Golfer’s Elbow

What is Golfer's Elbow?

Golfer's elbow, or medial epicondylitis, is a tendinopathy of the common flexor-pronator tendon, which attaches to the bony bump on the inner side of the elbow (the medial epicondyle).^[1] It results from repetitive overload of the muscles that bend the wrist and turn the forearm.^{[1, 2]}

Common symptoms

The main symptom is pain on the inner elbow, with tenderness over the tendon origin and pain when you bend the wrist or turn the forearm against resistance.^[1] Everyday tasks that involve gripping and lifting can make it worse, and throwing athletes may notice it during the throwing motion.^[2]

Causes and risk factors

Despite the name, most cases occur in people who do not play golf. The condition is more often seen in people who do repetitive, forceful gripping or manual work.^[1] It is also classically associated with golf and overhead throwing sports.^{[1, 2]}

Over time the overloaded tendon can undergo degeneration, which is why doctors now regard it as a tendinopathy rather than a simple inflammation.^{[2, 3]} Golfer's elbow is less common and often harder to manage than lateral epicondylitis (tennis elbow).^[1]

How it is diagnosed and treated conventionally

The diagnosis is made from your history and examination, which finds tenderness at the inner elbow and pain with resisted wrist flexion and forearm turning.^[1] Imaging may be used when the diagnosis is unclear.^[3]

Treatment starts with activity modification, anti-inflammatory medicine and sometimes corticosteroid injection. When the pain settles, the focus shifts to rehabilitation of the forearm muscles and prevention of reinjury.^[2] Surgery is reserved for people with persistent symptoms.^[2] Care should be taken with injections near load-bearing tendons because of the risk of rupture.^[3]

Why Golfer's Elbow calls for a whole-person approach

Golfer's elbow is not caused by one thing. Repeated loading is the trigger, but the same pattern of overload can come from work, sport and how the arm is used day to day.^[1]

Care that looks at several factors, alongside rehabilitation, is a reasonable addition. It does not replace the exercises and activity changes that standard treatment relies on.

Repetitive load at work and sport

Most cases arise in non-athletes who do repetitive, forceful gripping or manual labor.^[1] Changing how a task is done and giving the tendon relative rest are mainstays of treatment.^{[2, 3]}

Tendon degeneration, not just inflammation

A chronically overloaded tendon shows disordered, degenerative healing more than classic inflammation.^[3] This helps explain why anti-inflammatory medicine is mainly used to ease pain so that rehabilitation can go ahead.^[3]

Muscle strength and conditioning

In the closely related tennis elbow, a meta-analysis of 30 trials found that exercise gave better outcomes than passive treatments or corticosteroid injections, although the effects were small and the evidence low certainty.^[4] We do not know whether the same applies to the inner elbow, but rehabilitation is the standard next step once the acute pain settles.^[2]

Acupuncture for Golfer's Elbow

What the research shows

We found no clinical trials of acupuncture for golfer's elbow itself. The evidence below comes from tennis elbow (lateral epicondylitis), the better-studied tendon problem on the outer side of the elbow, and it may not carry over.

For tennis elbow, the evidence is limited and of mixed quality. A meta-analysis of 10 trials with 796 people found acupuncture appeared better than medicine or injection treatment, but its advantage over sham acupuncture was not statistically significant. The authors called the trials low quality.^[5] A meta-analysis of 14 trials found low-level evidence that manual acupuncture, but not electroacupuncture, reduced pain and disability in the short term.^[6] A review of 19 trials of acupuncture and moxibustion found that three moderate-quality trials favored acupuncture over sham, while most trials against other treatments were low quality.^[7]

Not all reviewers agree. An umbrella review of 40 meta-analyses concluded that injections and physical therapy were effective for tennis elbow, and that acupuncture and shockwave therapy were not.^[8] A meta-analysis of 17 trials of dry needling, a related technique, found short-term improvement in pain, function and grip strength in tennis elbow.^[9]

How acupuncture may work

How acupuncture might help a painful medial elbow tendon has not been studied. In traditional Chinese medicine, tendon pain at the elbow is described as obstruction of qi and blood in the channels of the arm, and needles are placed at the elbow and along the forearm to move this stagnation. This is a traditional framework, not a proven explanation.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points around the inner elbow and forearm, and sometimes elsewhere in the body, usually left in place for about 20 to 40 minutes. We plan a short course of visits and reassess whether it is helping.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[10] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Golfer's Elbow

The Ayurvedic view

Ayurveda has no classical name that matches golfer's elbow. In this tradition, tendon and joint pain with stiffness on movement is described as a Vata imbalance, sometimes with heat linked to Pitta. These are traditional categories used to plan care, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine intended to calm Vata, such as warm, regular meals and steady sleep
• Warm medicated oil massage of the forearm and elbow, and gentle local heat
• Herbs traditionally used for pain and swelling, such as turmeric, ginger and Boswellia, which need review if you take blood thinners^[11]
• Relative rest from the aggravating grip or throw, alongside the rehabilitation your clinician recommends^[2]

Panchakarma, the traditional cleansing program, is not directed at a single tendon and is not appropriate during pregnancy, acute illness or frailty.

What the research shows

There is no clinical research on Ayurveda for golfer's elbow. A PubMed search found no trials of Ayurvedic treatment, oil therapy or Ayurvedic herbs for medial or lateral epicondylitis. The therapies above are traditional practice, and we cannot point to evidence that they relieve golfer's elbow.

Herbal medicine for Golfer's Elbow

Herbs and formulas that have been studied

No herb or herbal formula has been tested in a clinical trial for golfer's elbow, as far as we could find. Turmeric (curcumin) and Boswellia are among the herbs that have been studied for tendon problems in general.^{[12, 13]} Chinese herbal medicine is traditionally used for tendon pain, often as a wash, plaster or liniment, and herbal preparations applied to the skin fall under the clinic's transdermal medication therapy.

What the research shows

The evidence for golfer's elbow is absent, and for tendon problems in general it is weak. A systematic review of supplements for tendinopathy, including curcumin and boswellic acid, found encouraging laboratory results that clinical studies had not confirmed, and the clinical studies were small, of poor quality and often tested several products together.^[12] A scoping review of 16 studies suggested some supplements may help alongside exercise, but noted there were few studies.^[13] None of this shows that an herb works for golfer's elbow.

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Case reports describe serious problems such as bleeding and hematomas when warfarin was combined with herbs including dan shen (Salvia miltiorrhiza), dang gui (Angelica sinensis), ginger and Boswellia.^[11] A systematic review also found that ginger and several other herbs can raise bleeding risk with warfarin.^[14] A broader review found that herb-drug interactions can have serious clinical consequences, so people taking blood thinners, aspirin or other prescription drugs need a practitioner's review first.^[15]

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[16] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, or have surgery planned.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine describes elbow tendon pain as stagnation of qi and blood in the arm channels, often after overuse. Biomedicine describes overload and degenerative change in the flexor-pronator tendon at the medial epicondyle.^{[1, 3]}

Ayurveda's aggravated Vata describes pain and stiffness that limit movement, which covers a similar picture in different words. No study has shown that a dosha or a qi pattern corresponds to a specific biological process in the elbow tendon.

How this care fits with your medical care

Integrative care for golfer's elbow is complementary. Keep your physician, sports medicine doctor or hand therapist, and continue the activity changes, injections or rehabilitation they recommend, because these are the standard treatments.^{[2, 3]} Do not stop or change prescribed medicines without your prescriber.

We do not diagnose the cause of elbow pain. Pain on the inner elbow can also come from the nerve or the joint, so a new problem should be assessed by a clinician.^[1] Please bring your diagnosis, any ultrasound or MRI reports, a full list of medicines and supplements, and details of past or planned injections or surgery.

When to seek urgent medical care

Some elbow problems are not tendinopathy and need prompt medical assessment.

• Elbow pain after a fall or injury, with a deformed or swollen joint
• A sudden pop, bulge or sudden weakness in the arm
• Numbness or tingling in the ring and little fingers, or a weakening grip, which can point to ulnar nerve involvement
• Redness, warmth, swelling and fever around the elbow, which can mean infection
• Pain at rest or at night that is steadily worsening, or pain with chest tightness or shortness of breath

If any of these occur with severe symptoms, call 911 or go to the nearest emergency department.