Golfer's Elbow: The Inside-of-Elbow Tendinopathy Most People Try to Rest Off
Quick answer: Golfer's elbow (medial epicondylalgia) is a tendinopathy of the wrist flexor/pronator tendon where it attaches on the inner side of the elbow. It's mostly a load problem, not an inflammation problem. Rest alone rarely fixes it - structured progressive loading does. Most cases resolve in 8-12 weeks of well-delivered physiotherapy.
What it feels like
- Pain on the inside of the elbow (as opposed to tennis elbow, which is on the outside)
- Worse with gripping, wrist flexion, or forearm pronation (turning palm down)
- Tender spot a couple of centimetres below the bony bump on the inner elbow (medial epicondyle)
- Sometimes radiates down the inner forearm
- Morning stiffness, better with warm-up, worse after activity
Who gets it
It's not just golfers. Anyone who repeatedly grips and flexes the wrist:
- Racket sports (tennis forehand, badminton)
- Resistance training (heavy rows, deadlifts, pull-ups with a thick bar)
- Manual work (carpenters, plumbers, anyone using screwdrivers or wrenches)
- Keyboard and mouse work in a poor wrist position
- Musicians (violin, guitar)
Why rest doesn't fix it
Tendinopathy is not active inflammation (that's "tendinitis," a term we've largely retired). It's degenerative collagen disorganisation - the tendon is structurally weaker than it should be for the loads you're putting on it. Rest removes the load, symptoms calm down, then the moment you return to activity the same load hits a still-underloaded tendon, and pain returns.
The fix is to gradually load the tendon above daily levels, below painful levels, and let it remodel stronger. This takes weeks, not days.
The loading protocol
Physiotherapy progresses roughly through:
- Isometric holds (week 1-2) - squeeze a ball for 45 seconds × 5 reps, daily. Reduces pain and starts the loading conversation with the tendon.
- Isotonic eccentrics (week 2-6) - wrist flexion with a light dumbbell, lowering slowly (3 seconds down), quick up. 3 × 15, every other day.
- Heavy slow resistance (week 4-12) - same movement, heavier load, both concentric and eccentric slow (3 seconds each direction). 3 × 8, twice a week.
- Return to activity - gradual reintroduction of the provoking sport/task, with load management.
Pain during exercise is acceptable up to 3/10 and settling within 24 hours. Anything above that is too much.
Adjuncts that help
- Counterforce brace - a strap just below the elbow, offloads the tendon during flare-ups. Bridge, not solution.
- Manual therapy - soft-tissue work to the forearm flexors, sometimes cervical spine if referred pain is suspected.
- Shockwave therapy - some evidence for chronic cases not responding to exercise; 3-5 sessions.
- Ergonomic review - mouse size, keyboard position, grip circumference of tools.
What doesn't work (well)
- Steroid injections - short-term relief but worse long-term outcomes in multiple trials.
- PRP and stem cells - mixed evidence; not first-line.
- Stretching alone - doesn't remodel the tendon.
In Ipoh
Expect RM80-150 per session, typically 6-10 sessions over 8-12 weeks. The home programme is where most of the work happens - so the clinic visits are about progression and technique, not daily treatment.