A Physical Therapy Guide to Golfer's Elbow (Medial Epicodylitis)
Elbow pain can happen even if you do not play sports. Your elbow anatomically lies in a very important spot of your body, between your shoulder and hand. This hinge joint is necessary to be in optimal shape to be functional. For example, reaching for items in a cabinet, scratching the back of your neck, or driving your car all require the surprisingly intricate movements of your elbow and forearm.
The elbow pain caused by medial epicondylitis prevents you from being able to grip tightly and causes pain with gripping. Medial epicondylitis is often referred to as golfer's elbow, although this is a misconception because medial epicondylitis is found in people who have never picked up a golf club. In fact, over 90% of cases are not even sports-related.1
Medial epicondylitis accounts for 10-20% of all epicondylitis, most commonly affecting people between 45-64 years old and women more often than men.1
This guide gives you in-depth information about medial epicondylitis, its treatment, and how seeing a physical therapist or occupational therapist can help.
- Understanding Medial Epicondylitis
- Symptoms of Medial Epicondylitis
- What are the Most Common Causes of Medial Epicondylitis?
- Diagnosing Medial Epicondylitis
- What to Expect from Hand Therapy
- What If Conservative Treatment Doesn't Work?
- Preventing Medial Epicondylitis
- Is It Time to Seek Treatment?
Your inner (or medial) elbow is the origin of a group of muscles that work together to bend your wrist and fingers, making a tight full grip. This group of muscles originate on the inner part of your humerus bone (upper arm bone) and can often be referred to as your "wrist flexors and pronators."
Medial epicondylitis is caused by repetitive, forceful motion combined with sustained gripping and poor mechanics. People who work in labor-intensive roles like carpentry and construction as well as those in sports like American football, golf, or baseball are at risk.
What are the symptoms of Medial Epicondylitis? Let's review.
- Dull ache on the inside (medial) side of the elbow especially when gripping and lifting objects
- Can progress to sharp, shooting pains radiating from the medial elbow down or up the arm
- Decreased ability to perform daily tasks like typing, opening jars, or lifting groceries
- Tenderness to touch over the inner or medial part of the elbow
- Decreased motion due to pain at the elbow or wrist
- Swelling over the medial (inside) elbow
- Weakness or pain and decreased motion with gripping
While many different types of folks can experience Medial Epicondylitis, below are the most common risk factors.2
- Repetitive stress on the tendons (like hammering, golfing, or pitching)
- Lack of strength, endurance, or flexibility in your upper extremity
- Occupation-based factors like heavy physical labor, excessive repetition
- High body mass index
- Tobacco consumer
If you are experiencing medial elbow pain, you will likely see your primary care doctor, orthopedic surgeon, or local Certified Hand Therapist (CHT) — physical or occupational therapist. To get the best conservative care with less need for pain medications, injections, or surgery, it's best to see a CHT for long-term relief and sustainable results.
In other words, proper diagnosis from a specialist like a CHT who is an occupational or physical therapist with additional specialty training, will help you get better quickly and return to those daily activities that are most meaningful to you, pain-free. In fact, therapy shows to have better long-term outcomes than quick-fixes like corticosteroid injections.3
The sooner your elbow pain is properly diagnosed, the better the results will be. Diagnosis is usually clinical with no imaging necessary. However, occasionally, your doctor may have routine imaging done like X-ray or MRI to rule out other possibilities of elbow pain. It's best to seek treatment as soon as possible.
Many folks are hesitant to seek medical care due to past traumatic experiences. We strive to make it more inviting by providing you with an idea of what you can expect at your evaluation.
Your therapist might ask you questions to get to know you to aid in shaping your recovery. The questions may be like:
- When did your elbow pain start?
- How did it start?
- What activities or positions make it better or worse?
- Do you have any medical conditions we should know about?
- What are three things you cannot do right now that you wish you could because of your elbow pain?
- What major life changes have you experienced in the last year?
Your therapist will also perform a thorough physical evaluation which may include:
- Differential diagnostic testing to evaluate tissue, joint, or muscle integrity
- Measuring range of motion and strength
- Testing functional abilities and coordination
- Noting sensory changes, like numbness or tingling
- Palpating areas of tenderness
- Observing swelling (edema)
Follow-up treatment may vary, but is likely to include the following:
- Hands-on treatment to reduce pain and increase motion
- Custom splinting to comfortably rest your healing structures
- Dry needling for pain-reduction
- Taping for soft tissue support
- Education for activity modification and proper lifting techniques
- Re-education of movement patterns to correct and prevent further injury
- Approachable exercises to improve range of motion, strength, and endurance
Sometimes, despite best efforts, conservative management fails. This can be due to the duration of symptoms or in the specific case of Medial Epicondylitis, some folks are unfortunate in the persistence of their symptoms. If you have tried conservative management and continue to experience pain and dysfunction, your therapist may refer you to your physician who may offer:
- Injections: Cortisone injections, while not always effective, can offer temporary relief from the pain to allow your body to heal itself.
- Surgery: When all else has failed, your physician may offer surgery to attempt to reduce your elbow pain. There are a variety of surgical approaches, all with mixed success rates. You will likely be referred to therapy post-operatively as well to ease you back into meaningful daily activities. Your hand therapist will help by addressing range of motion, functional adaptations, tendon gliding, swelling and scar management, and increased strength.
Whether you are a new golfer looking to prevent Medial Epicondylitis or someone who might be experiencing intermittent pain on the inside of your elbow, here are some ideas to consider for prevention.
- Stay active: Motion is lotion. Moving is grooving. Gentle stretching and strengthening as part of an active lifestyle can reduce the likelihood of developing Medial Epicondylitis.
- Focus on Shoulder and Core: Focusing on proximal strength and coordination can also help prevent the onset of Medial Epicondylitis. Proximal strengthening means including your shoulder, scapular muscles (shoulder blades), and core into your workouts and functional tasks.
- Proper Technique If you are a golfer or pitcher, consider a coach to teach you proper form to reduce the likelihood of developing elbow pain and dysfunction, sidelining you from your beloved sport.
- Make healthy lifestyle choices: Try to get enough sleep, stay hydrated, and eat nutrient dense foods. Practice healthy stress management. Do your best to stop tobacco use. Your whole body will thank you!
- Try splinting: Nighttime splinting in a wrist support splint can help position your wrist ergonomically while you sleep, giving your tendons a much needed break.
- Talk to a Certified Hand Therapist: If you have concerns or want professional advice on splinting, treatments at home, and functional adaptations, make an appointment with a CityPT specialist.
If your symptoms are getting in the way of your daily independence or if you have already tried self-treatment but your symptoms persist — it may be time to seek professional help. Or, if you are not sure where to start, it may be time to see a hand expert. A Certified Hand Therapist can create a custom plan to ease your pain and help you return to your most meaningful daily activities.
Schedule an appointment with one of our hand experts. They'll work with you to find the root of your pain and improve your independence with daily activities, getting you on the path to recovery.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Kiel J, Kaiser K. Golfers Elbow. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519000/. Accessed November 21, 2022. ↩ ↩2
Kiel J, Kaiser K. Golfers Elbow. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519000/. Accessed November 21, 2022. ↩
Epicondylitis and corticosteroid injection: fewer cures at one year. Prescrire Int. 2015 Jun;24(161):160-1. PMID: 26436174. ↩