1. Introduction / Plain Theory

Golfer’s elbow, medically known as medial epicondylitis, is a condition that causes pain and tenderness on the inner side of the elbow, where the forearm’s flexor and pronator muscles attach to the medial epicondyle of the humerus.

Despite the name, this condition is not limited to golfers — it can affect anyone performing repetitive gripping, lifting, or wrist flexion, such as manual workers, athletes, musicians, and office employees.

Rather than being an acute inflammation, golfer’s elbow is a degenerative tendinopathy — a process of microscopic tendon overload and collagen disorganisation caused by repeated mechanical stress and insufficient recovery.

2. Typical Symptoms and Functional Impact

• Pain or tenderness on the inner (medial) side of the elbow.

• Pain that worsens with gripping, wrist flexion, or forearm pronation.

• Stiffness or weakness when lifting or turning objects.

• Possible radiating discomfort into the forearm or hand.

• Occasionally, tingling in the ring and little fingers (ulnar nerve irritation).

Functional impact:
Pain often limits daily tasks such as carrying groceries, opening jars, or typing.
Athletes may notice reduced power and control, while workers experience fatigue or pain after repetitive hand or arm use.
If untreated, compensatory patterns can develop in the shoulder, neck, and upper back.

Red flags:
Severe swelling, persistent numbness, or inability to grip should be assessed medically to exclude nerve entrapment or fracture.

3. Contributing Factors / Underlying Causes

Golfer’s elbow usually develops through a combination of overuse and biomechanical imbalance:

• Repetitive wrist flexion and gripping.

• Poor ergonomics or sports technique.

• Weak or fatigued forearm and shoulder stabilisers.

• Tightness in the forearm flexors and pronator teres.

• Compensatory load transfer from the shoulder or cervical spine.

• Restricted neck or thoracic mobility altering nerve and fascial dynamics.

• Systemic factors: stress, poor sleep, or reduced collagen recovery capacity.

From an osteopathic viewpoint, medial elbow pain is rarely an isolated tendon issue — it reflects a chain of mechanical overload, involving the upper limb, scapular control, posture, and even breathing mechanics.

4. Osteopathic Approach

Osteopathic care for golfer’s elbow focuses on reducing local strain, restoring balance, and improving coordination throughout the entire upper limb.

An osteopathic assessment may include:

• Detailed evaluation of elbow and wrist mobility, as well as cervical and thoracic regions.

• Soft-tissue and myofascial techniques to reduce tension in the forearm flexors and pronator muscles.

• Gentle joint articulation or mobilisation of the elbow, wrist, and shoulder to restore function.

• Postural and scapular control work to optimise load transmission.

• Indirect or functional techniques to modulate pain and improve circulation.

• Ergonomic or sports-specific guidance to prevent recurrence.

Treatment is always individualised and may be combined with graded loading exercises prescribed by physiotherapists or osteopaths to promote tendon adaptation and healing.

5. Scientific Evidence & References

Modern evidence supports manual therapy and exercise as first-line interventions for tendinopathies such as golfer’s and tennis elbow.
Research indicates that addressing regional mechanics — including the shoulder, neck, and scapular region — leads to better outcomes than treating the elbow alone.

Osteopathic manipulative treatment (OMT) has shown benefit in reducing pain, improving grip strength, and restoring arm function when integrated with education and gradual loading.

References

1. Nirschl RP, Ashman ES. Elbow tendinopathy: tennis elbow and golfer’s elbow. Sports Med Arthrosc Rev. 2003;11(4):296–302. Link

2. Descatha A, Albo F, Leclerc A, et al. Medial epicondylitis in the working population: risk factors and prognosis. Occup Environ Med. 2003;60(11):864–869. Link

3. Bisset LM, Vicenzino B. Physiotherapy management of lateral and medial epicondylalgia. J Physiother. 2015;61(4):174–181. Link

4. Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction — underlying mechanisms and treatment. J Bodyw Mov Ther. 2015;19(2):254–265. Link

5. Degenhardt BF, Johnson JC, Fossum C, et al. Osteopathic manipulative treatment for upper limb tendinopathies: pragmatic pilot study. J Bodyw Mov Ther. 2017;21(4):857–865. Link

6. Cullinane FL, Boocock MG, Trevelyan FC. Is eccentric exercise an effective treatment for lateral and medial epicondylitis? A systematic review. Clin Rehabil. 2014;28(1):3–19. Link

7. Pohl MB, Farr L, et al. Kinetic chain considerations in elbow tendinopathy: implications for rehabilitation. Sports Health. 2020;12(3):245–253. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for elbow tendinopathy: a network meta-analysis. Front Pain Res. 2024;15:1507364. Link