Golfer's Elbow Exercises: The Four Exercises, in Full

Muscles attach to the elbow at the front, the back and both sides. Between them they bend and straighten the joint and rotate the forearm and wrist, which is what lets you turn the palm up or down and twist objects. Many of those attaching at the sides carry on down the length of the forearm to move the wrist and fingers. At each end, the muscles join bone through tendons, the tough fibrous bands built for that job.

Golfer's elbow is the commonest source of pain on the inside of the elbow, and the pain comes from the tendons anchoring those muscles to the inner side of the joint. The muscles in question bend the hand forwards and rotate the forearm to turn the palm down. Pain is usually felt over the inside of the elbow, sometimes running down the forearm as far as the wrist.

It can happen to anyone, though it turns up most often between the ages of 40 and 60. Fewer than 1% of the population are affected, which makes it considerably rarer than tennis elbow.

It is an overuse tendinopathy, driven by too much load on, or too much use of, the muscles and tendons that flex the wrist and turn the palm down. Tendons change with time, and for plenty of people those changes never hurt at all. Where a tendon does become painful, the symptoms usually build gradually and grow more noticeable. For some the pain arrives abruptly, and a sudden change in activity is generally behind it. Sometimes no cause is apparent.

The main symptoms are: tenderness on pressing the inside of the elbow, which can spread into the inner forearm; pain on bending the wrist or turning the palm down against resistance; pain when gripping, such as shaking hands or opening a jar; stiffness in the elbow, with making a fist sometimes sore; and weakness through the hand and wrist.

Golfer's elbow generally settles by itself given time. Strengthening exercises and stretches still earn their place, because they ease the pain around the elbow, and while they build muscle strength the more important effect is on the quality of the tendon tissue itself.

Exercise 3 is the one that does the heavy lifting, and the four-second lower is the active ingredient rather than an incidental detail. Slow lowering under load is what drives tendon adaptation, and rushing it turns the exercise into something considerably less useful.

The honest answer on timescale: golfer's elbow can last between 6 months and 2 years, and most people recover in a year. That is worth reading twice before judging whether four weeks of exercises have failed.

What is worth doing alongside the exercises: using the elbow does it no damage, though changing how you use it helps, and easing off the activities that provoke pain is worth trying. Ice the painful area with a small bag of frozen peas wrapped in a damp tea towel, 10 to 15 minutes, 3 to 4 times a day. Adjust your workstation or the tools you use, keeping them close to the body so the arm is not held out away from you. Lift with the palms facing up and the elbow bent, and avoid pinching objects between thumb and first finger. A golfer's elbow support or strap helps, worn for the activities that provoke pain rather than all day. A wrist splint suits some people. Over the counter painkillers and topical creams are options, and your pharmacist can advise on them.

The first of those is the one people find hardest to believe. Continuing to use a painful tendon, at a level that does not flare it for more than 24 hours, produces better outcomes than protecting it completely. Full rest lets the tendon lose the capacity it already had, and the return is then harder than the original problem.

Current guidance is plain about this: steroid injections are no longer recommended for golfer's elbow pain. The studies show they often take the pain away for a few weeks, after which it tends to return, sometimes worse than it was beforehand. Followed over one to two years, people who had a steroid injection tend to end up worse off than people who had no treatment at all.

That is drawn from a substantial evidence base. The 2010 systematic review and meta-analysis in The Lancet by Coombes and colleagues pooled randomised trials of injections for tendinopathy and found strong short-term benefit from corticosteroid alongside worse intermediate and long-term pain and function than other options, with the effect clearest for the elbow.

Surgery sits in a similar place. Very few people need it for golfer's elbow, and it would only be considered where nothing else has helped and it is seen as the only remaining option.

Where a tendon has genuinely failed to respond to months of proper loading, shockwave therapy is the option with the most reasonable case for stubborn tendon pain. It is worth being clear that this applies to tendons that have had a real loading programme rather than a few weeks of intermittent exercises.

The belief that arrives with inside-elbow pain is that it is a golf injury, and that not playing golf therefore rules it out. Almost nobody who turns up with it in Uckfield has been playing golf.

What testing usually finds is a gripping and wrist-flexing load that changed recently: a few weekends of decorating, a new job involving repeated lifting with the palm down, a return to the gym with heavy carries or pull-ups, or a season of padel or tennis with a topspin forehand. The tendon does not know what activity produced the load. It responds to how much changed and how fast. That is also why the strap helps for some people and not others: it reduces the pull at the tendon's attachment during gripping, which is useful if gripping is your aggravator and irrelevant if the problem is wrist flexion under load.

For an inside-elbow tendon that has not responded to a genuine loading programme, our page on shockwave therapy in Uckfield sets out where it fits and what the evidence supports.

How long does golfer's elbow take to heal?
Between six months and two years, with most people recovering within a year. Progress is slow and steady rather than sudden.

Should I rest my elbow completely?
No. Using the elbow will not damage it, and complete rest costs you tendon capacity. Modify the activities that flare it rather than stopping everything.

What is the difference between golfer's elbow and tennis elbow?
Golfer's elbow is on the inside of the elbow and involves the wrist flexors; tennis elbow is on the outside and involves the extensors. Our article on tennis elbow covers the outer version.

Should I have a steroid injection?
Current guidance advises against it for this condition. Short-term relief comes at the cost of worse outcomes at one to two years.

Do elbow straps work?
They help some people during aggravating activities. Wear one for the tasks that hurt rather than all day.