Golfer's Elbow

What Causes Golfer’s Elbow?

Golfer’s elbow — medial epicondylalgia or medial epicondylitis in medical terms — is pain on the inside of your elbow caused by tendinopathy (chronic overload and degeneration) of the flexor tendons that attach to the medial epicondyle.

These are the tendons that flex your wrist and fingers. When you grip something, curl your fingers into a fist, or perform pulling movements, these tendons are working. Overload them — through high volume, high intensity, or sudden increases in load — and they develop tendinopathy.

Common causes include heavy pulling exercises in the gym (deadlifts, rows, bicep curls), rock climbing (particularly crimping and dynamic movements), manual work involving repetitive gripping, throwing sports (cricket, javelin), racket sports with poor technique, or prolonged typing and desk work with poor wrist positioning.

Despite the name, golfer’s elbow has nothing to do with golf for most people. I see far more cases related to gym training and climbing than actual golf.

What most people don’t realise: golfer’s elbow is almost never an acute injury. It’s a gradual overload injury that develops over weeks or months when your tendon’s capacity can’t keep up with the demands you’re placing on it. By the time you notice pain, the tendon has already been struggling for a while.

I see golfer’s elbow constantly among gym-goers across Liverpool, Chester, and Merseyside who’ve ramped up deadlift or row volume too quickly, climbers from North Wales and Cheshire who’ve increased training intensity without adequate recovery, and desk workers with poor ergonomics causing chronic wrist flexion strain.

How Golfer’s Elbow Develops

Golfer’s elbow isn’t one condition — it’s a spectrum from acute reactive tendinopathy (early overload response) to chronic degenerative tendinopathy (longstanding structural changes). Understanding where you are on that spectrum guides treatment.

Reactive Tendinopathy (Early Stage)

The tendon is irritated and swollen from sudden overload, but there’s no structural damage yet. This is the early warning sign that you’ve exceeded your tendon’s current capacity.

Pain on the inside of the elbow, worse with gripping, pulling, or wrist flexion. You might notice it during specific exercises (deadlifts, rows, pull-ups) or activities (carrying shopping bags, opening tight lids, climbing).

This stage responds well to load management and progressive loading. If you catch it early and modify activity appropriately, you can settle symptoms quickly and build capacity without progressing to chronic tendinopathy.

Common among gym-goers across Chester and Liverpool who’ve increased pulling volume or deadlift frequency too quickly, or climbers who’ve done a high-intensity session after weeks of low activity.

Tendon Dysrepair (Mid-Stage)

The tendon has been chronically overloaded and is now undergoing structural changes — disorganised collagen, some degeneration, failed healing attempts.

Pain is more persistent. It’s not just during the aggravating activity — you might get pain at rest, at night, or with low-level activities like typing, driving, or lifting a cup.

This is where most people seek treatment. They’ve had symptoms for weeks or months, tried rest (it didn’t work), tried anti-inflammatories (temporary relief at best), and now they want answers.

Recovery takes longer at this stage because the tendon needs time to remodel and restore normal structure. But progressive loading still works — it just requires more patience and careful load management.

Degenerative Tendinopathy (Chronic Stage)

Longstanding golfer’s elbow with significant structural changes in the tendon. This is the person who’s had elbow pain for years, tried everything, and nothing has worked.

Pain is entrenched. The tendon is sensitive to almost any load. Sometimes there’s secondary muscle weakness, loss of grip strength, and significant functional limitation.

This stage needs comprehensive management — progressive loading combined with adjuncts like shockwave therapy to stimulate tendon remodelling. Recovery is measured in months, not weeks.

Common among climbers who’ve trained through pain for months or years, or people who’ve had symptoms for over a year without proper treatment.

What You Can Expect in Your Assessment

I’ll take a detailed history of how the pain started, what aggravates it, what you’ve tried already, and what your goals are — whether that’s getting back to heavy deadlifts, returning to climbing, or just being able to work without constant elbow pain.

Then I’ll assess your elbow — palpation to identify the exact tender structures (there are multiple flexor tendons and it matters which ones are involved), specific clinical tests to reproduce your pain and confirm the diagnosis, grip and wrist strength testing, and assessment of your shoulder and thoracic spine to identify any contributing factors.

Often I’ll watch you perform the movements that aggravate your symptoms — gripping, wrist flexion, pulling — to understand loading patterns and where compensations might be happening.

By the end of the session, you’ll have:

Do I Need a Scan?

Usually not. Golfer’s elbow is a clinical diagnosis based on history and examination.

Ultrasound can show tendon changes — thickening, disorganised structure, sometimes calcification or partial tearing — but the scan findings don’t always correlate with symptoms. You can have significant tendon changes on ultrasound with minimal pain, or severe pain with relatively minor structural changes.

Clinical assessment is enough to diagnose golfer’s elbow and guide treatment. We can start progressive loading straight away without waiting for imaging.

You might need imaging if:

• Symptoms aren’t improving as expected after 8-12 weeks of good conservative management
• There’s diagnostic uncertainty — other conditions need ruling out (ulnar nerve involvement is common with medial elbow pain)
• We’re considering shockwave therapy or injections and want to confirm tendon pathology
• There’s concern about ulnar nerve compression or other structures

Ultrasound is the best imaging modality for golfer’s elbow — it’s dynamic, shows tendon structure clearly, and can assess the ulnar nerve at the same time.

If imaging is needed, I’ll guide you on the best route — NHS referral via your GP, or private ultrasound if you want results quickly.

Why Rest Alone Doesn’t Work

People rest their elbow, avoid aggravating activities, stop training, and wait for pain to settle. Symptoms might improve slightly. Then they go back to lifting, climbing, or working and pain returns immediately, sometimes worse than before.

Here’s why: rest reduces pain by removing the aggravating load, but it doesn’t fix the underlying problem — your tendon has lost capacity and can’t tolerate the loads you’re asking it to handle.

Tendons adapt to load. When you rest completely, the tendon deconditions further. When you return to the same loads you were doing before, you’re asking a weaker, less resilient tendon to handle forces it couldn’t manage when it was stronger.

What Does Golfer’s Elbow Rehab Involve?

Depends on the specific stage and severity, but here’s what most golfer’s elbow rehab programmes include:

Load management: Identifying what activities are overloading the tendon and modifying them temporarily. For gym-goers, this might mean reducing deadlift volume or changing grip styles. For climbers, avoiding crimp grips and dynamic movements temporarily. For desk workers, ergonomic adjustments to reduce wrist flexion strain.

Progressive loading programme: This is the cornerstone of tendon rehab. Starting with isometric exercises (static holds in wrist flexion), progressing to isotonic strengthening (concentric and eccentric), then heavy slow resistance training. The load is carefully progressed based on symptom response.

Eccentric strengthening: Specific eccentric wrist flexion exercises have good evidence for golfer’s elbow. These involve loading the tendon while it lengthens, which promotes tendon remodelling and strength gains.

Grip strength training: Golfer’s elbow causes grip weakness. Rebuilding grip strength through progressive resistance exercises is essential for return to normal function.

Shoulder and scapular strengthening: Often overlooked but important. Poor shoulder and scapular control increases demand on the forearm flexors and contributes to elbow overload. Strengthening the posterior shoulder and improving scapular stability reduces load on the medial elbow tendons.

Ulnar nerve mobility: The ulnar nerve runs close to the medial epicondyle. Sometimes it becomes sensitised alongside tendon symptoms. Gentle nerve gliding exercises help if there’s nerve involvement.

Activity modification and return to sport/work: Progressive reintroduction of aggravating activities once you’ve built adequate tendon capacity. This is structured — you don’t just go back to what you were doing before and hope for the best.

Shockwave therapy (if indicated): For chronic degenerative tendinopathy, shockwave therapy can stimulate tendon remodelling and accelerate recovery. This is an adjunct to loading, not a replacement for it.

How Long Does Recovery Take?

Realistic timescales for golfer’s elbow:

Reactive tendinopathy (caught early, symptoms less than 6 weeks): 4-8 weeks. With good load management and progressive strengthening, most people see significant improvement relatively quickly.

Tendon dysrepair (symptoms 6 weeks to 6 months): 8-12 weeks. The tendon needs time to remodel. Progress is steady but requires patience and consistent adherence to the loading programme.

Chronic degenerative tendinopathy (symptoms over 6 months): 3-6 months, sometimes longer. The tendon has significant structural changes that take time to reverse. Shockwave therapy often helps at this stage.

Return to full training/climbing/work: Variable. Some people return to full activity within 8-12 weeks. Others need 4-6 months before they can tolerate pre-injury loads. It depends on severity, chronicity, and the demands of your sport or work.

These are broad ranges. Your specific timeline depends on how long you’ve had symptoms before seeking treatment, how severely you’ve overloaded the tendon, and how well you stick to the progressive loading programme.

The single biggest factor in recovery time: consistency with rehab. People who follow the loading programme consistently get better. People who skip exercises, keep aggravating the tendon with high loads, or bounce between rest and overload rarely improve.

When to Book an Assessment

Location and Booking

I run a clinic in Chester, with appointments available Monday, Wednesday, Thursday, and Friday.

Whether you’re a climber from North Wales struggling with medial elbow pain, a gym-goer across Cheshire dealing with deadlift-related symptoms, or a desk worker from Chester with chronic elbow pain from typing, I can help.

Book online to see available slots, or get in touch if you’ve got questions before booking.

No hard sell. No obligation. Just honest physio focused on getting your tendon properly rehabbed so you can get back to climbing, lifting, or working without ongoing pain.