Golfer's elbow: inner elbow pain and how to fix it

What golfer's elbow is

Golfer's elbow, or medial elbow tendinopathy, affects the common flexor tendon on the inner bony point of the elbow. The muscles that attach here bend the wrist and fingers and turn the palm to face down, so they work hard every time you grip, curl or pull. When the load on the tendon rises faster than it can adapt, it becomes painful and less tolerant.

It is the less common cousin of tennis elbow, which affects the outside of the elbow. The principles for managing both are similar, even though the muscles and triggers differ.

Common causes and who gets it

Golfer's elbow is most common in people aged roughly 40 to 60, but it shows up in younger athletes too. Only a minority of cases come from golf. The usual story is a sudden increase in gripping, pulling or throwing work.

• A jump in chin-ups, pull-ups or supinated rows
• High-volume or heavy biceps curls, especially with a straight bar
• Climbing, bouldering or a lot of hanging from a rig
• Throwing sports, cricket bowling and racket sports
• Manual work using hammers, screwdrivers or other tools
• Grip-heavy HYROX training blocks with lots of sled pulls and farmers carries

Fatigue matters. Grip work at the end of a long session, when forearms are already tired, tends to put more strain on the tendon than the same work done fresh. Sleep, stress and overall training load also play a part, because tendons adapt best when recovery is good. A busy month at work combined with a new pull-up challenge is a classic recipe for a flare-up.

Typical symptoms

Pain sits on the inner side of the elbow and can spread into the forearm. It is usually aggravated by gripping, carrying bags, pulling, curling, and bending the wrist against resistance. Some people feel it most at the bottom of a chin-up or when opening a jar.

The ulnar nerve runs just behind the inner elbow, so it is worth paying attention to any tingling or numbness in the ring and little fingers, or clumsiness in the hand. That suggests the nerve may be involved and needs a proper assessment rather than just tendon rehab.

What a physio assessment looks at

Your physio will ask about training, work and hobbies to find where the load is coming from, then examine the elbow for tenderness, test grip strength and resisted wrist flexion and forearm rotation, and check the ulnar nerve and the neck. In throwing athletes, they will also check the ligament on the inside of the elbow, which can be injured by repeated throwing.

Most people do not need a scan. An ultrasound or MRI may be useful if there was a specific injury, if ligament damage is suspected, or if symptoms are not improving after a good period of rehab.

What usually helps

The core of treatment is reducing the aggravating load without stopping training altogether, and progressively strengthening the wrist flexors, forearm rotators and grip. Programmes usually start with isometric holds, then slow dumbbell wrist curls and forearm rotation, then heavier and more sport-specific work. Expect steady progress over weeks to months.

Practical changes help a lot: swapping chin-ups for neutral-grip pull-ups or lat pulldowns, using an EZ bar or dumbbells for curls, reducing hanging volume, and using straps for heavy pulling for a while. Manual therapy can ease pain short term. As with tennis elbow, steroid injections may relieve pain briefly but are not a long-term fix.

What you can start with at home

1. Isometric wrist flexion: forearm on a table, palm up, press your palm up into your other hand at moderate effort for 30 to 45 seconds, 4 to 5 times.
2. Slow wrist curls with a light dumbbell, 3 seconds up and 3 seconds down, 3 sets of 15.
3. Forearm rotation holding a light hammer or dumbbell at one end, turning the palm up and down slowly, 3 sets of 10.
4. Grip squeezes with a soft ball, 3 sets of 10 to 15.
5. Reduce pulling volume by about half and swap grips as above for two to four weeks, then rebuild.

Keep discomfort during these exercises mild, around 3 or 4 out of 10 at most, and check that it settles by the next morning. Add a little weight to the wrist curls when 3 sets of 15 feel easy.

Once daily tasks are comfortable, reintroduce pulling gradually. A typical progression is lat pulldowns and neutral-grip rows, then neutral-grip pull-ups, then chin-ups and heavier curls, moving to the next stage only when the current one causes no flare the following day. Our guide to grip strength covers how to rebuild forearm and grip capacity so it copes better next time.

Recovery time and when to get help

Many people improve over 6 to 12 weeks with consistent rehab, but tendons are slow and some cases take several months. If it is not settling, or it keeps flaring when you return to pulling, the on-site physio at Lycan Strength can assess it and adjust your training, with 20% off for members. You can book a physio appointment online.

• Go to A&E if the elbow is deformed or very swollen, or you cannot move it after a fall, throw or injury.
• Call NHS 111 or see a GP urgently if the elbow is hot, red and swollen, or you have a fever.
• See your GP if you have numbness or tingling in the ring and little fingers, hand weakness or clumsiness.

Questions