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Tennis Elbow’s Twin on the Inner Side, and Why Grip Is the Real Culprit
Golfer’s elbow is an overload injury of the tendon on the INNER bony point of your elbow, where your gripping and wrist-bending muscles anchor. Most cases settle within 6 to 12 months, and a proper loading program usually takes 3 to 6 months to do its work.
The fix is graded strengthening of the wrist-bending and grip muscles, plus changing the grip load that caused it. Inner elbow pain WITH tingling in the ring and little fingers is a different story: that’s the ulnar nerve, and it needs checking.
And just like its more famous twin, most people who have it have never swung a golf club. Gym-goers doing pull-ups and rows. Climbers. Manual workers. Parents carrying an ever-growing toddler…on repeat.
Heck…even I developed golfer’s elbow. I was on my knees digging a hole in the sand at the beach for my kid, and the way I scooped with my right hand loaded the inner part of my right elbow…and I too got golfer’s elbow. From digging a beach hole, ha.
The trap: it feels minor, so you rest it, it calms, you go back, it flares. Repeat that for six months and you’ve built a tendon that’s more stubborn than the one you started with.
Same family as tennis elbow, same rules: it’s degeneration more than inflammation, rest alone rarely fixes it, and the honest timeline is months, not weeks.
What is golfer’s elbow?
The muscles that close your fist, bend your wrist forward and turn your palm down nearly all start from one bony point on the inner elbow, the medial epicondyle. Their shared tendon is called the common flexor origin.
One anchor, many muscles, firing with every grip, every carry, every pull.
Overload that anchor faster than it can rebuild…a new training block, a renovation weekend, a season of deadlifts with a grip that’s working harder than the back…and the tendon tissue starts becoming disorganized and weaker at its attachment. The medical name is medial epicondylalgia or medial elbow tendinopathy.
Same as tennis elbow: NOT a fire to put out. A structure to rebuild.
It’s several times less common than tennis elbow, most often seen in people in their 40s and 50s, and usually in the dominant arm.
Golfer’s elbow symptoms
- Pinpoint pain at the inner bony bump. Sometimes running down the inner forearm toward the wrist.
- Worse with gripping and carrying. Bags held by the handles, pull-ups, opening jars, wrist curls, a screwdriver, a firm handshake.
- Worse turning the palm down against resistance. Turning a stiff faucet or key, pouring from a heavy pitcher.
- Weaker grip on that side, and a forearm that feels tight first thing in the morning.
- Pain that lags. Often worse the evening or next morning after a heavy day.
Not sure it’s the inner side? Elbow pain by location and forearm pain by location sort the lookalikes.
Golfer’s elbow or cubital tunnel (ulnar nerve)?
One important neighbor to rule out: the ulnar nerve runs in a groove RIGHT behind that same inner bony point. It’s your funny bone.
If your inner elbow pain comes with tingling or numbness in the ring and little fingers…that’s not golfer’s elbow, or not only golfer’s elbow. That’s cubital tunnel territory, a nerve problem with different treatment. The two often turn up together, cos they live a centimeter apart.
- Pain alone, worse with gripping: tendon.
- Pins and needles in the ring and little fingers, worse with the elbow bent (phone calls, sleeping with arms folded, driving): nerve.
- Both: treat both. Get the nerve checked first.
This is where the Closing Window shows up for this condition. The tendon side doesn’t really have a window that SHUTS, it just gets slower. The nerve side does. Tingling that comes and goes is wide OPEN. Numbness that’s there all the time, clumsy fingers, or thinning of the muscle between your thumb and index finger means the nerve’s window is CLOSING. That’s weeks, not months, to get assessed.
How is golfer’s elbow diagnosed?
Mostly by examination. A clinician will usually:
- Press on the tendon anchor, just in front of and below the inner bony point.
- Resist your wrist bending forward with the elbow straight. Pain at the inner elbow is a yes.
- Resist your palm turning down. Same idea, different muscle.
- Measure grip strength and compare sides. Your progress tracker.
- Check the ulnar nerve: tapping behind the bony point, holding the elbow fully bent for a minute, testing the small hand muscles.
- Check the ligament if you throw. The ulnar collateral ligament sits right under this tendon.
Imaging is rarely needed early. X-ray after a fall or a pop. Ultrasound or MRI if it isn’t responding to months of good rehab, or a ligament injury is suspected. Nerve conduction studies if the ulnar nerve symptoms are persistent or getting worse.
How long does golfer’s elbow take to heal?
Most cases settle within 6 to 12 months. With a proper loading program:
- Weeks 2 to 6: daily pain starts to ease as the load changes.
- Months 3 to 6: most people are back to normal daily use, most work and modified training.
- Up to 12 months: full heavy grip without twinges, longer if it had been going for many months before you started.
And golfer’s elbow has a nasty habit worth naming: it tends to be A LOT MORE stubborn than tennis elbow once it’s established. The earlier the proper loading plan starts, the shorter the whole story.
When it stops being minor
Sore inner elbow after one heavy week, settling in days: normal tendon complaint, ease up and move on. No biggie.
Again…if the pain is still there at 2 to 3 weeks, or returns every time you go back to training or work: the tendon is losing the rebuild race, and it will keep losing while the load pattern stays the same.
Best exercises for golfer’s elbow
Graded loading, same principle as tennis elbow, aimed at the wrist-bending, grip and palm-down muscles. Start light, progress over weeks as the tendon tolerates more.
The pain rule: up to about 3 out of 10 during the exercise is fine, if it has settled by the next morning. Worse the next day means the dose was too high. Drop it back, don’t quit.
- Isometric wrist flexion holds. Forearm on a table, palm UP. Press the palm up into your other hand without letting the wrist move. Medium effort, 30 to 45 seconds, 5 holds, 2 to 3 times a day. The calm-down stage.
- Slow wrist curls. Forearm supported, palm up, a light dumbbell or water bottle. Curl up in 2 to 3 seconds, lower in 3 to 4. 3 sets of 15, once a day. Start at 0.5 to 1 kg (1 to 2 lb).
- Eccentric lowering. Help the weight up with the other hand, lower it slowly on the sore side. 3 sets of 15. Useful when the lift hurts but the lowering doesn’t.
- Reverse Tyler twist. The FlexBar twist done in the opposite direction to the tennis elbow version, so it loads the inner tendon. 3 sets of 15, daily.
- Pronation with a hammer. Hold a light hammer near the head, elbow at your side, turn the palm down slowly. Move your hand further down the handle to make it harder.
- Grip, then heavier and slower. Putty or a soft ball, then from about week 6, heavier wrist curls at 3 sets of 8 to 12, every other day.
Full progressions, and how to handle a flare, are in golfer’s elbow exercises.
Rest stops the damage. Only loading rebuilds the tendon.
Around that core: the load audit. What does this arm grip and carry for hours? Bar thickness, bag handles, tool grips, pull-up volume, carrying technique. Change the pattern that built the problem, or the rehab is bailing a boat with the faucet still running.
(If the ulnar nerve is irritated too, go easy on exercises done with the elbow fully bent. The nerve hates that position.)
Golfer’s elbow recovery, phase by phase
- Weeks 0 to 4: calm it down. Load management takes the daily sting down. Isometrics, then light curls. Strengthening starts light…suspiciously light. That’s correct.
- Weeks 4 to 12: build. Grip strength returns, training resumes in modified form. Don’t celebrate by maxing your deadlift. The tendon is behind your enthusiasm by about 6 weeks, always.
- Months 3 to 6: back to full work and sport, stepped up in stages.
- Months 6 to 12: the long tail. Twinges fading is winning. Twinges growing means the load is outrunning the tendon…adjust, don’t abandon.
Does a golfer’s elbow brace help?
Sometimes, for the gripping you can’t avoid. A counterforce strap works the same way as for tennis elbow, just placed on the INNER forearm, about two finger-widths below the inner bony point.
- Snug, not tight. Any tingling into the ring and little fingers means it’s pressing on the nerve. Loosen or move it.
- During tasks only. Not all day, not in bed.
- Helper, not cure. It doesn’t rebuild the tendon.
See counterforce straps for fitting. If the nerve is involved, a night splint that keeps the elbow straighter often matters more than any strap. See cubital tunnel night splint.
What causes it: gym, climbing, throwing and golf
- Gym: high-volume pull-ups and chin-ups, heavy curls with the wrist curled in, and deadlifts held by grip alone. Swap to neutral grips, use straps on heavy pulls, and cut pulling volume while you rebuild. See powerlifting wrist, elbow and grip injuries.
- Climbing: crimping and lots of pulling. Pain at the FRONT of the elbow is more likely brachialis, the classic climber’s elbow.
- Throwing: inner elbow pain during the throw, especially with a pop, a sudden loss of velocity or a feeling of the elbow opening up, may be the ligament underneath, not the tendon. See thrower’s elbow and the UCL.
- Golf: often the trail arm (the right arm for a right-handed golfer), and often after lots of heavy ground contact or range sessions off hard mats. A grip that’s too tight doesn’t help.
- Work and home: hammering, screwdrivers, carrying bags by the handles, lifting a toddler. Or digging beach holes.
Steroid injection, PRP and surgery
- Steroid injection. Even more caution here than tennis elbow, cos the ulnar nerve lives really nearby. Injecting into the nerve is not good. Repeated injections can also thin the skin and tissue. Short-term relief is real, long-term outcomes favor loading. More in steroid injections: how many?
- PRP. Less studied for golfer’s elbow than tennis elbow, and the evidence is mixed. Not a shortcut, and it doesn’t replace the loading.
- Surgery. Rare, last resort, for the few who still have significant pain after 6 to 12 months of proper rehab. If the ulnar nerve is involved, the surgeon may deal with it at the same time. Expect around 3 to 6 months back to full strength. See hand therapy or surgery: how to decide.
Can I keep working with golfer’s elbow?
Usually yes, with changes:
- Carry on the forearm or shoulder, not by the handles in your fingers.
- Thicker handles on tools and pens. Less squeeze for the same job.
- Power tools over hand tools for repetitive screwing.
- Short breaks every 20 to 30 minutes of sustained gripping.
- Don’t lean on the inner elbow on desks or armrests, for the nerve’s sake.
Heavy manual work may need lighter duties for a few weeks while the strength catches up. See returning to work after a hand injury.
What a hand therapist does differently
- Separates tendon from nerve from ligament, the three things sharing that inner bony point.
- Sets your starting dose and moves it on every week or two.
- Tracks grip strength so progress is a number.
- Audits the load: your bar, your bag, your tools, your sleep position.
- Fits the right support for the right weeks, including a night splint if the nerve is involved.
Get it checked today if
- There was a pop during a throw or a fall, with swelling or bruising on the inner elbow.
- The elbow is hot, red and swollen, or you feel feverish.
- Your fingers have suddenly gone weak or numb.
Get it checked if
- Tingling or numbness in the ring and little fingers that keeps coming back or is now constant.
- Clumsy fingers, a weak pinch, or thinning of the muscle between your thumb and index finger.
- The elbow feels loose or gives way when you throw.
- No improvement after 6 to 8 weeks of consistent, progressive loading.
- It’s been going for more than 6 months.
Pain alone is a tendon you can rebuild. Pain plus tingling is a nerve on a clock.
Related: golfers get the outer-elbow version more often: tennis elbow from golf
Written by Nigel Chua, hand occupational therapist in practice since 2005. Thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. Inner elbow pain that’s outstayed 3 weeks deserves a proper assessment.
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.