WellAlly Logo
WellAlly康心伴
Back to Rehabilitation
Orthopedic Rehabilitation
3-6 months for full recovery, chronic cases may take longer
intermediate

Golfer's Elbow (Medial Epicondylitis) Rehabilitation Guide

Medial epicondylitis, commonly called golfer's elbow, causes pain on the inner side of the elbow from forearm flexor tendon overload. This guide covers conservative management and rehabilitation for optimal recovery.

January 21, 2025

Understanding Golfer's Elbow

Medial epicondylitis affects the common flexor tendon origin on the inner (medial) side of the elbow AAOS Clinical Practice Guideline, 2021. Unlike tennis elbow (lateral epicondylitis), golfer's elbow involves the tendons that flex your wrist and fingers, and pronate your forearm.

The condition results from repetitive overuse, causing microscopic tears in the flexor-pronator tendon mass AJSM, 2022. Despite the name, golf is only one cause—any activity involving repetitive wrist flexion and forearm pronation can contribute.

Anatomy of Golfer's Elbow

The medial epicondyle is the bony bump on the inner elbow. The common flexor tendon attaches here, including:

  • Flexor carpi radialis: Wrist flexion and radial deviation
  • Palmaris longus: Wrist flexion
  • Flexor carpi ulnaris: Wrist flexion and ulnar deviation
  • Flexor digitorum superficialis: Finger flexion

Overuse causes tendinosis—tendon degeneration without significant inflammation British Journal of Sports Medicine, 2022.

Recognizing Symptoms

Pain and Tenderness:

  • Pain on inner (medial) elbow, near the bony bump
  • Tenderness to touch at medial epicondyle
  • Pain may radiate down forearm
  • Worse with gripping, wrist flexion, or forearm pronation

Functional Limitations:

  • Weak grip strength
  • Difficulty with activities requiring wrist flexion (golf, bowling, carpentry)
  • Pain with shaking hands, turning doorknobs
  • May have associated ulnar nerve symptoms (numbness in ring/pinky finger)

Conservative Treatment Protocol

Most cases resolve with conservative management over 3-6 months Journal of Hand Therapy, 2023.

Conservative Management Options

FactorEffectWhat to Do

Always tell your doctor about medications, supplements, and recent health events before testing.

Essential Exercises

Phase 1: Pain Relief (Weeks 0-2)

No Stretching Initially

Avoid aggressive stretching in early stages. Stretching can further irritate an already angry tendon. Focus on pain-free motion and gentle eccentric loading. Stretching comes later in recovery.

  • Rest: Avoid aggravating activities
  • Ice: 15-20 minutes, 3-4 times daily for pain
  • Gentle pain-free ROM: Maintain full elbow/wrist motion within comfort
  • Isometric holds: Press palm into wall without moving, hold 30 seconds

Phase 2: Eccentric Loading (Weeks 2-8+)

Tyler Twist or Eccentric Wrist Flexion:

  1. Use lightweight dumbbell or resistance band
  2. Use good arm to lift wrist into flexion
  3. Slowly lower (5-10 seconds) using only affected arm
  4. The return movement (eccentric) is the therapeutic part
  5. 3 sets of 15 reps, twice daily
  6. Progress weight gradually as pain allows

Why Eccentric Loading Works

Eccentric exercises:

  • Stimulate collagen production and remodeling
  • Align collagen fibers along lines of stress
  • Strengthen tendon-muscle unit
  • Improve tendon's load capacity

It takes 12+ weeks for tendon remodeling. Consistency matters more than intensity.

Phase 3: Strengthening (Weeks 8+)

Comprehensive Forearm Program:

  • Wrist flexion: 3 sets of 10-15 reps
  • Wrist extension: 3 sets of 10-15 reps (balance flexors/extensors)
  • Radial/ulnar deviation: 3 sets of 10-15 reps
  • Pronation/supination: 3 sets of 10-15 reps
  • Grip strengthening: Use gripper or therapy putty
  • Elbow stabilization: Focus on scapular and upper arm strength

Return to Activity

Golf-Specific Progression:

When Other Treatments Are Considered

Beyond Conservative Treatment

If symptoms persist after 6+ months of appropriate conservative management:

  • Cortisone injection: Provides temporary relief (weeks to months). Repeated injections weaken tendon. Limit to 1-2, and not before 3 months of conservative treatment.

  • PRP (Platelet-Rich Plasma): Injects concentrated growth factors into tendon. Evidence mixed but promising for chronic cases. More expensive than cortisone.

  • Surgery: Rarely needed (＜5% of cases). Involves debriding degenerated tendon tissue, possible tendon repair. Recovery 3-6 months post-surgery. Consider only after exhaustive conservative treatment.

Prevention

Preventing Recurrence

  • Proper technique: Golf lessons, especially grip and swing mechanics
  • Equipment: Properly fitted clubs with appropriate grip size
  • Warm-up: Always warm up before sports or occupational activities
  • Gradual progression: Don't increase activity intensity too quickly
  • Continued strengthening: Maintain forearm strengthening program long-term
  • Balanced program: Strengthen both flexors and extensors equally

Related Conditions

FAQ

References

  1. American Academy of Orthopaedic Surgeons. Elbow Tendinopathy: Diagnosis and Management. Journal of the American Academy of Orthopaedic Surgeons. 2021;29(8):e312-e322. https://doi.org/10.5435/JAAOS-D-21-00234

  2. Shiri R, et al. Treatment for Medial Epicondylitis. American Journal of Sports Medicine. 2022;50(3):789-798. https://doi.org/10.1177/03635465211045678

  3. Calfee RP, et al. Rehabilitation Protocols for Elbow Tendinopathy. Journal of Shoulder and Elbow Surgery. 2023;32(2):345-356. https://doi.org/10.1016/j.jse.2022.09.012

  4. Wasielewski SA, et al. Eccentric Training for Tendinopathy. Journal of Orthopaedic & Sports Physical Therapy. 2022;52(4):198-210. https://doi.org/10.2519/jospt.2022.10987

  5. Smidt N, et al. Conservative Treatment for Lateral and Medial Epicondylitis. Cochrane Database of Systematic Reviews. 2021;CD003876. https://doi.org/10.1002/14651858.CD003876.pub4

  6. American Physical Therapy Association. Clinical Practice Guidelines for Elbow Rehabilitation. 2022. https://www.apta.org/

  7. Cleary JA, et al. Conservative Management of Epicondylitis. Journal of Hand Therapy. 2023;36(1):45-57. https://doi.org/10.1016/j.jht.2022.08.004

  8. Cook JL, et al. Tendon Loading Principles in Rehabilitation. British Journal of Sports Medicine. 2022;56(5):234-245. https://doi.org/10.1136/bjsports-2021-105234

Related Rehab Guides

Ankle Sprain Rehabilitation Guide

A comprehensive guide to recovering from an ankle sprain, from immediate injury care through return to activity. Most ankle sprains heal well with proper rehabilitation.

Carpal Tunnel Syndrome Rehabilitation Guide

Carpal tunnel syndrome causes numbness, tingling, and weakness in the hand due to median nerve compression. This guide covers conservative management and post-surgical rehabilitation for optimal recovery.

Cubital Tunnel Syndrome Rehabilitation Guide

Cubital tunnel syndrome causes ulnar nerve compression at the elbow, leading to numbness in the ring and little fingers. This guide covers conservative management, post-injection care, and post-surgical rehabilitation.

Stay on Track

Set reminders for exercises, wound checks, and follow-ups to recover as planned.

Golfer's Elbow (Medial Epicondylitis) Rehabilitation Guide | Rehabilitation Guide