Golfers Elbow Research

Current research views golfer’s elbow, or medial epicondylitis, less as simple inflammation and more as a degenerative tendinopathy of the common flexor tendon, especially involving wrist flexor and forearm pronator load. Wojciech Konarski, Tomasz Poboży, Kamil Poboży, Julia Domańska, and Klaudia Konarska describe it as a condition related to repeated wrist flexion, pronation, supination, gripping, lifting, and occupational strain, not only golf.

Alicja Grzelak’s 2024 systematic review also emphasizes repetitive strain at the medial epicondyle, forceful gripping, weightlifting, and repeated wrist-flexion tasks. The current model is that small tendon overload episodes accumulate faster than the tissue can adapt, producing tenderness, reduced grip tolerance, and pain with resisted wrist flexion or forearm pronation.

For manual therapists, the important shift is that golfer’s elbow is not just a “tight forearm” problem. The common flexor tendon includes pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis, and flexor carpi ulnaris, so symptoms may be influenced by grip habits, wrist position, elbow angle, shoulder mechanics, tool use, sports technique, and workload recovery. Konarski’s group specifically notes that occupational factors such as strong lifting, extreme elbow flexion or extension, pronation, and supination can contribute.

Current diagnosis remains mostly clinical. Researchers Daniel Li, Ahmad Hammad, and Kimberly Kaiser describe medial epicondylitis as pain around the medial elbow commonly aggravated by gripping, wrist flexion, and pronation. Imaging may help when symptoms are persistent, unclear, traumatic, or mixed with nerve symptoms, but the client’s history and provocation tests still matter most.

Ultrasound and MRI research has helped clinicians see the tendon more clearly. Studies commonly look for tendon thickening, reduced echogenicity, irregular fiber pattern, calcification, partial tearing, and Doppler signs of vascular change. Konarski and colleagues highlight ultrasound as useful in evaluating common flexor tendon changes and tracking tissue response after interventions such as platelet-rich plasma.

One major current theme is that corticosteroid injections may help short-term pain but may not be the best long-term strategy for chronic tendinopathy. PRP research is growing, although medial epicondylitis has less evidence than tennis elbow. WorkSafeBC’s 2023 evidence review specifically examined whether platelet-rich plasma has evidence for medial epicondylitis, showing that this question is clinically active but still not fully settled.

Exercise therapy remains central. Older and newer research supports progressive tendon loading rather than only rest, friction, or passive care. Z. H. See’s recent review on eccentric exercise for medial epicondylitis reports that current evidence suggests eccentric exercise may reduce pain and improve function, although the evidence base is still smaller than for lateral elbow tendinopathy.

This matters because tendons usually recover through graded exposure, not avoidance alone. A practical rehab model often begins with reducing painful overload, then restoring pain-free wrist, elbow, and shoulder motion, then adding isometrics, eccentrics, concentric strengthening, grip endurance, and eventually task-specific loading. For a massage therapist, manual work may reduce guarding and improve tolerance, but the tendon usually needs progressive loading to regain capacity.

Researchers Pieter Hoogvliet, Marjolein Randsdorp, Rachelle Dingemanse, Bart Koes, and Bionka Huisstede reviewed exercise therapy and mobilization techniques for medial and lateral epicondylitis, showing that clinicians continue to look for guidance on whether strengthening, manual therapy, or combined care is most effective.

Surgical research is usually reserved for chronic, refractory cases. Andrew Arevalo, Sharath Rao, Daniel Willier, Christopher Schrock, Brandon Erickson, Rachel Jack, Steven Cohen, and Michael Ciccotti published a systematic review on surgical techniques and outcomes. More recently, A. Barakat, G. Jha, P. Raval, E. Abourisha, P. Divall, H. P. Singh, and R. Pandey reviewed surgical techniques and examined the effect of prior injections and ulnar neuritis on outcomes.

The ulnar nerve is an important part of current thinking. Medial elbow pain can overlap with cubital tunnel irritation, nerve sensitivity, numbness, tingling into the ring and little fingers, or grip weakness. When those signs are present, the condition should not be treated as tendon pain only. Manual therapists should screen carefully and refer when neurological symptoms are progressive, severe, or unexplained.

In short, current research supports a broader model: golfer’s elbow is a load-management and tendon-capacity problem involving the common flexor-pronator origin, grip behavior, occupational repetition, sport mechanics, and sometimes ulnar nerve involvement. The strongest conservative direction is education, relative load reduction, progressive strengthening, and careful return to gripping tasks, with injections or surgery considered only when symptoms remain persistent despite appropriate care.