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If you’re reading this, chances are you’ve already tried a golfer’s elbow remedy—rest, ice, a brace, stretching, maybe even a cortisone shot—and you’re still feeling that sharp ache on the inside of the elbow every time you grip, lift, or swing. That stuck feeling can be exhausting: you start avoiding workouts, you change how you carry groceries, and golf (or your job) becomes a constant negotiation with pain.
Here’s the truth I want you to hear first: persistent golfer’s elbow doesn’t mean you’re broken or “not healing.” It often means one (or more) key pieces of tendon recovery and load management were missed—or the problem wasn’t truly golfer’s elbow in the first place. Research on medial epicondylitis (the medical term for golfer’s elbow) also shows the condition is frequently more complex than a simple “inflammation” problem, especially when symptoms have lasted a while.
Disclaimer: This article is for education only and not a medical diagnosis. Results may vary; always consult a licensed healthcare provider for personalized advice—especially if symptoms are severe, worsening, or include numbness/tingling.
Golfer’s elbow (medial epicondylitis) is pain where the forearm flexor/pronator tendon attaches to the medial epicondyle (the bony bump on the inside of your elbow). In plain language: the tissue that helps you grip, flex your wrist, and rotate your forearm gets irritated, overloaded, and less tolerant to force.
A big reason pain persists is that many longer-lasting cases behave more like tendinosis/epicondylosis (tendon degeneration and disorganized healing) than a short-term inflammatory flare-up. One randomized trial discussing medial epicondylitis notes that in chronic settings, the underlying process appears more like degeneration and granulation tissue (“tendinosis”) rather than a clearly inflammatory process—while also acknowledging early stages may include inflammation.
From the client point of view, golfer’s elbow often gets trapped in a pattern like this:
You rest until it calms down → you return to activity (golf, lifting, tools, typing) → pain comes back → you rest again.
The problem is tendons usually don’t rebuild capacity from rest alone. They typically need the right kind of progressive loading—not random pushing through pain, and not endless avoidance. That’s why many people feel like nothing works even though they’re “doing all the right things.”
Inside-elbow pain can come from more than one structure. A randomized clinical trial on medial epicondylitis specifically notes that the condition can be harder to diagnose and treat when there’s ulnar nerve involvement, and it also emphasizes differentiating medial epicondylitis from ulnar neuropathy and medial collateral ligament (MCL) instability.
That matters because the wrong diagnosis = the wrong plan.
Let’s get practical. These are the most evidence-consistent “why” factors I see behind stubborn golfer’s elbow, tied to what research shows about treatments and recovery patterns.
You only “rested it”… but the tendon never rebuilt strength
Rest may calm symptoms, but if your tendon has become deconditioned or degenerative, it may flare again when life demands gripping and lifting. The research landscape also reflects that medial epicondylitis has fewer high-quality trials than lateral epicondylitis (tennis elbow), so many generic protocols people find online are borrowed from tennis elbow research or based on clinical tradition rather than direct medial-epicondylitis trials.
A golfer’s elbow support brace (often a counterforce strap worn around the forearm) can reduce strain during activity by changing how force transmits through the tendon. But it doesn’t magically retrain tissue capacity.
Think of a brace as a volume knob, not a full fix. It can help you stay active while you rebuild strength—but it’s rarely the whole plan.
Steroid injections can reduce pain in the short term, but multiple studies suggest the benefit may not last.
A randomized clinical trial of medial epicondylitis comparing methylprednisolone + lidocaine vs saline + lidocaine (with both groups also receiving NSAIDs, splinting, and physical therapy) found a significant difference at 2 months, but no difference at 4 months or at 12 months.
A separate prospective randomized double-blind JBJS study summary also reports steroid injection effects are short-term (details accessible via abstract).
This doesn’t mean steroids are “bad” for everyone. It means if you’re relying on injections as the primary strategy, you may end up in a cycle of temporary quieting without rebuilding the tendon’s long-term tolerance.
Many people try ultrasound, TENS, lasers, and other electrophysical treatments. A systematic review looking for trials in both medial and lateral epicondylitis found that the included trials were all on lateral epicondylitis—highlighting a major evidence gap for medial epicondylitis.
This doesn’t mean every modality is useless. It means your plan may need to be built around the highest-leverage drivers of tendon recovery (diagnosis accuracy + progressive loading + targeted tissue work), with modalities as support rather than the core.
Stretching can help reduce perceived tightness and may reduce symptoms temporarily—but strength is usually the missing link. If you only stretch, the tissue may still be intolerant to the forces of gripping, swinging, or lifting.
Because medial epicondylitis is less researched than tennis elbow, the best approach is to rely on the highest-quality medial-epicondylitis trials we do have, and to be transparent where evidence is limited.
In the randomized trial published from Arch Iranian Medicine, steroid injection showed a statistically significant pain difference at 2 months, but the groups were similar by 4 and 12 months—leading the authors to conclude the injection had only short-term benefits and not to recommend it as the main treatment approach.
Clinically, this often matches what patients feel: “It helped… until it didn’t.”
A randomized controlled trial comparing ultrasound-guided PRP injection vs extracorporeal shock wave therapy (ESWT) in medial epicondylitis reported improvement in both groups, with improvement significantly greater in the PRP group at 12 and 24 weeks (6 months), using VAS pain and Mayo Elbow Performance Score.
Important nuance: this is one trial, and different protocols (PRP type, dosing, shockwave parameters, symptom duration) can change outcomes. But it’s meaningful evidence that regenerative injection approaches may have a role—especially when a simple home plan hasn’t been enough.
A randomized trial that included both lateral and medial epicondylitis compared low-energy ESWT to local steroid injection, assigning patients by block randomization. Both groups improved over time; steroid performed better early, but by later follow-ups the differences narrowed, and patient-reported satisfaction patterns shifted.
A broader systematic review of ESWT across upper limb soft tissue conditions (including medial and lateral epicondylitis) concluded ESWT is generally safe and effective, while also reflecting that outcomes vary and depend on energy levels and protocols.
What this means for you: Shockwave isn’t a “one zap cure.” It’s a stimulus that may support tendon remodeling—best used inside a plan that also restores strength, mechanics, and capacity.
Two separate systematic reviews searching for randomized trials in both medial and lateral epicondylitis found that the included RCTs were only in lateral epicondylitis.
That gap helps explain why your experience may feel messy: many “standard” recommendations are adapted from tennis elbow research or based on clinical reasoning rather than direct medial trials.
At Unpain Clinic, our goal isn’t to chase the symptom. It’s to answer the question: Why is this still happening?
That means we look at: your grip/forearm capacity, shoulder and wrist mechanics, training volume, work demands, recovery, and whether nerves (like the ulnar nerve) are contributing—because research shows nerve involvement can complicate diagnosis and treatment.
Shockwave (ESWT) is one of the better-studied “regenerative-style” tools for tendon issues, including epicondylitis. Randomized evidence exists for medial epicondylitis populations (often small), and systematic review evidence across upper-limb disorders supports its use as a conservative option.
At the clinic level, we use shockwave as part of a plan that also includes: progressive loading, technique modifications, and addressing the surrounding tissues that keep pulling on the sore tendon attachment.
EMTT (a form of pulsed electromagnetic field therapy) is used in some clinics as a complement to shockwave. The higher-quality evidence base for “electrophysical modalities” in elbow epicondylitis is stronger for lateral than medial, and systematic reviews highlight that research quality varies and that more high-quality trials are needed—especially for medial.
So we keep expectations grounded: EMTT may be considered an adjunct in a broader plan—not a standalone fix—especially if your case behaves like persistent tendinopathy.
When pain starts to feel disproportionate—burny, irritable, unpredictable, or lingering long after activity—your nervous system may be amplifying the signal. Tools like TENS and other neuromodulatory approaches have been studied as part of the broader electrophysical modality landscape in epicondylitis (again, mainly lateral in the published RCTs).
We use neuromodulation strategically: to help you tolerate loading and movement again, so the rehab process doesn’t stall.
Manual therapy can help restore motion and reduce local sensitivity, but it’s rarely enough by itself. Exercise therapy and mobilization have established research in lateral epicondylitis, while systematic reviews show the evidence base for medial-specific trials is limited—so we apply the principles carefully and track your response.
In short: we don’t just “treat the elbow.” We rebuild the system that loads the elbow.
In the Unpain Clinic Podcast episode “#16 – Why Cortisone Shots May Not Be Your Best Bet! Exploring Alternative Therapies for Pain Relief” (Aug 22, 2024), the conversation highlights a pattern we see often: quick symptom suppression may not address the underlying driver, and a more durable plan usually includes restoring function and tissue capacity rather than only masking pain.
“I stopped golfing for weeks, wore a strap, iced daily, and did stretches I found online. The pain improved… until the first range session. Then it was back—sometimes worse. I started gripping differently, which made my wrist sore, and suddenly my whole arm felt unreliable.”
In cases like this, the elbow tendon often didn’t regain capacity—it just got calmer. We typically start by: confirming the diagnosis (and screening ulnar nerve signs), identifying the exact loads that trigger symptoms (grip, wrist flexion/pronation, swing volume), and rebuilding strength in phases.
When appropriate, we layer in regenerative tools (like shockwave) while the patient reintroduces controlled loading—so the tendon is adapting, not just surviving.
This section is designed to be simple and low-risk. If anything causes sharp worsening pain, numbness/tingling into the ring/little fingers, or escalating night pain, stop and get assessed (ulnar nerve involvement can complicate medial elbow pain).
These are “gentle reset” options. You should feel a stretch—not a jabby pain.
Wrist extensor stretch (helps forearm balance even in golfer’s elbow) Straighten your elbow, palm down. Gently bend your wrist so fingers point toward the floor. Use the other hand to add light pressure. Hold 20–30 seconds, 2–3 rounds.
Wrist flexor stretch (more direct for golfer’s elbow) Straighten elbow, palm up, gently extend your wrist (fingers toward the floor). Hold 20–30 seconds, 2–3 rounds.
Phase one: isometric “pain-calming” wrist flexion Forearm supported on a table, palm up. Make a fist. Use your other hand to resist wrist flexion so you’re pushing but not moving. Hold 20–30 seconds, 3–5 reps.
Goal: mild discomfort is okay; avoid “spikes.”
Phase two: slow strengthening Once isometrics are tolerable, add a light dumbbell or resistance band: slow wrist flexion and pronation control. The tendon typically adapts to gradual load, not sudden jumps. Research framing of chronic epicondylitis supports the concept that tendon degeneration/“tendinosis” may underlie persistent symptoms—so strength and remodeling matter.
Phase three: return-to-golf loading Rebuild grip endurance and swing volume gradually. Don’t go from “no golf” to 150 balls in a weekend—this is one of the fastest ways to restart the cycle.
In general, ice is often used for short-term symptom relief after irritating activity, while heat may feel better for stiffness before movement. Standard conservative regimens described in shockwave-focused literature for upper limb tendinopathies include cryotherapy, activity modification, stretching, and eccentric loading.
The key message: heat/ice can help you feel better, but they usually don’t replace progressive strengthening for longer-lasting tendinopathy patterns.
A randomized clinical trial describing medial epicondylitis diagnosis includes: local tenderness over the flexor-pronator origin and increased pain with forearm pronation and wrist flexion against resistance.
At-home check idea: With your elbow straight, try gently resisting wrist flexion (palm up) and adding pronation resistance. If that consistently reproduces your familiar inner-elbow pain, golfer’s elbow is possible. But because other conditions can mimic it (including ulnar nerve irritation), testing should be confirmed clinically.
The most common “classic” cause is medial epicondylitis (golfer’s elbow), involving the flexor-pronator tendon attachment at the medial epicondyle. However, research in medial epicondylitis trials notes the importance of differentiating it from ulnar nerve neuropathy and medial collateral ligament instability, because those can change the treatment approach.
Common symptoms include: pain and tenderness on the inner elbow (medial epicondyle), pain with gripping or wrist flexion/pronation, and reduced tolerance for repetitive use. Clinical trial descriptions of medial epicondylitis diagnosis emphasize localized tenderness and pain provoked by resisted wrist flexion and pronation.
Most people do best with: accurate diagnosis, smart activity modification, a short-term support strategy (brace if needed), and a progressive loading plan that rebuilds tendon capacity. Evidence suggests steroid injections may help short term but not hold long term, while PRP and shockwave both show promise in randomized research—PRP showing greater improvement at 6 months in one RCT.
Most people choose between: a counterforce strap (forearm band) or a compressive elbow sleeve. A strap is often used during gripping/sport to reduce tendon strain, but it’s usually a symptom-management tool, not a full solution. Trials and clinical discussions in medial epicondylitis research describe braces/splints as part of conservative management.
Canada note: Many brace styles are widely available through Canadian pharmacies, sports stores, and online retailers. Fit and comfort matter more than brand. If you’re unsure, your physiotherapist can help you choose the correct type and placement.
Rather than chasing “the one perfect product,” look for: a strap that sits 1–2 inches below the painful bony point, feels snug (not numb/tingly), and reduces pain during gripping tasks. Medial epicondylitis trials also include splinting/bracing as part of conservative care.
If you develop tingling in the ring/little fingers, remove the brace and get assessed to rule out ulnar nerve irritation.
Often, yes—but it depends on severity, irritability, and your ability to modify load. A common mistake is returning at full volume too quickly. Because epicondylitis can involve degenerative tendon change in more persistent cases, a graded return tends to be safer than “all-or-nothing.”
If pain persists beyond a few weeks of smart loading changes, keeps recurring, or includes nerve symptoms (numbness/tingling), it’s worth getting assessed—especially because medial elbow pain can overlap with ulnar nerve issues and other diagnoses.
If your golfer’s elbow remedy hasn’t worked, it’s usually not because you didn’t try hard enough. It’s more often because the plan didn’t match what your tendon needed: a confirmed diagnosis, the right amount of protection (not total avoidance), and progressive loading that rebuilds capacity—sometimes supported by evidence-based options like shockwave or PRP rather than relying only on short-term symptom suppression like steroid injections.
And if you’re feeling discouraged: that’s normal. But you don’t have to keep guessing.
At Unpain Clinic, we don’t just ask “Where does it hurt?” — we uncover “Why does it hurt?”
If you’ve been frustrated by the cycle of “try everything, feel nothing,” this assessment is for you. We take a whole-body approach so you leave with clarity, not more questions.
✅ What’s Included
Comprehensive history & goal setting
Orthopedic & muscle testing (head-to-toe)
Motion analysis
Imaging decisions (if needed)
Pain pattern mapping
Personalized treatment roadmap
Benefit guidance
🕑 Important Details
60 minutes, assessment only
No treatment in this visit
👩⚕️ Who You’ll See
A licensed Registered Physiotherapist or Chiropractor
🔜 What Happens Next
If you’re a fit, we schedule your first treatment and start executing your plan.
🌟 Why Choose Unpain Clinic
Whole-body assessment, not symptom-chasing
Root-cause focus, not temporary relief
Non-invasive where possible
No long-term upsells — just honest, effective care
🎯 Outcome
You’ll walk out knowing:
What’s wrong
Why it hurts
The fastest path to fix it
Author: Uran Berisha, BSc PT, RMT, Shockwave Expert
1. Singh SA, et al. “Effectiveness of ultrasound guided platelet rich plasma injection in comparison with extracorporeal shock wave therapy on improving pain and function in medial epicondylitis of elbow: a randomized controlled trial.” International Journal of Advances in Medicine (2024).
2. Bahari M, Gharehdaghi M, Rahimi H. “Injection of Methylprednisolone and Lidocaine in the Treatment of Medial Epicondylitis: A Randomized Clinical Trial.” Arch Iranian Med (2003).
3. Dingemanse R, Randsdorp M, Koes BW, Huisstede BMA. “Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: A systematic review.” British Journal of Sports Medicine (2014).
4. Hoogvliet P, Randsdorp MS, Dingemanse R, Koes BW, Huisstede BMA. “Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review.” British Journal of Sports Medicine (2013).
5. Testa G, Vescio A, Perez S, et al. “Extracorporeal Shockwave Therapy Treatment in Upper Limb Diseases: A Systematic Review.” Journal of Clinical Medicine (2020).
6. Stahl S, Kaufman T. “The Efficacy of an Injection of Steroids for Medial Epicondylitis. A Prospective Study of Sixty Elbows.” The Journal of Bone & Joint Surgery (1997) (abstract).
7. Unpain Clinic Podcast (Uran Berisha host): “#16 – Why Cortisone Shots May Not Be Your Best Bet! Exploring Alternative Therapies for Pain Relief” (Aug 22, 2024).
