Medial epicondylitis, commonly known as Golfer’s Elbow, is a common tendon injury resulting from the overuse of the forearm flexor muscles. This condition involves the tendons connecting the forearm muscles to the bone on the inner side of the elbow. Effective rehabilitation combines initial rest and acute pain management with a progressive exercise program. Following a guided protocol of stretching and strengthening helps individuals achieve lasting relief and return to regular activities.
What Causes Medial Epicondylitis
Medial epicondylitis is characterized by pain and degeneration in the common flexor tendon originating at the medial epicondyle, the bony prominence on the inside of the elbow. This tendon connects the muscles responsible for wrist flexion and forearm pronation to the humerus bone. The injury is often a tendinosis, involving disorganized collagen fibers and micro-tears from chronic overload, rather than pure inflammation.
The condition is triggered by repetitive or forceful activities involving gripping, twisting, or bending the wrist toward the palm. While often associated with golf, it is also common in baseball pitchers, javelin throwers, weightlifters, and individuals in manual labor requiring frequent use of hand tools. It is distinct from Tennis Elbow (lateral epicondylitis), which affects the extensor tendons on the outer side of the elbow.
Acute Pain Management Strategies
Before beginning active rehabilitation, the initial goal is to reduce pain and prevent further tendon damage. This phase requires relative rest, meaning temporarily avoiding painful activities, especially strong gripping and repetitive wrist movements. Continuing to stress the injured tendon during this acute phase can worsen micro-tearing and prolong recovery.
Applying cold therapy is one of the most effective interventions for acute discomfort. Ice packs should be applied to the tender area for 15 to 20 minutes at a time, repeated three to four times per day. Always place a thin cloth between the skin and the ice pack to prevent frostbite.
A counterforce brace or epicondylitis clasp can be used during daily activities that strain the forearm. This strap is worn one to two inches below the elbow and works by compressing the forearm muscles, lessening the force transmitted to the injured tendon. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may provide short-term pain relief, but they do not accelerate healing.
Guided Stretches and Strengthening Exercises
Active rehabilitation should only begin once acute pain has subsided, allowing gentle, pain-free movement. The focus is to restore flexibility and progressively increase the load tolerance of the affected tendon structure. This structured loading encourages tendon fibers to align correctly and rebuild tensile strength.
Stretches for Flexibility
Stretching the tight wrist flexor and pronator muscles improves range of motion and reduces tension on the medial epicondyle. The Wrist Flexor Stretch is performed with the affected arm extended straight out, palm facing up. Use the opposite hand to gently pull the fingers and wrist downward until a mild stretch is felt along the inner forearm. Hold this position for 15 to 30 seconds and repeat two to four times per session.
A variation involves performing the same wrist flexor stretch but with the elbow bent to a 90-degree angle, which can isolate the stretch to different parts of the muscle group. Perform the stretches slowly and stop immediately if any sharp pain is felt. These stretches can be done several times a day to maintain tissue length and mobility.
Strengthening for Load Management
Tendon healing requires progressive loading, and eccentric exercises are the most effective way to strengthen the tendon and surrounding muscle tissue. Eccentric contractions involve the muscle lengthening while under tension, such as when slowly setting a weight down. This controlled lengthening stimulates collagen production and strengthens the tendon structure.
The Eccentric Wrist Curl is the primary strengthening movement. Start by sitting and resting the forearm on a table, with the hand hanging off the edge, palm facing up. Hold a very light weight (no weight or one pound initially). Use the unaffected hand to lift the weight into wrist flexion (concentric phase), then slowly lower the weight back down over a count of three to five seconds using only the affected arm (eccentric phase). Perform three sets of 10 to 15 repetitions daily or every other day.
As symptoms improve, Isometric Wrist Flexion can be introduced to manage pain and build static strength. With the palm up and the forearm supported, curl the wrist upward and use the opposite hand to press down, resisting any movement. Hold this for 10 to 30 seconds and repeat five to eight times throughout the day. Once pain-free and stronger, simple Concentric Wrist Curls can be performed, where the affected arm lifts the weight and lowers it under control without assistance.
Gradual Return to Function and Prevention
The final stage of rehabilitation involves a systematic return to high-demand activities, such as sports or heavy manual work. Criteria for returning to full function include achieving a full, pain-free range of motion and demonstrating comparable grip and forearm strength to the uninjured arm. Rushing this stage often leads to a recurrence of the injury.
For athletes, a gradual return uses an interval program, starting with low-intensity activities like putting and chip shots before progressing to full swings. Prevention requires long-term adjustments, including a thorough warm-up routine incorporating dynamic movements. Assessing and modifying technique is necessary, such as ensuring proper grip size or adjusting swing mechanics to reduce strain on the medial elbow. Continuing a maintenance program of stretching and strengthening helps the tendon manage future stresses.