Physical Therapy Guide to Golfer's Elbow (Medial Epicondylitis)
Medial epicondylitis is commonly called golfer's elbow or thrower's elbow. It is a condition that develops when the tendons on the inside of the forearm become irritated, inflamed, and painful. Repetitive use of the hand, wrist, forearm, and elbow causes golfer's elbow. This condition often gets diagnosed in people who repeatedly swing a golf club or other activities that require gripping, twisting, or throwing. Using a computer or performing yard work also can cause the condition. Athletes who perform overhead motions, carpenters, and plumbers are most at risk. Golfer's elbow is most common in men over the age of 35. It is less common than tennis elbow (lateral epicondylitis). A physical therapist can help decrease the pain caused by medial epicondylitis and improve the affected elbow's motion, strength, and function.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
What Is Golfer's Elbow (Medial Epicondylitis)?
Golfer's elbow (medial epicondylitis) is a condition that occurs when the tendons on the inside of the forearm become irritated, inflamed, and painful due to repetitive use of the hand, wrist, and forearm. A tendon is a soft tissue that attaches a muscle to a bone. The group of muscles affected by golfer's elbow is those that flex (bend) the wrist, fingers, and thumb and pronate (turn or hold) the wrist and forearm so that the palm faces downward.
The muscle group comes together into a common sheath and attaches to the humerus bone (the bone in your upper arm). As the muscles in this group spread across the elbow and the wrist, they stabilize the elbow and allow for wrist movement. A bony bump, called the medial epicondyle, is located along the inside of the elbow. Pain occurs on or near this bump, where the tendons of your forearm muscles connect to the bone. Repetitive forces can cause the tendon to become tender and irritated. Without treatment, these forces can cause the tendon to tear away from the bone. Because it is a two-joint tendon, it is more vulnerable to injury.
How Does It Feel?
People with golfer's elbow may experience:
- Pain along the inside of the forearm with wrist, hand, or elbow movements.
- Pain or numbness and tingling that radiates from the inside of the elbow into the hand and fingers when gripping or squeezing.
- Tenderness to touch and swelling along the inside of the forearm.
- Weakness in the hand and forearm when gripping objects.
- Elbow stiffness.
How Is It Diagnosed?
Your physical therapist will perform a thorough evaluation. They will ask you questions about any pain or other symptoms you may have. Your physical therapist may:
- Perform strength and motion tests on your wrist, forearm, and elbow.
- Ask about your job duties and hobbies.
- Evaluate your posture.
- Check for any muscle imbalances and weakness that can occur along the path from your shoulder blade to your hand.
- Gently touch your elbow in specific areas to find out which tendon or tendons may be inflamed.
- Conduct special muscle tests as needed, such as bending the wrist or rotating the forearm with resistance to confirm a diagnosis.
How Can a Physical Therapist Help?
It is important to get treatment for golfer's elbow as soon as it occurs. As tendons do not have a good blood supply, an inflamed tendon that goes untreated can begin to tear. If this happens, a more serious condition can result.
If you have golfer's elbow, your physical therapist will work with you to devise a treatment plan specific to your condition and goals. Your personalized treatment program may include:
Pain management. Your physical therapist will help you identify and avoid painful movements. Avoiding these will allow the inflamed tendon to heal. Your physical therapist may use or recommend:
- Ice, ice massage, or moist heat.
- Iontophoresis (medication delivered through an electrically charged patch).
- Bracing or splinting.
In severe cases, you may need to cease work or sport activities that continue to cause pain. Continuing to do them may delay your recovery. Physical therapists are experts in prescribing pain management techniques that reduce or eliminate the need for medication, including opioids.
Manual therapy. Your physical therapist may use manual techniques to help the muscles regain full movement. These may include:
- Gentle joint movements.
- Soft-tissue massage.
- Elbow, forearm, and wrist stretches.
- Manual stretching and other techniques on your shoulder and thoracic spine. These areas also can be affected by muscle imbalances along the chain of muscles and connective tissue involving the elbow.
Range-of-motion exercises. You will learn mobility exercises and self-stretches to help your elbow and wrist maintain proper movement.
Strengthening exercises. Your physical therapist will determine which exercises are right for you to do as your pain lessens. They will design a home-exercise program to continue after you have completed a formal physical therapy program. Doing these exercises will help you maintain your arm, forearm, elbow, and hand strength. The exercises they prescribe will depend on your specific condition. Exercises may include:
- Isometric exercises (muscle contractions).
- Resistance exercises to challenge weaker muscles (using weights, medicine balls, or resistance bands).
Patient education. Learning about your condition and possible causes is an important part of rehabilitation. Your physical therapist may recommend changes to how you perform various tasks. They also may suggest ways to improve your form during sport activities to reduce the risk of injury. Adjustments made in your golf swing, throwing techniques, or work tasks can help reduce pressure placed on the tendons in the forearm region.
Functional training. As your symptoms improve, your physical therapist will help you return to your previous level of function. They will teach you how to modify specific movement patterns to promote less stress on the medial tendons. You and your physical therapist will determine what your goals are. They will help you safely get back to your prior performance levels as much and as soon as possible.
Can This Injury or Condition Be Prevented?
Understanding the risk of injury and being aware of your daily movements can help prevent medial epicondylitis. Individuals should:
- Use proper form and technique when doing repetitive work tasks or sports movements, like golf swings.
- Maintain shoulder, forearm, and wrist muscle strength.
- Perform gentle forearm muscle stretches before and after performing tasks.
- Use proper posture and body mechanics when lifting heavy objects to reduce joint strain.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat medial epicondylitis. However, you may want to consider:
- A physical therapist with experience treating people with medial epicondylitis. Some physical therapists have a practice with an orthopedic focus.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or manual physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association. This tool will help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family, friends, or other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping active individuals.
- Be prepared to describe your symptoms in as much detail as possible, and report what activities make your symptoms better or worse.
The American Physical Therapy Association believes that consumers should have access to information to help them make health care decisions and prepare them for a visit with a health care provider.
The following resources offer some of the best scientific evidence related to physical therapy treatment of medial epicondylitis or golfer’s elbow. They report recent research and give an overview of the standards of practice both in the United States and internationally. They link to a PubMed* abstract of the article which may also offer free access to the full text, or to other resources, so that you can read them or print out a copy to bring with you to your health care provider.
Reece CL, Susmarski A. Medial Epicondylitis. Treasure Island, FL: StatPearls Publishing LLC; 2020. https://www.ncbi.nlm.nih.gov/books/NBK557869/
Tarpada SP, Morris MT, Lian J, Rashidi S. Current advances in the treatment of medial and lateral epicondylitis. J Orthop. 2018;15(1):107–110. Article Summary in PubMed.
Barco R, Antuna SA. Medial Elbow Pain. EFORT Open Rev. 2017;2(8):362–371. Article Summary in PubMed.
Hui T. Effective conservative treatment of medial epicondylitis with physical therapy: a case study. British J Advances Medicine Medical Res. 2016;13(3):1–5. Doi: 10.9734/BJMMR/2016/23416. Article Summary Not Available.
Pitzer ME, Seidenberg PH, Bader DA. Elbow tendinopathy. Med Clin North Am. 2014;98(4):833–849, xiii. Article Summary in PubMed.
Dingemanse R, Randsdorp M, Koes BW, Huisstede BM. Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: a systematic review. Br J Sports Med. 2014;48(12):957–965. Article Summary in PubMed .
Hoogvliet P, Randsdorp MS, Dingemanse R, Koes BW, Huisstede BM. Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review. Br J Sports Med. 2013;47(17):1112–1119. Article Summary in PubMed .
*PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.
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