“That’s not possible, I don’t play golf!”  Pain on the inside of the elbow is commonly referred to as Golfer’s Elbow but you don’t need to play golf to be (un)lucky enough to get it!  Pain can range from an ache in the bulky part of the forearm muscles to severe pain at the bony part on the inside of the elbow.  Some people have no pain or a dull ache at rest but most have sharp pain with use.  Understanding this condition will help you address the problem and, hopefully, get rid of the pain.

The upper arm bone, the humerus, flares out on both the inside (medial) and outside (lateral) into what are called epicondyles for muscles to attach.  When standing with your arms by your side and your palms facing forward, the part of your arm facing forward contains the flexor muscles.  Five of these muscles’ tendons come together into a common flexor tendon that attaches onto the bony bump, the medial epicondyle.  These are the muscles that act to bend the wrist, turn the forearm and tighten the fingers into a fist.  It's the common flexor tendon that is the main area of pain with Golfer's Elbow.

A variety of factors can cause golfer’s elbow, including tightness or weakness in the muscles or a traumatic event.  In golf, a right handed golfer should swing the club primarily with their left arm, ‘pulling’ the club through the swing.  When their right arm tries to ‘push’ the club through, the result will typically be hitting the ground before the ball, often termed ‘hitting fat.’  With a strong grip on the club while ‘pushing’ it through the swing, the repeated sudden impact of hitting the ground creates a traumatic strain in the muscle(s) or tendon(s).  Pain arises when these areas become strained.

Perhaps more common are non-golfing injuries.  Many jobs require good manual grip strength to either stabilize or move something.  If there is weakness in the forearm muscles, then more of the strain is absorbed through the tendons and can result in tearing, inflammation and pain.  Activities that require someone to use their arm/forearm and hands repeatedly over a long period of time can also lead to Golfer's elbow.  Gradually, muscle tightness develops which places increased strain on the tendons and decreased ability within the muscle to absorb the force. 

Finally, a full history of activity and mechanics should be completed for anyone with pain on the inside of their elbow.  Mechanically compensating for problems elsewhere in the body can place more strain on the elbow, leading to pain.  Poor upper body posture in the back or shoulder blades can place abnormal strain on the arm and forearm, leading to overuse injuries. 

Any change in activity level can overload an unprepared arm, resulting in similar problems.  The person who works at a desk job and leads a relatively sedentary lifestyle who accepts an invitation to play in a 3-day golf tournament over a long weekend is likely to develop problems.

Treatment is geared toward restoring flexibility and strength in the forearm/wrist muscles as well as addressing any mechanical problems that may have contributed to the injury.  Stretching should focus on the forearm muscles that flex and extend the wrist and fingers.  Pronation (palm down) and supination (palm up) should also be worked on until you can turn your hand facing fully up and completely down.  Elbow extension (straightening) should be completely straight and can be addressed by keeping your upper arm on a table and letting your forearm hang over the edge with a 2-3 pound weight.

Strengthening exercises should address not only the areas around the injury but also any areas that have been identified as contributing to abnormal mechanics.  The wrist flexor and extensor muscle groups can be exercised with low weight and higher repetitions.  With a rounded-shoulder posture, often thoracic (upper back) extension is helpful along with rotator cuff exercises.  Demonstrations of most of these exercises can be found in video format in the rehab section.