Golfer’s Elbow: A Physical Therapist’s Guide to Treatment


Golfer’s elbow is a common injury among golf enthusiasts and professional golfers alike. This type of injury, also known as medial epicondylitis, can cause pain and discomfort in the arm and elbow, affecting a golfer’s performance on the course. In this blog post, we will explore the causes of golfer’s elbow and I will provide my insight and expertise as a Doctor of Physical Therapy on how to prevent and treat this injury.

Symptoms of Golfers Elbow

  • Pain and/or tenderness: This will typically occur on the inside of the elbow. If you put pressure on the inside of the elbow and it is tender this is a sign of golfers elbow.
  • Numbness and/or tingling: Another common symptom is numbness in the forearm area which can radiate down to the hand and fingers. The ulnar nerve runs between the medial epicondyle and the olecranon. If you have golfers elbow the muscles and tendons which attach to the medial epicondyle can become inflamed which places pressure on the ulnar nerve causing numbness or tingling.
  • Weakness: If you are having difficulty lifting objects with the affected side this may be a sign that the forearm muscles which attach to the medial epicondyle have become inflamed and need to be rested.
  • Stiffness: You may experience a feeling of stiffness in your elbow and forearm which may also radiate down to the wrist.

Basic Anatomy

Anatomy of forearm showing medial epicondylitis or golfers elbow

As mentioned above there is a bone on the inside of your elbow called the medial epicondyle. There are many different forearm and wrist muscles that attach to this bone via tendons. These muscles allow for pronation and flexion of the wrist and to a lesser extent supination. Pronation is when the hand/forearm is turned down to face the floor or used when pouring out a jug of water. Supination is used when turning the hand upwards and forearm/wrist flexion is bending the wrist towards you such as when performing a wrist curl with a light dumbbell.

How could i get this playing golf?

Golfers elbow and medial epicondylitis typically occurs in sports or activities which involve a repetitive motion such as the baseball pitcher throwing a pitch, a tennis playing hitting a serve, and a golfer hitting a golf ball. These all involve a repetitive motion which is performed over and over again. In addition to being repetitive these motions cause a valgus stress on the elbow which over time can create micro tears of the tendons and tissue around the medial epicondyle. While golfers elbow will typically occur due to this repetitive motion it is also possible that one particular incident can cause enough damage to this structure that medial epicondylitis will ensue.

Whiffing a shot

Golf club hitting tree root

This will typically occur in the amateur golfer if they take a swing and whiff the golf ball but still hit the ground. Even worse is if the golfer is trying to take a swing near tree roots or other hard objects and strikes that object. The golf swing is a very violent motion which produces a fast club head speed. It is meant to hit a small golf ball which only weighs about 1.62 oz. By hitting such a light object there won’t be much of an effect on the body however if that fast motion is abruptly stopped by hitting a tree root or the ground a large valgus force will have occurred to the elbow which will cause damage to the medial epicondyle, the ulnar nerve, and the ulnar collateral ligament to name a few of the structures which could be affected. This could lead to medial epicondylitis with pain and inflammation to that area which can last several months or indefinitely if not treated.

Different phases

There are three main phases which occur with golfers elbow or medial epicondylitis. There is no set in stone timeframe for how long these phases will occur as they are dependent upon the severity of the damage, how consistent the individual is in sticking to their treatment, and also individual differences such as age/fitness level.

Acute Phase

The first is the acute phase which will consist of pain and inflammation. It is imperative that if you begin feeling any of the symptoms listed above such as pain, numbness, weakness, or stiffness that you stop playing golf and begin the healing process. If you try and tough it out you will only be causing more damage to your body which will take even longer to recover from.

Treatment for Acute Phase

Treatment for the acute phase will focus on rest and ice. What will work very well for icing the elbow is using a small coffee cup which are cheap to buy. Simply fill it with water then freeze the water. After the water is frozen cut off the top portion of the cup with scissors or a knife which will allow you to roll the ice on the affected area. This technique is so effective that it is used in Physical Therapy clinics throughout the country.

Ice in Coffee cup protocol

Small cup showing ice to demonstrate how to ice forearm or golfers elbow
  • Roll ice on the affected area (inside of elbow) for 3 to 5 minutes
  • Use a small circular motion
  • Light pressure only- Do not place pressure on the affected area as it is still in the acute phase and may only further hurt the affected area
  • May perform 2 to 3 times per day if tolerable

Regular Ice pack or gel pack

If you do not have small coffee cups or something comparable to use you can use a standard ice or cold pack or if you really need to some frozen peas.

  • Ice for 10 to 15 minutes on affected area (inside of elbow)
  • Should not be so cold that affected area becomes numb or is intolerable
  • May perform 2 to 3 times per day if tolerable

Self massage

Forearm self massage
Self Massage to Elbow

Another effective technique for the acute phase is self massage however this should not be done to the medial epicondyle or where you are having the discomfort. In the next phase we will discuss cross friction massage which can be done directly on the affected area but it is not appropriate for the acute phase. Self massage should be performed on the forearm muscles and I would not go any higher on the forearm than 2 to 3 inches below the elbow.

  • Perform self massage for 5 to 10 minutes daily if tolerable- if sore perform every other day
  • Use your thumb and press deep into the forearm musculature
  • Can also use your knuckles and really knead into the forearm muscles
  • Site may be a little tender which is ok however if you experience moderate pain or discomfort than stop this activity and only perform ice and rest

Intermediate/Healing phase

If you have been following the above treatment of rest and ice as well as self massage and your pain level is below a 5/10 you should be ready to progress to the intermediate phase which will consist of stretching and cross friction massage. It is important to slowly work into the intermediate phase and start off slowly so as to not reaggravate the elbow.

Stretching

Stretching is a vital component of this phase and should be performed on a regular basis if tolerable.

  • Grab affected sides hand with nonaffected hand and pull the fingers down- hold for 15 to 30 seconds and repeat 3 times. When first starting only perform for 15 seconds and work your way up to 30. (1st picture below)
  • Also perform by pointing the fingers up to the sky/ceiling and pull the hand back-hold for 15 to 30 seconds and repeat 3 times. (2nd picture below)
  • If you feel sore the next day than regress to performing every other day until your body is ready to perform daily
  • As a further progression you can lay your hand flat on a table- (3rd picture below)
Forearm stretch down
Forearm stretch up
Forearm stretch on table

Cross Friction Massage

Cross friction massage is a more aggressive form of massage than the self massage and serves a different purpose. The self massage you can continue to perform in the intermediate/healing phase. The cross friction massage differs in that it is performed directly on the pain site whereas the self massage in the acute phase should be performed lower on the forearm to the larger muscles in the lower arm. With golfers elbow the fibers around the elbow tend to become a jumbled mess and may begin laying down scar tissue. Cross friction massage works to realign the fibers and break up any scar tissue which has formed.

  • To perform use your thumb and find your medial epicondyle which will be the bone pointing out on the inside of your elbow
  • With your thumb perpendicular to your forearm or at 90 degrees start just inside your medial epicondyle so you are off the bone and begin rubbing perpendicular back and forth for about 3 to 4 minutes
  • If tolerable perform twice per day

Strength and recovery phase

The last phase is strength and recovery. A rough guide is that your pain should be less than 3/10 and you should have minimal weakness or stiffness in the affected arm to begin this phase. I would like to point out that the exercises used here can also be used not only for treatment but also to prevent golfers elbow so once you have healed you can continue to perform to prevent re-injury.

Supination/Pronation

Forearm pronation and supination
  • To perform- grab a light dumbbell less than 5 pounds- If you do not have a dumbbell you can use a hammer or other light household object of similar dimensions
  • When first starting have your forearm rested on your thigh with dumbbell just hanging off past your knee or use a table
  • Use starting position of dumbbell in neutral position pointed up then slowly turn your hand down as if pouring out a glass of water- return to starting position and turn your hand the other way so your palm is facing towards the ceiling
  • Perform 2 sets of 10 repetitions- Start off with performing once per day and increase to twice per day when this becomes too easy
  • Can also progress by not using your thigh or table as support and having forearm perpendicular to the floor

wrist flexion

Wrist flexion with dumbbell
  • Use the same weight dumbbell as in supination/pronation or the same household object you were using
  • To start- rest forearm on your thigh or table with dumbbell just hanging off
  • Curl your wrist up towards you in a slow controlled motion
  • Perform 2 sets of 10 repetitions- Just as above start off with once per day and increase to twice per day when once per day is too easy
  • Progress by increasing weight or no longer using the table or your thigh as support

Advanced exercises

These should only be performed after you have performed wrist flexion and pronation/supination for several weeks and you no longer feel that it is providing you with enough of a challenge. In addition your pain should be minimal to nonexistent. These exercises consist of all the muscles of the elbow joint including the biceps and triceps to tie everything together and provide even greater stability and support to your elbow joint. By strengthening these muscles, tendons, and ligaments your chance for injury will be less. Try to incorporate these exercises into a weekly strength or fitness routine as consistency will lead to better results. If you just perform these for a few weeks and then stop all together you will open yourself up to reaggravating the injury and you may have to start all the way at the acute phase.

  • Biceps curl- 2 to 3 sets of 10 repetitions
  • Hammer curl- Similar to biceps curl however the weight will be held perpendicular and pointing to the ceiling- 2 to 3 sets of 10 repetitions-(picture 1 below)
  • Triceps extension- If you have access to a gym or home-exercise equipment this can be performed using a triceps pushdown machine. If you only have a dumbbell you can perform a triceps kickback-(see picture 2 below)
  • Increase weight as tolerable
Hammer curl with weights
Triceps kickback

Importance of nutrition

I would be remiss if I did not discuss the importance of your diet and nutrition when going through all three phases. Recovering from any injury/ailment such as golfers elbow is no different than many other injuries. In order to repair tissue and heal itself your body requires the proper intake of vitamins, minerals, and macronutrients. Protein is of even greater importance as it is the main nutrient used to repair ligaments, tendons, and muscles after they have been damaged. You can follow all of the steps above perfectly but if your diet is a mess or if you aren’t getting enough protein, your recovery and healing will be negatively impacted. If you are having a difficult time getting enough protein in through your diet check out this article Do you need Protein for Golf?Opens in a new tab. on the importance of protein in golf which has a list of protein powders you can buy.

Picture of healthy Foods
Protein Powder

For Immediate Relief

For immediate relief you can use a medial epicondylitis band or brace which wraps around the forearm which takes some pressure off the medial epicondyle. Please be aware however that this will not cure your golfers elbow, this is solely for some symptom relief and to decrease pain. In order to actually heal and treat the problem you must do as prescribed above or see a medical professional such as a Physical Therapist.

Golfers elbow brace
Golfers elbow brace
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Disclaimer

Although I am a Doctor of Physical Therapy by profession, I am not your Physical Therapist nor am I a Medical Doctor. All content and information on this website are for informational purposes only, do not constitute medical advice, and do not establish any kind of patient-client relationship by your use of this website. A patient-client relationship with you is only formed after we have expressly entered into a written agreement with you that you have signed including our terms to represent you in a specific manner. Although we strive to provide accurate general information, the information presented here is not a substitute for any kind of professional advice, and you should not rely solely on this information. Always consult a professional in the area for your particular needs and circumstances prior to making any professional, legal, medical and financial, or tax-related decisions.

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