Golfer's Elbow

This page has been designed to provide you with the right information about golfer’s elbow and the rehabilitation that may help you in your recovery.

What is golfer’s elbow?

Firstly, golfer’s elbow is not a dangerous issue and often has nothing to do with the game of golf. It normally relates to pain around the inside of the elbow.

Pain around the inside of the elbow can be caused by a number of things, but golfer’s elbow is known as one of the most common causes.

Golf.

You haven’t explained what it is yet!

You’re right, we haven’t!

Golfer’s elbow relates to an irritation of the tendon/s (which attach muscle to bone) in the front of your forearm as it meets the elbow. You have a number of muscles in your forearm and the ones on the front (and the ones that are implicated in golfer’s elbow) are generally involved with the action of bending your fingers and curling your wrist.

Why is it called golfer’s elbow then? 

The problem is normally associated with overuse or repetitive movements and as such, can often be seen in people who play sports such as golf. It is probably because some people who play golf get issues with their elbow, and the name is easy to remember, so it still gets used widely today.

The medical name for golfer’s elbow is medial epicondylalgia. The term ‘medial’ means to the inside of the body; the term ‘epicondyle’ is the name for a small lump on the end of bone (which is supposed to be there!); and the term ‘algia’ is a word that indicates pain.

For the purpose of this information page, we will use the term golfer’s elbow.

Lady shrugging shoulders to indicate confuion.

What is a tendon and why are mine irritated?

A tendon is a normal part of your anatomy. Their main job is to connect muscle to bone so that when your muscle contracts (works) it passes the force (or energy) to the tendon and then to the bone, which creates movement.

Tendons are incredibly strong and robust things and they are designed to work hard, and they normally do this without any issues. Just like any other body part, they can be trained to work harder if you need them to (i.e. by lifting weights or doing your job), but equally, they can become less efficient at doing their job if you don’t use them.

Tendon irritation can be caused by many things, but in a lot of cases it is normally caused by one of the following three things:

1. Doing more than you are used to

2. Doing something new or different that you are not used to

3. Doing either of the two things above but having a period (sometimes a long time) of doing less before

OK, so what happens to the tendon?

If you think of your tendons as being really good at doing their job (passing the energy from the muscle to bone to create movement), it means they can put up with a lot of work when they need to. If you find yourself doing more than you are used to, doing something you are not used to doing or more importantly, having a period of doing less activity before, then you can push your tendon’s ability to cope. Most of the time you notice very little, maybe a bit of an ache here and there, but sometimes your tendons can react and say “I’m struggling”.

If this happens, you will normally notice some discomfort and may find that moving can be uncomfortable. Think of this as your tendon being an ‘unhappy worker’ and as now struggling to do its normal day job and complaining about the work it has to do. Most of the time the soreness will settle with time, but sometimes it can last a bit longer, maybe into weeks or months. 

 

 

So, what are the common symptoms of golfer’s elbow?

In most cases, golfer’s elbow results in discomfort around the inside of the elbow. This discomfort can sometimes spread down into your forearm or fingers.

People with golfer’s elbow often find that gripping, twisting the forearm or carrying/lifting things will be sore.

 

 

Ok, I think I might have golfer’s elbow - what can I do about it?

Firstly, you should know that it is possible to feel better. Sometimes, these issues can be really quite sore and can get in the way of things that you would normally take for granted, however, most cases of golfer’s elbow will get better by themselves over time. If it hasn’t settled by itself, then physiotherapy can help.

Understanding the issue is often the best place to start. By reading the information above, you can better understand that golfer’s elbow is not a damage or dangerous problem and that it can get better.

There are two important things that can help you on your recovery journey:

1. Calm the problem down

2. Build yourself back up again

What does ‘calm the problem down’ mean?

If you think back to the idea that your irritated tendon is an unhappy worker, if you keep asking your tendon to do the same job, in the same way that it always has, then the tendon will keep being sore. In other words, when something is sore, think of it like your tendons saying “I can’t do that as easily as I used to right now”. Making some changes to the things that are sore may help calm the issue down and allow you to move on with your recovery. Think of it as putting the tendon on lighter or amended duties whilst it’s sore.

We have written a whole page on ‘calming things down’; you can find it here along with some homework to try to help your elbow’s recovery:

Go to our 'Load Management' page

Can you give some examples of what you mean?

Sure, but remember everyone is different, and you will have to do some thinking yourself around how your elbow is affecting you and some of the changes you might need to make.

 

Things that are sore
Why is it sore?
Possible solution

 

Gripping

 

Sore tendons will find hard work challenging

Try not to grip too hard or tightly or use your other hand if you can

 

Lifting

 

Sore tendons will tire more quickly and will find hard work more challenging

Reduce how much you are lifting or change the way you lift i.e. hand facing in or up. Use your other hand if possible

 

Typing or writing

 

Sore tendons will tire more quickly

 

Try to take more regular breaks or gentle exercises throughout the day

 

Pressure on the elbow

 

 

Sore tendons don’t like pressure

 

Don’t press it!

 

So, should I just rest it and do nothing?

No, this is not what we are trying to say.

Firstly, it is impossible to completely rest your elbow as you still have everyday tasks to complete, like brushing your teeth, making a cup of tea, working etc.

Secondly, completely resting your elbow may temporarily ease the symptoms, but it will not address the underlying cause. If you simply rest and make no other changes (such as looking at the things that make your elbow sore and completing the exercises set out below), then you are unlikely to progress as well or as quickly as you might like.

How long should I work on ‘calming things down’?

This is a little tricky to be specific about and it is probably best to think about what your elbow is saying. If you have been good at adjusting, modifying and looking at the things that make your elbow sore, then you should notice some changes within a few short weeks.

Ok, what do I do once it feels calmer?

Firstly, well done! Often ‘calming it down’ is the hardest part of your recovery.

Now that your elbow feels somewhat calmer, the temptation might be to start going back to your normal activities in the same way you did before your elbow issue. Sometimes this can be ok but equally, sometimes you might find that your elbow is not quite ready to return to normal just yet and may get irritated again. It might be best to think that your elbow needs to get fit and strong again in order to get back to doing normal things in normal ways.

As we’ve said before, if you consider your sore elbow as an unhappy worker then you’ve adjusted and modified things (putting it on ‘lighter duties’) to help calm it down. Now you’ve got to start a gradual or phased return to work (or normal). Jumping in at the deep end and going back to normal might result in your elbow becoming grumpy and sore again.

OK, I know I’ve got to build it up and understand it’s got to be done in the right way, but how?

Understanding that it might take some time and that your elbow will be more likely to cope better if you do things in a gradual way, is very important as the temptation will be to rush in, especially if it’s less sore than before.

No one is the same, just like no elbow problem is the same as the next, therefore there are no ‘formulas' that will be right for everyone. However, we have provided an exercise programme below that, if followed, can be effective in helping you move forwards with your elbow complaint.

Before I start, I’d like to know what the exercises are trying to do.

Excellent point, as it’s often useful to know what you’re aiming to do before you start.

Firstly, the exercises are aiming to introduce a little bit of work into the tendon by asking the muscles to do some work. The aim is to start with only a little bit of work (within what is comfortable) and not much movement.

As you move through the exercises (as your elbow allows), you will notice that the amount of work/effort and the amount of movement increases.

Lastly, one of the most important things about all of these exercises, is that they are trying to help you regain some trust in your elbow. If your elbow has been sore for some time, it is only normal to be a little cautious when you start to move back into doing things that caused you pain before. This is why the exercises are done gradually and shouldn’t be rushed too much.

 

What should I expect with these exercises? Will they be painful?

This is a very important question.

If your elbow has been sore for some time, it would be unrealistic to expect that it will be pain-free when doing these exercises. However, it is important that you don’t do too much to then upset the problem all over again.

A good marker for how hard to work is that you should feel some discomfort (not too much though), but it should settle within 24 hours. If you are still obviously sore the following day, you may have done too much/pushed too hard, therefore next time you do the exercises, reduce the effort a bit.

Will this get better with just adjusting the things that are sore and carrying out the exercises?

Something that is reassuring about golfer’s elbow is that it will often get better by itself over time. In a review of the research on tennis elbow (the equivalent of golfer’s elbow but with the pain on the outside of the elbow), Bissett and Vicenzino (2015) suggest that physiotherapy (adjusting things that are sore, exercise, advice and possibly manual therapy) is consistently better at improving outcomes such as pain and function (doing things), than corticosteroid injections and ‘wait and see’ (not actively treating it and letting time take its course).

a human hand performing the thumbs up gesture on white background.

Apart from these exercises, is there anything else I can be doing to help myself?

Yes there is - here are just a couple of the most important things.

 

Some people will choose to manage their elbow pain with pain relief, whereas some may choose to avoid medication. Applying something cold to your elbow may also be useful in helping with some of the pain (do remember to wrap your frozen peas in a towel before applying them to your skin to avoid cold burns).

General exercise, including strengthening exercise (working against something like a weight, gravity or exercise bands) is considered one of the key treatments for most aches and pains, even if it doesn’t specifically involve your elbow.

Exercise comes in many shapes and forms and there is no ‘best’ exercise. Often it is best to think of the most effective exercise as the one you enjoy and will actually do. Current recommendations on exercise and how often we should be looking to do it can be found here: Understanding Exercise

We have included a series of exercises at the bottom of the page that will help you move forwards with managing your elbow complaint.

Weight loss is recommended as something that is important for the management of most muscle and bone issues, although we understand that losing weight can be difficult.

You may be thinking “how is losing weight going to help my elbow?”. Often, people think that simply putting more weight through their joints is the reason why they get problems, and being closer to their ideal body weight will simply stop their symptoms. Unfortunately, it isn’t that easy. It is worth knowing that fat cells are very active cells and one thing they do is produce chemicals that can affect your pain sensitivity (Tashani et al, 2017).

By looking at diet, exercise, sensible goal setting and establishing a good support network, a weight loss journey is more likely to succeed and the benefits to your elbow are more likely to be influenced by the journey you take to lose weight, rather than being lighter.

If you would like some support to help you with your weight loss journey, please contact our partners at Feel Good Suffolk  or Active Norfolk

Getting the best out of your diet is important to support your training programme. There are lots of different opinions as what is best but generally it is agreed that if you want to build muscle, you should look to increase the protein in your diet. 1.5 grams of protein to every kilogram of your body weight is often suggested as a good starting point. More advice about diet can be found here: https://www.nhs.uk/live-well/eat-well/food-and-drinks-for-sport/

Sleeping well will help your recovery and support your training programme. More advice about sleeping better can be found here: https://sleepcouncil.org.uk/

Frequently asked questions

 

A:  Some people do find wearing a brace (commonly called an epiclasp) for their elbows useful, however it is not essential for helping your elbow improve and most people recover without having to use one.

A: A steroid injection for golfer’s elbow is an option. However, like most drugs, steroids come with side-effects, and some of these can cause problems in the future for your elbow (particularly the tendons). Olaussen et al (2013) suggest that corticosteroid injections for tennis elbow (the equivalent of golfer’s elbow but with pain on the outside of the elbow) may be of benefit in the short-term, but can actually have a negative effect in the intermediate term. When compared to exercise and manual therapy, the result of the injection is poorer. In other words, they may help for a short time, but the better long-term effects are found with exercise/physiotherapy input.

A: Scans (MRIs or ultrasound scans) are very useful in a lot of cases, however they are not normally needed for the assessment or management of golfer’s elbow. If your GP or physio decides they would like to arrange a scan for you, it is likely they are checking for something in particular, but the treatment (outlined above) remains the same and the most effective way of managing golfer’s elbow.

A: Often people will make a better recovery if they are able to remain at work rather than take time off sick. As mentioned before, the best way to approach golfer’s elbow is to adjust the things that are sore (including work and sport) and when you are ready, try to work the tendons ‘better’ with exercises.

A: Firstly, ask yourself if you tried the ‘calm it down’ approach first. If you didn’t, then that might be the reason why you haven’t moved forwards. If you have, ask yourself if you did everything you could do and really commit yourself to adjusting/modifying all the things your elbow was telling you it was struggling with.

A: Often these types of problems take a long time (weeks into months) to settle, so be patient with yourself. If you have been dedicated to the ‘calm it down’ work and the exercises, as well as being patient and giving it time and still you feel no better, do discuss this with your physio as they may be able to discuss other options with you.

Exercise Videos:

The following programme is a rough guide that might be useful for your golfer's elbow. Your physiotherapist will be able to guide you if any adaptations are needed.

Phase one:

 
Exercise tip: Hold the wrist position for 15-30 seconds and repeat 2-3 times. Have a rest for about 1-2 minutes then repeat again, aiming for a total of 2-3 sets overall. Aim to complete this exercise every other day.

Move onto the next phase when these exercises start becoming too easy.

Exercise 1

Phase two:

 
Exercise tip: You only have to pick one of these exercises. Concentrate on making the movement (particularly the lowering down part) nice and slow (about 3-5 seconds) and repeat 5-10 times for 2-3 sets. Aim to complete this exercise every other day.

Move onto the next phase when these exercises start becoming too easy.

Exercise 1
Exercise 2

Phase three:



Exercise tip: You only have to pick one of these exercises. Concentrate on making the movement (particularly the lowering down part) nice and slow (about 3-5 seconds) and repeat 12-15 times for 3 sets. Aim to complete this exercise every other day.

Move onto the next phase when these exercises start becoming too easy.

 

Exercise 1
Exercise 2
Exercise 3
Exercise 4

Phase four:

 

Exercise tip: You only have to pick one of these exercises, but a variety is good. With this phase, you can start to play around with speed. This section is important to help your elbow regain its ability to tolerate high level fast movements.

Exercise 1
Exercise 2
Exercise 3

Need more help? Refer yourself here.

References:
Bissett, L. M. and Vicenzino, B. (2015). Physiotherapy management of lateral epicondylalgia. Journal of Physiotherapy, 61(4) 174-181. https://doi.org/10.1016/j.jphys.2015.07.015 (accessed 02/02/2021)

Olaussen, M., Holmedal, O., Lindbaek, M., Brage, S. & Solvang, H. (2013). Treating lateral epicondylitis with corticosteroid injections or non-electrotherapeutical physiotherapy: a systematic review. Sports and Exercise Medicine, 3 (10). http://dx.doi.org/10.1136/bmjopen-2013-003564 (accessed 02/02/2021)

Tashani, O.A., Astita, R., Sharp, D. & Johnson, M.I. (2017). Body mass index and distribution of fat can influence sensory detection and pain sensitivity. European Journal of Pain. 21(7):1186-1196.
doi: 10.1002/ejp.1019 (accessed 16/12/2020).