Elbow pain is a familiar problem for many golfers, but what golfers commonly call “golfer’s elbow” may be more complicated than simple soreness or inflammation.
In this episode of the Chicago Golf Report Podcast, we spoke with Dr. John Fernandez, an orthopedic surgeon at Midwest Orthopaedics at Rush specializing in hand, wrist and elbow conditions, about what causes golfer’s elbow, how golfers can recognize when an injury needs attention, and what they can do to get healthy and stay on the course.
The conversation also explored how the golf swing contributes to elbow and wrist injuries, the potential effects of hitting balls off mats, equipment changes that may reduce stress on the body, and treatments ranging from physical therapy to cortisone and platelet-rich plasma (PRP).
What is golfer’s elbow?
Golfer’s elbow is the common name for medial epicondylitis, a condition affecting the tendons that attach to the bony prominence on the inside of the elbow.
Those tendons play an important role in gripping and flexing the wrist. Fernandez explained that although the “-itis” terminology suggests inflammation, the condition is better understood as structural damage involving microscopic tearing of tendon fibers.
He compared a tendon to a rope made up of individual fibers. With golfer’s elbow, some of those fibers begin to fail rather than the entire tendon suddenly rupturing.
The good news for golfers is that the prognosis is generally excellent.
Fernandez said approximately 90 percent of cases heal without surgery and described the condition as fully recoverable. The bigger question is often how long the recovery takes and what can be done to accelerate it.
Golfers may actually experience “tennis elbow” more often
Despite the name, golfer’s elbow isn’t necessarily the most common elbow problem Fernandez sees among golfers.
He said he sees lateral epicondylitis, commonly known as tennis elbow, about five times more frequently in golfers than medial epicondylitis.
The distinction can be related to swing mechanics.
Fernandez explained that amateur golfers who don’t rotate effectively may release the angle of the wrist too early or develop a “chicken wing” through impact. Those movements can put stress on the leading arm and contribute to tennis elbow.
Casting and other movements involving the trailing arm can instead increase forces on the inside of the elbow and contribute to golfer’s elbow.
That makes technique an important part of the injury equation—not simply the number of golf balls a player hits.
Amateur and professional golfers experience different injuries
One of the more interesting distinctions Fernandez discussed was the difference between injuries experienced by recreational golfers and professionals.
Back injuries are among the most common golf injuries overall, but upper-extremity injuries also play a major role. Fernandez said amateurs tend to experience more elbow problems, while professionals experience more wrist injuries.
Among the wrist conditions Fernandez sees in golfers are ECU tendinitis, triangular fibrocartilage complex (TFCC) problems and hook of hamate fractures.
Are golf mats bad for your elbows?
This is an especially relevant question for Chicago golfers who spend much of the winter practicing indoors.
Fernandez identified hitting from hard surfaces as a potential risk factor. The vibration created at impact can aggravate elbow problems, particularly when a golfer repeatedly strikes the surface beneath the ball.
His suggestion when warming up on a hard practice surface is simple: consider teeing the ball slightly rather than repeatedly hitting directly from the mat.
That doesn’t mean golfers need to abandon indoor practice, but it does provide another reason to pay attention to practice volume, the quality of the hitting surface and how the body responds.
When should golfers worry about elbow pain?
Not every sore elbow requires a trip to an orthopedic surgeon.
Fernandez said some mild discomfort following a demanding round or weekend of golf can be expected. Pain in the range of roughly three or four out of 10 should generally improve within 24 to 72 hours.
The situation becomes more concerning when symptoms persist, become increasingly intense or begin appearing during normal activities away from the golf course.
If a golfer is still experiencing elbow pain a week later while gripping the steering wheel, for example, or is waking up with significant stiffness, that’s an indication that the problem deserves more attention.
Interestingly, that doesn’t necessarily mean completely shutting down golf.
Fernandez favors reducing intensity while remaining active, along with appropriate stretching and treatment.
Stretching, therapy and bracing
The first level of treatment can be relatively conservative.
Fernandez discussed physical therapy—often a limited number of sessions designed in part to teach the golfer appropriate exercises—along with eccentric stretching, nighttime wrist splints and counterforce straps around the forearm.
He also emphasized something golfers frequently neglect: warming up before playing.
Simple wrist, back and elbow stretches, followed by partial swings with a wedge, can prepare the tendons for the forces they’re about to experience.
Cortisone vs. PRP for golfer’s elbow
For persistent cases, treatment may progress to injections.
Fernandez described cortisone as inexpensive and readily available, but something he uses judiciously. He said repeated cortisone injections can contribute to tissue atrophy and weakness, and he generally tries to limit their use.
He also characterized cortisone as potentially more useful for short-term symptom relief than as a long-term solution.
PRP takes a different approach.
With platelet-rich plasma (PRP), blood is drawn from the patient and processed to concentrate platelets. The resulting material is then injected into the injured area with the goal of stimulating the body’s healing response.
Fernandez said evidence supports PRP’s potential effectiveness, particularly over longer periods, while cautioning that it isn’t guaranteed to work. He summarized the distinction as cortisone tending to perform better in the short term and PRP offering greater potential over the longer term.
Your golf equipment could make a difference
The solution to elbow problems doesn’t necessarily stop at the doctor’s office.
Equipment can potentially reduce some of the forces transmitted through a golfer’s hands and arms.
Fernandez suggested that graphite or softer shafts and some hollow-body iron designs can help reduce vibration and soften impact.
But one of his simplest recommendations involves something considerably less expensive: golf grips.
Old grips lose elasticity, which can cause golfers to squeeze the club harder. Fernandez recommends keeping grips fresh and said moving to a midsize grip can be beneficial for some golfers, particularly as they get older, because it may reduce the need for excessive grip pressure.
He called grips one of the least expensive equipment changes golfers can make to potentially reduce stress on the elbow.
Keeping golfers in the game
Fernandez brings an additional perspective to treating golfers: he plays the game himself.
He appreciates golf’s science and technology, but also understands that playing golf can represent much more than recreation.
For some people, golf is a major part of their social life. For others, relationships developed on the golf course extend into their professional lives. And unlike many sports, golf is something people can continue playing as they age.
That’s why Fernandez doesn’t dismiss a patient who says an elbow or wrist injury is interfering with golf.
He understands why getting back on the course matters.
And perhaps that’s the most encouraging takeaway from the conversation: golfer’s elbow can be frustrating, but in most cases it doesn’t have to mean the end of a season—or the end of a golfer’s ability to enjoy the game.
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