Physical Therapy Guide to Golfer's Elbow (Medial Epicondylitis)
Medial epicondylitis (commonly called golfer's elbow or thrower's elbow) is a condition that develops when the tendons on the inside of the forearm become irritated, inflamed, and painful due to repetitive use of the hand, wrist, forearm and elbow. It is often diagnosed in people who perform repetitive motions, such as swinging a golf club or tennis racket, or activities requiring gripping, twisting, or throwing. Even using a computer or performing yard work can cause the condition. It is most common in men over the age of 35. A physical therapist can help decrease the pain caused by medial epicondylitis, and improve the affected elbow's motion, strength, and function.
What is 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 medial epicondylitis are those that function to flex (bend) the wrist, fingers, and thumb and pronate (rotate palm-down) the wrist and forearm. The muscle group comes together into a common sheath and attaches to the humerus bone of the upper arm. This bony prominence, called the medial epicondyle, is located along the inside of the elbow. Pain occurs on or near the medial epicondyle, at the area where the tendon connects to the bone. Repetitive forces can cause the tendon to become tender and irritated, and without treatment, can cause it to even tear away from the bone. In addition, as the muscle groups travel across both the elbow and the wrist, they function to stabilize at the elbow allowing for wrist movement. As this is a 2-joint tendon, it is more vulnerable to injury.
How Does It Feel?
Persons with medial epicondylitis 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 down into the hand and fingers, with gripping or squeezing movements.
- Tenderness to touch and swelling along the inside of the forearm.
- Weakness in the hand and forearm when attempting to grip objects.
- Elbow stiffness.
How Is It Diagnosed?
Your physical therapist will perform an evaluation and ask you questions about pain or other symptoms you are feeling. 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; and check for any muscle imbalances and weakness that can occur anywhere along the path from your shoulder blade to your hand. Your physical therapist will gently touch your elbow in specific areas to determine which tendon or tendons may be inflamed. Special muscle tests, such as bending the wrist or rotating the forearm with resistance, also may be performed to ensure a proper diagnosis.
How Can a Physical Therapist Help?
It is important to get proper treatment for medial epicondylitis as soon as it occurs, as tendons do not have a good blood supply. An inflamed tendon that is not treated can begin to tear, causing a more serious condition.
When a diagnosis of medial epicondylitis is made, you will work with your physical therapist to devise a treatment plan that is specific to your condition and goals. Your individual treatment program may include:
Pain Management. Your physical therapist will help you identify and avoid painful movements to allow the inflamed tendon to heal. Ice, ice massage, or moist heat may be used for pain management. Therapeutic modalities, such as iontophoresis (medication delivered through an electrically charged patch), and ultrasound may be applied. Bracing or splinting may also be prescribed. In severe cases, it may be necessary to rest the elbow and not perform work or sport activities that continue causing pain, which may slow the recovery process.
Manual Therapy. Your physical therapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and elbow, forearm, and wrist stretches to help the muscles regain full movement. Your therapist may also do manual stretching and manual techniques to your shoulder and thoracic spine, as your tendons along the medial elbow can be affected by muscle imbalances all the way up the chain.
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 strengthening exercises are right for you, depending on your specific condition, as your pain subsides. You may use weights, medicine balls, resistance bands, and other types of resistance training to challenge your weaker muscles. You will receive a home-exercise program to maintain your arm, forearm, elbow, and hand strength long after you have completed your formal physical therapy.
Patient Education. Education is an important part of rehabilitation. Your physical therapist may suggest adjustments to how you perform various tasks, and make suggestions to improve your form and reduce any chance 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. Functional training will include modifications in specific movement patterns, promoting less stress on the medial tendons. As mentioned previously in patient education, you and your physical therapist will decide what your goals are, and safely get you back to your prior performance levels 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 the development of medial epicondylitis. Individuals should:
- Maintain proper form and technique when performing 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.
Real Life Experiences
Lauren is a 47-year-old woman who has built a successful career as a cake decorator. During the spring and summer wedding seasons, she can hardly keep up with the demand for her award-winning designs.
Recently, Lauren has begun experiencing pain along the inside of her forearm near her elbow, when squeezing the icing bag she uses all day long to create her designs. The pain has continued to worsen and has begun to radiate down into her forearm. Because the pain is affecting her work performance as she attempts to fill her many orders, Lauren calls her physical therapist.
Lauren's physical therapist performs a comprehensive evaluation, asking several questions about her job duties, household activities, and hobbies. He also measures Lauren's elbow and wrist motion and strength, gently feels the tendons around the elbow, and performs some special tests to determine the source of her symptoms. Lauren's grip strength is weaker than usual, and she feels pain when she bends her right wrist. Her tendon is tender to touch along the inside of the elbow. Based on these findings, Lauren is diagnosed with medial epicondylitis.
Lauren and her physical therapist work together to establish short- and long-term goals for her treatment. He prescribes ice to help decrease her pain, and teaches her some gentle movement and strengthening exercises. He also recommends an elbow brace to help alleviate pressure on the tendons in the elbow, which allows her to return to her important work tasks. He also shows Lauren how to better position her wrist when squeezing the icing bag, and teaches her a stretching and strengthening home-exercise program, which he modifies throughout the course of her therapy as her condition improves.
Lauren and her physical therapist work together in a 6-week program of 2 to 3 rehabilitation sessions per week. After a few weeks of therapy sessions and working with her home-exercise program, Lauren notices she is able to resume her job duties without elbow pain. This wedding season proves to be her best one yet!
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 who is experienced in 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 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 to 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):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have underlying medial epicondylitis.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions, and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of little league elbow. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
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.
Gosheger G, Liem D, Ludwig K, Greshake O, Winkelmann W. Injuries and overuse syndromes in golf. Am J Sports Med. 2003;31(3):438–443. Article Summary in PubMed.
McCarroll JR. Overuse injuries of the upper extremity in golf. Clin Sports Med. 2001;20(3):469–479. Article Summary in PubMed.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Authored by Julie A. Mulcahy, PT, MPT. Reviewed by the editorial board