What is golfer’s elbow?
Golfer’s elbow is also known as medial epicondylitis or epicondylopathy. It is a condition which causes pain around the inside bony part of the elbow and can radiate down into the forearm. People of any age can get golfer’s elbow but it mainly affects people between the ages of 40 and 60 with males and females equally affected.
Golfer’s elbow can happen as a result of a specific injury but is more often an overuse injury primarily due to repetitive strain from tasks and activities that involve gripping, rotating your arm and flexing your wrist. Repeated movements of flexing the wrist, gripping or swinging can cause strains or small tears in the tendons at the elbow.
Risk factors include:
- Smoking
- Obesity
- Repetitive movements which are carried out for more than two hours per day
- Vigorous activity (managing loads of over 20kg)
- Sports such as golf, tennis, bowling, cricket and baseball
What are the symptoms of golfer’s elbow?
Some common symptoms of golfer’s elbow include:
- Pain on the inside of your elbow just below the bend of the elbow
- Pain radiating into the forearm down to the wrist
- Difficulty lifting or bending your arm
- Difficulty with twisting movements e.g. turning a door handle, opening jars
- Difficulty with gripping due to pain
- Your elbow being painful to touch
What causes golfer’s elbow?
Golfer’s elbow is caused by a variety of activities which involve repetitive use of the forearm muscles through repetitive flexion movements of the wrist and hand. This includes gripping and twisting activities that are done in manual jobs.
What can I do to help my golfer’s elbow?
Golfer’s elbow may take weeks or months to settle. This can depend on how long symptoms have been present and whether you are able to avoid or reduce the activities or movements which aggravate your elbow pain. Changes in lifestyle and modifying the known causes, as previously explained, can reduce the symptoms getting worse. The one professional who can help you manage your symptoms is you!
Avoid aggravating movements
If your elbow pain is aggravated by certain movements try to avoid these aggravating movements. Often symptoms and flare ups of golfer’s elbow can be settled by modifying your activity. If certain movements or activities at your work seem to be the biggest issue in aggravating your symptoms you could speak to your occupational health department for an assessment and support.
Activity modification
- Try lifting objects with your palm facing your body rather than gripping.
- You could try changing the grip size on objects you use such as sports rackets or tools; increasing the grip size may help to reduce the strain.
- You could also try reducing the weight of your tools or racket.
- Try and use the larger muscles in your arm to reduce the strain, for example from the shoulder and elbow rather than your wrist and hand.
- Try and reduce time spent on repetitive activities.
Ice
Use a cold compress, such as a bag of ice, wrap this in a damp towel and place on the painful area. Leave for 15 minutes, checking the skin regularly. Repeat this 3-4 times per day particularly after activity. If you have any concerns about your circulation or ability to feel this area then please consult with your GP prior to applying ice to this area.
Exercise
If you have golfer’s elbow it is important to keep your arm moving. Rest can be helpful for a few days if you have had a flare up of pain but it is important to keep your elbow moving so it does not stiffen up and get weak. Exercises to maintain your elbow range of movement and strength are extremely important.
Local NHS Ayrshire & Arran physiotherapists have devised exercise videos to help with strengthening the correct muscles, which can be found further down this page.
Painkillers
A range of different medications may be available to help reduce your pain to allow you to move more comfortably. Do not exceed the daily allowance of these medicines even if your pain is high and always consult a health professional prior to taking any new medication. If you are unsure of what medication you can take, speak with your local pharmacist, practice nurse or GP for guidance.
It is important that if you are prescribed medication that you take them regularly and at the recommended dose (see medication packet for details). All medicines can cause side-effects, particularly if they are not used as prescribed. Side-effects range from common to uncommon and vary from person to person. Information on possible side-effects are available on the leaflet inside the packaging of your medication. It is important to speak to your local pharmacist, practice nurse or GP who may be able to change the dose or the medication itself to something that is more suitable.
You should try and use the prescribed medication regularly at the recommend dose as prescribed. Some medicines can take a number of weeks to have significant effect, however this is dependent on the person. It is best to speak again with your GP or pharmacist about what other options are available if you don’t feel your medicines are helping.
Reduce or quit smoking
It is thought smoking could interfere with the circulation to tendons. This means the tendons are at increased risk of injury. If circulation is poor, tendons may take longer to heal or may not heal well. Previous smokers are also at increase risk of tennis elbow due to the previous exposure and effects of tobacco on the vascular system.
See our advice on reducing or quitting smoking.
Weight loss
Being overweight can increase the number inflammatory molecules in the body which can lead to local and systemic inflammation within the body and therefore poorer healing and resolution of pain. Follow this link to an NHS BMI Calculator to guide you on whether you should consider weight management.
If you need help with your weight control, you can find help in your local area:
- East Ayrshire: Weigh To Go – East Ayrshire
- North Ayrshire: Weigh To Go – North Ayrshire
- South Ayrshire: Weigh To Go – South Ayrshire
What else can be done for golfer’s elbow?
- Epiclasp: some people find an epiclasp/elbow orthosis is helpful in the treatment of golfer’s elbow. Research suggests they may be helpful in the short term but there is limited evidence to support their use and does not recommend any one in particular.
- Acupuncture: acupuncture may provide some short term relief in the treatment of golfer’s elbow. However, research remains unclear on long term benefits.
- Injection: a corticosteroid injection may provide some short term relief in the treatment of Golfer’s Elbow. However, research has shown that having a corticosteroid injection for golfer’s elbow can result in a poorer outcome long term. See our information on corticosteroid injections.
- Surgery: surgery is only considered in extremely severe and persistent cases of Golfer’s Elbow and when conservative measures have not been effective in treating the condition. Research shows there is only a 60-70% chance of surgery helping to improve symptoms.
Golfer’s elbow exercises
The exercises in the videos below have been provided to help with your golfer’s elbow pain. If there is any doubt about your fitness to do these exercises then please discuss this with your GP.
You may find that these exercises may slightly increase your symptoms initially. However you should find that the exercises themselves will become easier to do. These exercises can take up around 12 weeks for you to notice a great improvement.
If the exercises do cause some discomfort then taking prescribed medication from your GP or pharmacist may help you to continue to exercise.
If these exercises cause a large increase in your pain or after 12 weeks there are no noticeable changes in your day to day symptoms then please contact your GP or NHS Inform for more advice.
The guide below will help ensure you are working at the right level.
Pain during exercise
Within the scale, aim to stay in the green or amber boxes. If you are in the red area then you can modify the exercises by:
- reducing the amount of movement during an exercise
- reducing the number of repetitions
- reducing the weights
- reducing your speed
- increasing rest time between sets
Pain after exercise
Your pain or other symptoms should return to your pre-exercise baseline within 30 minutes of exercising. On the morning after your exercises, you should not feel an increase in pain or stiffness that lasts longer than 60 minutes.
Disclaimer
Please note: These exercises should not be used without prior consultation with a medical professional as the use of the wrong exercise may cause additional health related issues and discomfort. NHS Ayrshire & Arran and MSK NHS Ayrshire & Arran are not liable or responsible for any harm, losses or damages whatsoever resulting from the use or misuse of the information contained in or implied by the provided information in each video. These are provided for information only.
If you have any concerns about your ability to perform exercise then please discuss your concerns with your doctor or healthcare provider prior to participating in any advice that is on the MSK NHS Ayrshire & Arran website.
It is recommended to use your ice pack (cryocuff) or cool pack after your exercises to reduce the pain and discomfort this may cause.
Please choose the most relevant exercise section for you.
Section 1: Isometric Strengthening Exercises
Isometric exercises are a type strength training that causes a gentle static contraction of the muscle.
This is usually the first phase of tendon rehabilitation where this type of exercise can help to reduce your pain if done correctly. These exercises need to be repeated several times a day, and slowly increased to 40 second holds to reduce pain, maintain some muscle capacity and tendon load.
In highly irritable tendons, shorter holding time may be indicated and can result in this phase taking longer to complete but should be steadily increased to 40 seconds over time.
This phase can take over four weeks to achieve before progressing to Section 2.
Exercise 1: Isometric Wrist Flexion
To do this exercise sit in a chair with your painful arm resting on a table with your palm facing towards the roof. Pull the wrist of your arm towards you and place the non-painful hand into the palm. Gently push for 10 seconds, 5 times, 4 time per day.
Once you have reached 10 seconds contractions 5 times and you are able to do 4 times per day the slowly increase the time of your hold, so:
- Week 2 – increase to 20 seconds, 5 times, 4 times per day for a week
- Week 3 – increase to 30 seconds, 5 times, 4 times per day for a week
- Week 4 – increase to 40 seconds, 5 times, 4 times per day for a week
Section 2: Strengthening Exercises
Once pain has slightly settled you can progress to work on strength. Strength is the ability to produce force and in this context we are aiming to improve the muscle and tendon’s ability to produce force and manage load. Strength is an essential building block for muscle function, without adequate strength muscle will have poor power and endurance.
Exercise 1: Concentric Wrist Flexion
To do this exercise, place the painful arm on a table with your palm facing towards the roof and over the edge of a table. Place a hand weight into your hand (a can or bottle of water will also be appropriate). Slowly raise towards yourself and then lower back to the starting position. Repeat 15 times.
Once you become fitter and stronger increase to 3 sets of 15 repetitions as your pain allows twice per day.
Exercise 2: Eccentric Wrist Flexion
To do this exercise, place your painful arm on a table surface with your palm facing towards the roof and over the edge of the table. Place a light hand weight into your palm (a can or bottle of water can also be used). Slowly raise your affected hand with the other side. Then slowly return to the starting position. Repeat 15 times twice per day.
Once you become fitter and stronger try and aim for 3 sets of 15 repetitions twice per day as your pain allows.
Exercise 3: Forearm Supination/Pronation
To do this exercise, sit in a chair with your painful arm resting on a table with a light hand weight in your hand (you can use a can, bottle or water or hammer). Position this vertically as shown in the video and have your elbow bent to 90 degrees. Let the weight of the object you are holding rotate the forearm so your palm is facing towards the roof and then return to the starting position. Repeat 15 times.
Once you become fitter and stronger, try to increase to 3 sets of 15 repetitions as your pain allows.