01 Sep How To Treat Golfer’s Elbow
Golfer’s elbow, which in the medical world is referred to as medial epicondylitis or medial epicondyle tendinopathy, is an orthopedic condition that can involve pain located on the inside of the elbow. However, this injury is far from being exclusive only to golfers. Golfer’s elbow can happen to anyone and it can make simple activities of daily living frustrating and painful like carrying objects, opening a door or jar, and shaking someone’s hand. It is also a common elbow injury with other sports including baseball, field & track throwing sports, and even tennis (think serving and forehand strokes). In this article, you’ll learn what golfer’s elbow is, how to treat golfer’s elbow with a free [P]Rehab program, and elbow [P]Rehab exercises to try and avoid this injury in the future.
What is ‘Golfer’s Elbow’?
Golfer’s elbow refers to pain that is typically on the inside of the elbow and originates in what is known as the common flexor tendon origin, where multiple muscles in the forearm attach to the elbow. The most common muscles involved with golfer’s elbow are the pronator teres and the flexor carpi radialis, but it can also involve other wrist flexors including the flexor digitorum superficialis, flexor carpi ulnaris, and palmaris longus (1).
Similar to tennis elbow, golfer’s elbow is often a result of repetitive microtrauma to the common flexor tendon where it originates at the medial epicondyle. In some cases it can truly present as medial epicondylitis, meaning inflammation of the tendon. This is likely the scenario with your average person that plays a few rounds of golf in a row or performs a lot of home improvements using power tools, which they never do on a regular basis. Simply put, the load exceeds the tissue capacity and the body works to repair itself. This can take maybe a couple of weeks to resolve with the right education and action. In more chronic cases of golfer’s elbow, meaning this isn’t your first time dealing with this, there may be degenerative changes occurring at the involved tendon. These degenerative changes are occurring due to the body’s inability to complete the reparative process, which can lead to this vicious cycle of your elbow flaring up and never feeling the same (1).
How To Treat Golfer’s Elbow
With any injury, conservative management should always be the first line of defense. Although it could take up to a year in some cases, most people dealing with golfer’s elbow can get back to regular life without experiencing symptoms or activity restrictions. Addressing golfer’s elbow EARLY on is key to better long-term outcomes! A model we like to use with golfer’s elbow cases is the EdUReP Model (2).
What is The EdUReP Model? Education, Unload, Reload, Prevention
Education is one of the most important aspects of managing golfer’s elbow. A common aggravating motion that someone with golfer’s elbow may want to avoid is repetitive wrist flexion, especially with load (bending your wrists so that your palms are facing you).
In the early stage of golfer’s elbow, try to avoid activities that reproduce pain and symptoms, and rest your elbow if needed from repetitive movements. So if playing golf is aggravating your elbow, take a break! We will get into specific exercises for true cases of golfer’s elbow (meaning your elbow pain is due to golf). Let’s say it is that home improvement case and it hurts to use to a screwdriver. One way to modify your activity accordingly would be to use your other hand instead, which would unload your aggravated elbow. When appropriate, it will be time to reload the common flexor tendon with specific exercises. Last but not least, you will want to continue with a maintenance exercise program to try and prevent experiencing golfer’s elbow symptoms down the road (2).
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How To Treat Golfer’s Elbow: Should I Get A Corticosteroid Shot?
In this day and age with technology, instant gratification is easy to come by. It is fair to say most people do not enjoy being in pain, and the idea of getting a cortisone injection in your elbow to make your pain go away fast sounds tempting. However, think twice.
“Corticosteroid injections improved symptoms at 6 weeks but showed no difference when compared with controls at 3 and 12 months.” (3)
It is fair to say we could not agree more with this statement. Unfortunately, most people will only address golfer’s elbow symptoms when it is a real burden. Getting a cortisone shot can provide immediate relief within a few days, which means no more pain! However, because there is no more pain, there is no reason to do elbow [P]Rehab exercises right? This is the mindset that can lead to golfer’s elbow coming back and worse long-term outcomes, thus we do not recommend a cortisone shot as the first line of treatment for golfer’s elbow.
How To Treat Golfer’s Elbow: What Are Effective Exercises?
How To Treat Golfer’s Elbow: One Size Does Not Fit All
Due to tennis elbow being more common than golfer’s elbow, there is a larger body of evidence for tennis elbow. What we know from research focused on tennis elbow is that education and exercise are beneficial. However, there is no consensus on exercise programming for tennis elbow! “Despite clear benefits, the most optimal exercise intensity, duration, frequency, and type of load for the rehabilitation of lateral epicondylitis (LET) have not been established.”(4)
We can apply this same model to golfer’s elbow! It honestly depends on every single case of golfer’s elbow, but we will share a brief overview of what we have found to be successful for treating golfer’s elbow. Below we will cover various elbow, wrist, and hand exercises as well as other exercises we typically prescribe for golfer’s elbow. If you do not have access to a lightweight dumbbell at home, you can use your other hand for resistance with most of the exercises demonstrated. Be sure to watch the entire video and listen in for tips and tricks!
How To Treat Golfer’s Elbow: Isometrics
What we do know is that when the elbow is extremely sensitive and painful in acute cases of golfer’s elbow, the angry tendon responds well to rest, unloading, and isometric exercises early on. Isometrics produce what is called an analgesic effect that can reduce the pain you feel by altering the nociceptive/pain pathways to your brain.
Wrist Flexion Isometrics With Elbow Flexion
This is a great starting point for golfer’s elbow exercises. This focuses on the primary motion at the wrist involved with golfer’s elbow, wrist flexion!
Ulnar Deviation Isometrics With Elbow Extension
As mentioned earlier, the flexor carpi ulnaris can also be involved in golfer’s elbow. With golf and throwing sports like baseball, there can be a lot of ulnar deviation that occurs extremely fast. This is a great exercise to work on controlling and slowing down the motion. I like to use a hammer, golf club, or a baseball bat with this exercise!
Pronation Isometrics With Elbow Flexion
The pronator teres is one of the most common muscles involved with golfer’s elbow. The pronator teres is responsible for forearm pronation as it originates on the medial epicondyle and inserts on the proximal radius. If you don’t have access to this equipment and set-up, we suggest using a larger object like a hammer, golf club, or a baseball bat to create enough torque to make it challenging.
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How To Treat Golfer’s Elbow: Eccentrics
When appropriate, it is important to progress towards eccentric exercises. Eccentric exercises are excellent for golfer’s elbow as they specifically load the affected common flexor tendon. A progressive loading program is required in order for the tendon to undergo positive adaptations so that it can tolerate the demands imposed on it! Eccentrics can be a good starting point for long-standing cases of golfer’s elbow that have not responded well to other treatments. Eccentrics are also a nice progression from isometrics. Detailed instruction, as well as tips and tricks, are included with every video!
Wrist Flexion Eccentrics With Elbow Flexion With Dumbbell
Pronation Eccentrics With Elbow Flexion With Dumbbell And Band
As mentioned earlier, one size does not fit all. There may be some individuals with golfer’s elbow that only respond well to isometrics, or eccentrics, or neither… now what? Isotonic exercises are another option for golfer’s elbow. Isotonics are a combination of concentric motion and eccentric motion. An example of this is a bicep curl. For the biceps muscle, the concentric portion of the exercise is curling the weight up while the eccentric portion is lowering the weight back down. Detailed instruction, as well as tips and tricks, are included with every video!
Wrist Flexion With Elbow Extension With Flexbar
Ulnar Deviation With Elbow Extension With Dumbbell
Pronation & Supination With Elbow Flexion
How To Treat Golfer’s Elbow: True ‘Golfer’s Elbow’ Exercises
True cases of golfer’s elbow are more common with recreational and amateur golfers because of mechanics. This group of golfers are more likely to compensate and excessively use their upper body, compared to the professional athletes that use their legs and their core efficiently. The average golfer is more likely to ‘hit from the top’, or cast their wrists, which can lead to excessive repetitive stress on the common flexor tendon. Building off of the last section, below you will find exercises that focus on proximal strengthening and stability throughout the kinetic chain.
Spieths For Golfer’s Elbow
Ever wonder how the PGA pros warm up? Check out this exercise that is part of Jordan Spieth’s dynamic warm-up routine. This drill helps with activating the hip stabilizing musculature, scapular stabilizers, and promoting thoracic spine mobility.
Dowel Golf Swing Drill
Taking the arms out of the equation with the golf swing is one of the best things you can do to learn how to use your lower body and your core. This is especially true for golfers that like to muscle their swing with their arms. I love this drill just to practice ‘grooving’ your swing pattern, I use this as a warm-up sometimes! The best part about this drill is when your elbow is aggravated, you can still practice your swing pain-free!
Band Pull Through Golf Swing Drill
For the golfer that feels their elbow pain during the downswing and impact zone, this drill is for you. Using the band set-up demonstrated, we are generating power from the lower body, the core, and the lead arm. This completely removes the trailing arm from the equation, which is typically the side that the golfer’s elbow is on. This drill also helps with integrating the kinetic chain and promoting a weight shift, which is what you want during the downswing and follow-through.
Kinetic Chain Rotation Acceleration Drill
This is one of my favorite Reactive Neuromuscular Training (RNT) exercises for golfers and any rotational sport athlete. RNT is a technique used to improve movement quality and exercise form. RNT utilizes external resistance (I.E., resistance band) to facilitate an automatic, subconscious response at the neuromuscular level. This can translate into improved movement patterns with less compensation.
Using the band set-up demonstrated in the video creates a rotational resistance that the legs, the pelvis, and the trunk muscles have to resist. This is an excellent technique to help golfers with using their legs and their core to generate power into their golf swing rather than just with their arms. This can help with something called kinematic sequencing, which can lead to fewer energy leaks throughout the kinetic chain, which can lead to less stress and compensation at distal joints, including the elbow. Everything is connected!
Like we mentioned above, one size does not fit all. There is some evidence for other elbow conditions (tennis elbow) to suggest a combination of isometrics, concentrics, and eccentrics lead to better outcomes in regards to how to treat golfer’s elbow. It is a matter of finding out what works for you! If you’re having trouble managing your golfer’s elbow, please seek a consultation with a physical therapist or other healthcare professional. This is not strict medical advice, rather a guide to try and help you to manage this on your own. It is also important to consider other factors in life including the demands of your job, your habits, stress, hobbies, and anything else that could be contributing to your golfer’s elbow symptoms. Remember, most cases resolve within a year. Only in rare cases do people with golfer’s elbow elect to have surgery. It is important to be patient and trust the EdUReP model (2, 4).
- Michael, C. C., Michael, A. S., & Michael, G. C. (2004). Diagnosis and treatment of medial epicondylitis of the elbow. Clinics in Sports Medicine, 23, 693e705.
- Davenport, TE; Kulig, K; Matharu, Y; Blanco, CE: The EdUReP model for nonsurgical management of tendinopathy. Phys Ther. 85(10):1093 – 1103, 2005.
- Taylor SA, Hannafin JA (2012) Evaluation and management of elbow tendinopathy. Sports Health 4: 384-393.
- Coombes BK, Bisset L, Vicenzino B. Management of lateral elbow tendinopathy: one size does not fit all. J Orthop Sports Phys Ther. 2015;45:938- 949.