused by golf.

It is caused by repetitive loading of the tissues on the medial side of the elbow.

💪Common Causes of Golfer's Elbow

Common contributors include:

• Repetitive gripping

• Wrist flexion

• Forearm pronation

• Golf swings

• Baseball pitching

• Baseball hitting

• Tennis

• Rock climbing

• Weightlifting

• Manual labor

• Repetitive tools

• Sudden increases in training volume

• Poor recovery

• Weak forearm musculature

• Poor kinetic-chain mechanics

For athletes, a sudden increase in workload is often a major contributor.

For example, a baseball player who increases throwing volume dramatically after an offseason may develop medial elbow pain because the tissues have not yet rebuilt enough capacity.

🚨Golfer's Elbow Symptoms

The hallmark symptom is pain over the inside of the elbow.

Symptoms may occur with:

• Gripping

• Carrying

• Lifting

• Wrist flexion

• Forearm pronation

• Golfing

• Throwing

• Batting

• Pull-ups

• Weightlifting

Patients may also report:

• Tenderness over the medial epicondyle

• Forearm weakness

• Reduced grip strength

• Pain after activity

• Morning stiffness

• Pain with resisted wrist flexion

• Pain with resisted forearm pronation

Some patients also experience numbness or tingling into the ring and small fingers.

That is important.

The ulnar nerve runs directly behind the medial epicondyle, so medial elbow pain accompanied by numbness, tingling or weakness requires careful evaluation.

In throwing athletes, medial elbow pain also needs to be differentiated from ulnar collateral ligament (UCL) injury.

🩻How Is Golfer's Elbow Diagnosed?

Diagnosis begins with a thorough history and physical examination.

A clinician may evaluate:

• Location of pain

• Elbow range of motion

• Wrist strength

• Grip strength

• Forearm pronation/supination

• Pain with resisted wrist flexion

• Pain with resisted pronation

• Ulnar nerve function

• Cervical spine

• Shoulder strength

• Scapular control

• Throwing or swing mechanics

• Training volume

Imaging is not always required.

Ultrasound or MRI may be appropriate when:

• Symptoms are persistent

• The diagnosis is uncertain

• Significant tendon damage is suspected

• A UCL injury is suspected

• There are neurologic symptoms

• Symptoms fail to respond to appropriate treatment

Medial elbow pain has a broad differential diagnosis, including flexor-pronator tendinopathy, UCL injury, ulnar neuropathy, medial elbow impingement and other conditions.

⚕️Treatment for Golfer's Elbow

Treatment should be based on the severity of the condition and the demands being placed on the elbow.

1. Activity Modification

The first step is often reducing the activity that is exceeding the tendon’s current capacity.

This may mean temporarily modifying:

• Golf volume

• Throwing volume

• Batting volume

• Weightlifting

• Grip-intensive work

• Repetitive occupational activities

Complete rest is not always necessary.

The objective is to find a workload the tendon can tolerate while beginning the process of rebuilding strength.

2. Physical Therapy

Physical therapy is the cornerstone of conservative treatment.

The rehabilitation program typically progresses from symptom control to loading and eventually sport-specific capacity.

Early-stage exercises

Depending on the athlete, treatment may begin with:

• Isometric wrist flexion

• Isometric pronation

• Gentle gripping

• Pain-limited range-of-motion exercises

Progressive strengthening

As symptoms improve:

• Wrist flexion strengthening

• Wrist extension strengthening

• Forearm pronation/supination

• Grip strengthening

• Radial/ulnar deviation

• Eccentric loading

• Heavy-slow resistance

The goal is progressive loading of the tendon.

3. Strengthen More Than the Forearm

For athletes, the elbow is only one link in the kinetic chain.

Rehabilitation may also include:

• Rotator cuff strengthening

• Scapular strengthening

• Thoracic mobility

• Shoulder mobility

• Core strengthening

• Hip strength

• Lower-body strength

• Throwing mechanics

This becomes especially important for baseball and softball players.

The forearm should not have to compensate for deficits elsewhere in the kinetic chain.

4. Bracing

A counterforce strap can sometimes decrease symptoms during activity.

A wrist brace may also temporarily reduce the amount of wrist flexion and gripping required.

Bracing may allow an athlete to participate more comfortably while rehabilitation occurs.

However:

A brace does not rebuild tendon capacity.

It should be considered an adjunct rather than the primary treatment.

5. Ice, Heat and Symptom Management

Ice can be useful after aggravating activity.

Heat may be helpful before exercise if stiffness is present.

These approaches are primarily for symptom management.

The long-term solution is restoring the ability of the tendon to tolerate load.

6. Medication

Medications may help control symptoms while rehabilitation progresses.

Options may include:

• Acetaminophen

• Ibuprofen

• Naproxen

• Topical diclofenac

NSAIDs are not appropriate for everyone, and prolonged use should be discussed with a physician or pharmacist.

Most importantly, pain medication should not be used to mask symptoms so that an athlete can continue increasing workload.

7. Corticosteroid Injection

Corticosteroid injections may provide short-term pain relief.

However, their role in chronic tendinopathy is controversial because symptom relief does not necessarily correspond to improved tendon capacity.

For this reason, an injection should not automatically be viewed as a "fix."

If used, it should generally be incorporated into an overall treatment plan.

8. PRP and Other Biologic Injections

PRP and autologous blood injections have been investigated for chronic medial elbow tendinopathy.

The evidence is less robust than it is for some other elbow conditions, and treatment protocols vary.

For patients with persistent symptoms despite appropriate rehabilitation, these may be discussed with a sports medicine physician.

However, the underlying rehabilitation program remains important.

9. Shockwave Therapy

Extracorporeal shockwave therapy has been studied as another option for chronic medial elbow tendinopathy.

Some studies demonstrate potential benefit, but evidence remains variable.

It should be considered an adjunct rather than a substitute for progressive strengthening.

10. Surgery for Golfer's Elbow

Most patients do not require surgery.

Surgery may be considered when:

• Symptoms persist despite an appropriate conservative program

• Pain significantly interferes with work or sport

• Significant tendon degeneration is present

• Other diagnoses have been excluded

• Symptoms remain debilitating after approximately 6 months or more of nonoperative treatment

Surgical treatment generally involves removing diseased tendon tissue and repairing or reattaching the tendon to the medial epicondyle.

If the ulnar nerve is also involved, the surgical plan may need to address the nerve.

Recent literature suggests that surgery can provide good outcomes for appropriately selected patients with recalcitrant medial epicondylitis, although high-quality evidence remains limited.

💪Golfer's Elbow and Baseball Players

This is particularly important for throwing athletes.

Medial elbow pain in a baseball pitcher should never automatically be diagnosed as golfer's elbow.

The medial elbow also contains the UCL, ulnar nerve and other important structures.

A pitcher with medial elbow pain should be evaluated for:

• Flexor-pronator injury

• UCL injury

• Ulnar neuropathy

• Medial elbow impingement

• Tendinopathy

• Bone or joint pathology

If pain occurs during throwing—especially during acceleration or the late cocking phase—an athlete should be evaluated before simply returning to the mound.

⛳Returning to Golf

Returning to golf should be gradual.

A typical progression might be:

Stage 1

Putting and chipping

Stage 2

Short irons at reduced intensity

Stage 3

Longer irons

Stage 4

Woods

Stage 5

Gradually increase swing intensity

Stage 6

Increase number of shots

Stage 7

Return to full practice

Stage 8

Return to competitive play

Don't increase distance, intensity and volume all at once.

If symptoms increase significantly during the session or remain substantially worse the following day, the workload was probably too high.

⚾Returning to Baseball

Throwing athletes require a more structured return.

Before returning to unrestricted throwing, the athlete should demonstrate:

• Full or near-full elbow ROM

• Minimal or no pain

• Restored grip strength

• Restored forearm strength

• Adequate shoulder strength

• Adequate scapular control

• Good tolerance to progressive strengthening

• Ability to perform sport-specific activities

Throwing should then progress through controlled increases in:

Volume → distance → intensity → mound/competition demands

The exact progression should be individualized based on the injury and whether the UCL or other structures are involved.

🎾Returning to Tennis

Tennis players should gradually rebuild:

• Grip tolerance

• Forearm strength

• Groundstrokes

• Backhand volume

• Serving

• Match duration

The backhand and serve may place significant demands on the elbow and forearm.

Technique and equipment should also be evaluated if symptoms repeatedly return.

Five Tips for Managing Golfer's Elbow

1. Don't ignore medial elbow pain.

Especially if you are a throwing athlete.

2. Watch your workload.

A sudden increase in golf, throwing, lifting or repetitive work can overwhelm the tendon.

3. Strengthen progressively.

The tendon needs capacity—not just rest.

4. Don't rely on a brace or injection.

These may help symptoms, but they don't replace rehabilitation.

5. Watch for nerve symptoms.

Numbness or tingling into the ring and small fingers warrants evaluation of the ulnar nerve.

Tennis Elbow vs. Golfer's Elbow

	Tennis Elbow	Golfer's Elbow
Medical term	Lateral elbow tendinopathy	Medial elbow tendinopathy
Pain location	Outside of elbow	Inside of elbow
Primary tendon group	Wrist/finger extensors	Wrist/finger flexors + pronators
Common activities	Tennis, gripping, lifting	Golf, throwing, gripping
Baseball relevance	Hitting/throwing/gripping	Particularly important in throwing athletes
Main treatment	Progressive loading	Progressive loading
Bracing	Counterforce/wrist brace	Counterforce/wrist brace
Injections	Steroid, PRP, others	Steroid, PRP, others
Surgery	Rare	Rare
Key concern	Radial tunnel/other lateral pathology	UCL and ulnar nerve pathology

The Bottom Line

Golfer's elbow is not simply a golf injury. It is a medial elbow tendon capacity problem that can affect anyone exposed to repetitive gripping, wrist flexion, pronation or throwing. The best long-term treatment is generally a structured progression of: Load management → symptom control → progressive strengthening → kinetic-chain rehabilitation → sport-specific loading → return to sport.

For athletes, the goal should not simply be to get the pain to go away.

The goal is to build an elbow and entire kinetic chain that can tolerate the demands of the sport. If medial elbow pain is affecting your golf game, tennis, baseball, softball, weightlifting or daily activities, a sports physical therapy evaluation can help identify the source of the pain and develop an individualized plan to safely return to activity. Call us ☎️ today at 224-505-3343 to schedule your appointment.