Managing Golfer’s Elbow with Physical Therapy

Golfer’s elbow is an overuse injury that develops when the flexor tendons of the forearm become inflamed due to repetitive use of the forearm, hand, wrist, and elbow.  Golfer’s elbow can affect golfers, baseball and softball players, those who work on computers all day, and manual laborers in construction, carpentry, or plumbing. Physical therapy offers timely and effective treatment for golfer’s elbow to reduce pain, restore function and strength to the elbow, forearm, and wrist, and address body mechanics to prevent recurrence of the condition.

Forearm & Elbow Anatomy

Each elbow has two epicondyles, which are the bony protrusions that can be felt on either side of the elbows. Tendons of the forearm and other connective tissues attach to the epicondyles, including the flexor tendon-muscle group which is located on the inside of the elbow joint and connects to the medial epicondyle. These flexor muscles act to bend the wrist, bringing the palm of the hand towards the forearm (flex) and allowing the forearm to pronate (turn towards a thumb-down position). These muscles allow you to flex your fingers and wrist.

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Golfer’s Elbow FAQ

Golfer’s elbow (medial epicondylitis) is an overuse injury that develops when the flexor tendons of the forearm become inflamed due to repetitive use of the forearm, hand, wrist, and elbow.  These tendons, located on the inside of the elbow joint, become inflamed and develop microtears due to repetitive overuse of the tendons without sufficient rest and recovery. Golfer’s elbow typically develops in those in their 40s and 50s, occurs in men and women equally, and most often develops in your dominant arm.

Golfer’s elbow can affect golfers due to the repetitive swing of the golf club which places a repetitive load on the tendons of the inside of the elbow. Golfers who develop this condition often have an incorrect weight shift and tend to “hit from the top” which increases the stress on the muscles on the inside of the forearm. Golfer’s elbow can also develop in baseball, softball, and tennis players as these sports require repetitive gripping and throwing.

Certain jobs can also increase your risk of developing golfer’s elbow, particularly those who work on a computer all day and manual labor jobs like construction, plumbing, painting, and carpentry which require forceful repetitive movements and gripping.

Symptoms of golfer’s elbow includes:

• Pain along the inside of the forearm that occurs with hand, wrist, and elbow movements

• Tenderness to touch and swelling along the inside of the forearm

• Weakness in the hand and forearm when gripping objects

• Stiffness in the elbow

• Pain or numbness and tingling that radiates from the inside of the elbow into the hand and fingers when gripping or squeezing

Physical Therapy for Golfer’s Elbow

Physical therapy offers timely and effective treatment for golfer’s elbow to reduce pain, restore function and strength to the elbow, forearm, and wrist, and address body mechanics to prevent recurrence of the condition. Treating golfer’s elbow early with physical therapy can prevent the condition from becoming chronic.

A physical therapist initially conducts an evaluation to assess the cause of the pain and identify impairments in range of motion, strength, and movement patterns that may be contributing to golfer’s elbow before designing a customized treatment program.

Physical therapy treatment for golfer’s elbow can include:

• Pain management: involves resting from aggravating activities, using ice to reduce inflammation and swelling during the acute phase, and heat therapy including ultrasound therapy for deep heat to increase blood flow and flow of nutrients to the injured area.

• Manual therapy: soft tissue and joint mobilizations to help increase tissue mobility, improve circulation, and lessen pain.

• Stretching exercises: these exercises help affected tendons become more flexible and loosen tight tendons in the forearm. A common stretch for gofer’s elbow is the wrist flexor stretch, which involves extending the affected arm in front of you with palm facing away from body, bending back the wrist and pointing the hand up toward the ceiling, and using your other hand to gently bend your wrist farther until you feel a mild stretch in the forearm.

• Strengthening exercises: these exercises involve targeted strengthening of the forearm, elbow and hand muscles by incorporating resistance exercises using weights and resistance bands. This helps address muscle weaknesses or imbalances that contributed to the condition.

  • Isometric exercises generate force without changing the length of the muscle and are commonly done during the acute phase of golfer’s elbow,

  • Eccentric exercises cause muscles to elongate in response to a greater opposing force to build muscle flexibility. These exercises strengthen muscles, tendons, and ligaments. The therapist uses a progressive loading program of eccentric exercises on the injured tendon to help the tendon gradually adapt to tolerate the demands placed on it.

  • Common strengthening exercises include wrist flexion with a dumbbell to strengthen the wrist, forearm supination and pronation using a dumbbell, towel squeezes, and elbow curls.

• Dry needling: involves inserting thin filiform needles into taut bands of muscle to relieve pain and loosen tight muscle bands. Dry needling can help increase blood supply and oxygenation in the injured area for an improved healing response and reduce pain.

• Functional training: involves modifying specific movement patterns to lessen stress on the tendons, forearm, elbow and wrist. It also can involve an assessment of the patient’s sports technique or work task movements to reduce the pressure placed on the tendons of the forearm.