Golfer's Elbow

The simplest test is location: golf's elbow hurts on the inside of the elbow (the bony bump on the side closest to your body when your arm is at your side), while tennis elbow hurts on the outside bump. Golfer's elbow involves the flexor-pronator tendon group — the muscles that curl the wrist and fingers and rotate the palm down — so pain is triggered by gripping palm-up, flexing the wrist, or pronating. Tennis elbow involves the extensor tendons and flares with wrist extension and lifting. Both can radiate into the forearm; golfer's elbow radiates toward the pinky side.

Yes, it can be. The ulnar nerve runs immediately behind the medial epicondyle, and in roughly 60% of golfer's elbow cases, that nerve becomes irritated alongside the tendon — either from swelling, compression, or direct mechanical irritation. When tingling in the ring and pinky fingers is present, we need to assess whether the nerve itself needs treatment, not just the tendon. Cervical spine involvement (a nerve irritated further up the chain in the neck) can also produce this pattern, which is why we evaluate the upper cervical spine as part of every golfer's elbow workup.

Stopping the aggravating activity reduces load and usually quiets acute pain, but unless the underlying tendon tissue is actually remodeled, symptoms reliably return when activity resumes. Tendons in a degenerative state don't spontaneously rebuild without progressive mechanical stimulus — they need controlled loading to reorganize collagen and regain tensile strength. Complete rest also weakens the surrounding musculature, which reduces the tendon's support system. Relative rest (modifying the offending activity without stopping entirely) combined with graded eccentric loading is a much better strategy than full stop-and-start cycling.

Usually you don't need to stop entirely, but modification is almost always necessary in the early phase. A counterforce brace worn just below the elbow reduces strain at the medial epicondyle during the swing, and most golfers can continue playing with it while in treatment. Swing mechanics are often a real contributing factor: a strong grip, early wrist extension at impact, or hitting from the ground up with force through the medial side all load the flexor tendon aggressively. A review of grip pressure and swing technique pays dividends both for recovery and prevention of recurrence.

The principles are identical — eccentric loading program, manual therapy to the tendon and joint, shockwave for resistant cases, cervical and thoracic adjustments — but the specific exercises target the wrist flexors and forearm pronators rather than the extensors. One meaningful clinical difference is that the ulnar nerve is more frequently involved in golfer's elbow, so neural mobilization (gentle nerve-gliding exercises) is often added to the program. The medial side of the elbow also tends to take slightly longer than the lateral side to fully settle, so we typically counsel patients to expect six to ten weeks rather than a faster timeline.