Golfer's Elbow (Medial Epicondylalgia)

Overview

Golfer's elbow is the mirror image of tennis elbow. It affects the bony point on the inside of the elbow, where the muscles that bend your wrist and fingers and turn your palm down attach by a shared tendon. Like tennis elbow, it is a tendinopathy — a tendon that has been loaded beyond its ability to recover — rather than a simple inflammation.

It is less common than tennis elbow but often more stubborn, partly because the flexor tendon is used in almost every gripping and pulling activity. In London we see it most in climbers and bouldering enthusiasts, people doing pull-ups and heavy rows in the gym, throwers, racket players with a heavy forehand, and people in manual trades.

Pain is felt on the inner elbow and can spread down the inside of the forearm. It is worse with gripping, wrist curls, pull-ups, carrying bags and turning the hand. Because the ulnar nerve runs just behind the same bony point, some people also notice tingling into the ring and little fingers, which we check carefully.

Causes and risk factors

• Climbing and bouldering, especially crimp grips and sudden increases in volume
• Pull-ups, rows, deadlifts and heavy gripping in the gym
• Throwing and racket sports, particularly with a heavy forehand or topspin
• Manual work with repeated gripping and tool use
• Age 35–55
• Poor warm-up and rapid increases in training load
• Smoking and diabetes, which affect tendon health

How we may be able to help

We assess the elbow, forearm and grip, and test the ulnar nerve to check whether it is irritated alongside the tendon, since the two can coexist and change the plan. The neck and shoulder are also screened. If needed, we can arrange an online GP consultation for an ultrasound scan or a specialist opinion.

Physiotherapy is built around progressive loading of the flexor tendon: isometric holds to calm pain, then slow heavy wrist and forearm work, and finally sport-specific loading — hangboard progressions for climbers, graded pulling for gym-goers. Hands-on treatment supports this: IASTM and dry needling for the dense forearm flexor muscles, elbow joint mobilisation, and kinesiology taping to offload the tendon during training.

Focused shockwave therapy may help in longer-standing cases that have plateaued with exercise alone, and therapeutic ultrasound can provide pain relief in the early, irritable phase. If the neck or upper back is contributing to arm pain, our chiropractor can assess and treat it.

What you can do at home

• Reduce — do not stop — gripping and pulling volume; climbers should temporarily drop grade and avoid crimps
• Try an isometric hold: press your palm up against the underside of a table for 30–45 seconds, several times a day
• Warm up the forearms before climbing or lifting with light wrist curls and open-hand squeezes
• Carry bags with a strap over the shoulder rather than in the hand for now
• Check your keyboard and mouse position so your wrist is not bent for long periods
• Avoid forceful stretching of the inner forearm while the elbow is very sore