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Golfer’s elbow treatment

Published by Al-Shama Physiotherapy ClinicIllustrated portrait of Dr. Zahra Fatima in burgundy scrubsClinically reviewed by Dr. Zahra Fatima, DPT
Your guide at a glance
  1. RecogniseExplore the symptoms
  2. UnderstandRead about treatment
  3. Move forwardExercises and precautions

What is golfers elbow

Golfer's elbow is pain where the forearm muscles attach to the bony bump on the inside of the elbow. Those muscles bend the wrist and turn the palm down, so this elbow hurts when you grip, twist a lid, lift a child or carry a bag.

It is the same problem as tennis elbow at a different corner of the same joint, and less common. Almost nobody who gets it plays golf. Here it comes from gripping work, carrying, kneading, wringing and lifting children.

As with tennis elbow, the tendon is weakened rather than inflamed, and rest alone does not fix it. The treatment is graded loading, over months rather than weeks.

Symptoms you might have

  • Pain and sharp tenderness right on the bony bump on the inside of the elbow
  • Pain on gripping, especially when turning the palm downwards
  • Pain on wringing cloth, opening a tight lid or lifting a child under the arms
  • Pain that runs down the inner side of the forearm towards the wrist
  • No pins and needles. Numbness or tingling in the little and ring fingers means the nerve behind that bump, not the tendon

Why it happens

  • Repeated gripping and twisting with the palm turning down: spanners, screwdrivers, tailoring, kneading, scrubbing
  • Wringing out clothes by hand, which loads these tendons more than any other household task
  • Lifting and carrying children on one arm
  • A sudden increase in heavy manual work, which is the classic trigger
  • Throwing sports, including cricket bowling, where the inner elbow takes repeated strain
  • Weak shoulder and grip strength, so the forearm takes load it is not built for

When you should see a physiotherapist

Come in once it has lasted two or three weeks, or sooner if it is affecting your work. The sooner the loading programme starts, the shorter the whole course is.

Get it assessed rather than assuming, because three things sit within an inch of each other there: the tendon, the ulnar nerve and the ligament. They need different treatment.

See a doctor promptly if there is numbness or tingling in the little and ring fingers, especially if it is constant, or if the muscle between the thumb and index finger looks thinner than on the other hand. That is the nerve and it needs protecting.

Go to a hospital if the pain started suddenly during a heavy lift or a throw with a snapping sensation, or if the elbow is hot, red and swollen with fever.

How it is treated

Loading the tendon is the treatment here too. The exercises differ from tennis elbow because the muscles involved bend the wrist rather than lift it, but the principle is identical.

  • Exercise therapy, the core of treatment. Isometric holds first for pain relief, then slow wrist curls and forearm rotation work with light weight, progressed for months
  • Manual therapy, elbow and wrist mobilisation plus soft tissue work to the forearm flexor muscles
  • Dry needling for tender bands in the forearm muscles. We avoid the area immediately behind the bony bump, where the nerve runs, and we do not needle numb skin or anyone on blood thinners
  • A forearm strap and taping for gripping tasks, which reduce pain for some people but are not a treatment on their own
  • Grip and load changes, thicker handles, lifting with the palm up, two hands instead of one

Surgery is uncommon and only considered after a year or more of proper treatment. Steroid injections are a doctor's decision, and as with tennis elbow they help for a few weeks but give worse results than exercise at six to twelve months.

Exercises, and what to avoid

What helps

  • Isometric holds: squeeze a rolled towel steadily for 30 to 45 seconds, five times, when it is too sore to move
  • Slow wrist curls, palm up over the edge of a table with a light weight, three seconds up and three seconds down
  • Forearm rotation with a light weight or hammer held at the end of the handle, turning the palm up and down slowly
  • Shoulder blade strengthening, so the arm is not working entirely from the forearm

What to avoid

  • Wringing out clothes by hand. Press the water out between flat palms, or use a machine
  • Complete rest for weeks, which leaves the tendon weaker than it started
  • Lifting children or heavy pots with the palm down and the arm straight
  • Pushing through sharp pain. Soreness while exercising is acceptable if it settles within 24 hours

What you can do at home

Do the loading exercises every day or every second day, and keep doing them after the pain eases. The tendon takes months to become strong, and stopping early is why this returns.

Lift with the palm up and the elbow bent, and hold loads close to your body.

Use ice for ten minutes if the elbow is sharply painful after work, with a cloth against the skin. Use heat for 15 minutes before exercising if it is stiff.

Do not lean on the inside of the elbow, and avoid sleeping with the elbow fully bent, because the nerve sitting right there is easily irritated too.

How long it takes

With consistent loading, most people improve clearly in six to twelve weeks and settle over three to six months.

Pain that has been present over a year usually takes six to twelve months to resolve. The tendon still responds, it just takes longer, and the programme has to keep progressing rather than staying at the same weight.

It is faster when the main aggravating grip is changed and the shoulder is strengthened too. It is slower with repeated injections, with weeks of rest, and when work cannot be modified.

Expect good days and bad days rather than a straight line. Judge it by the trend over a month.

Urdu / Roman Urdu

Choose your reading script / اپنی پسند کا رسم الخط منتخب کریں

اردوUrdu script

گالفرز کہنی میں درد کہنی کی اندر والی ہڈی پر ہوتا ہے۔ کچھ پکڑنے، ڈھکن کھولنے، کپڑے نچوڑنے یا بچے کو اٹھانے سے بڑھتا ہے۔ گالف کھیلنے سے کوئی تعلق نہیں۔

یہ ٹینس کہنی جیسا ہی مسئلہ ہے، بس جگہ دوسری ہے۔ ٹینڈن کمزور ہوتا ہے، سوجن نہیں ہوتی، اس لیے صرف آرام سے ٹھیک نہیں ہوتا۔

اصل علاج ورزش ہے: پہلے تولیہ پکڑ کر 30 سے 45 سیکنڈ زور لگانا، پھر ہتھیلی اوپر رکھ کر ہلکے وزن سے کلائی کی آہستہ ورزش۔

کپڑے ہاتھ سے نچوڑنا چھوڑ دیں۔ بچے اور بارہویں ہتھیلی اوپر رکھ کر اٹھائیں۔

چھوٹی اور اس سے اگلی انگلی میں جھنجھناہٹ ہو تو یہ ٹینڈن نہیں، نس کا مسئلہ ہے، اور اس کے لیے ڈاکٹر سے ملنا چاہیے۔

Roman Urdu

Golfer's elbow mein dard kohni ki andar wali haddi par hota hai. Kuch pakarne, dakkan kholne, kapre nichorne ya bachay ko uthane se barhta hai. Golf khelne se koi taluq nahi.

Ye tennis elbow jaisa hi masla hai, bas jagah doosri hai. Tendon kamzor hota hai, sujan nahi hoti, is liye sirf aaram se theek nahi hota.

Asal ilaj warzish hai: pehle towel pakar kar 30 se 45 second zor lagana, phir palm upar rakh kar halke wazan se kalai ki aahista warzish.

Kapre haath se nichorna chhor dein. Bachay aur barwein palm upar rakh kar uthayen.

Chhoti aur us se agli ungli mein jhunjhuni ho to ye tendon nahi, nas ka masla hai, aur is ke liye doctor se milna chahiye.

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Questions people ask

What is the difference between tennis elbow and golfer's elbow?
The side. Tennis elbow is the bony bump on the outside of the elbow and hurts when you lift the wrist or grip palm down. Golfer's elbow is the bump on the inside and hurts when you bend the wrist, turn the palm down or wring cloth.
Can I get golfer's elbow without playing golf?
Easily, and almost everyone who has it does not play. It comes from gripping and twisting: tools, wringing clothes, kneading dough, lifting children, carrying loads. Both elbow conditions are tendon problems from load, not sports injuries, and the names are historical and misleading.
Is rest enough to fix it?
No. Rest reduces the pain while you are resting and leaves the tendon weak, so the pain returns as soon as you use the arm. The tendon needs graded loading to get stronger. Reducing the heaviest gripping while you load it is the right balance.
Why are my little and ring fingers tingling as well?
Because the ulnar nerve runs in a tunnel directly behind that bony bump. Tingling or numbness in those two fingers is a nerve problem, not a tendon one, and it needs the pressure taken off rather than loading. Constant numbness, or thinning hand muscles, needs a doctor.
How long will it take to get better?
Six to twelve weeks for a clear change and three to six months to settle, if the exercises are done at least every second day. Longer if it has been there over a year. Judge progress by the trend over a month rather than by yesterday.

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