Golfer's Elbow Treatment Exercises for Lifters and Athletes

Golfer's elbow - medial epicondylitis if you want the medical term - is one of the most common overuse injuries I see in Malaysian gym-goers. Ironically, most of them have never touched a golf club. It comes from heavy pulling movements: deadlifts, rows, chin-ups, and curls.

That nagging pain on the inside of your elbow that gets worse when you grip a barbell? That is your medial epicondyle telling you the forearm flexor tendons are overloaded. If you have been ignoring it and training through the pain, stop. It will not go away on its own. It will get worse.

What Exactly Is Golfer's Elbow?

The medial epicondyle is the bony bump on the inside of your elbow. Several forearm muscles that control wrist flexion and grip attach here via tendons. When these tendons are overloaded repeatedly, the collagen fibres degrade faster than they can repair. This creates a cycle of micro-damage and pain.

It is technically a tendinopathy, not tendinitis. The distinction matters - tendinitis implies acute inflammation, while tendinopathy involves structural changes in the tendon. Anti-inflammatory drugs may help short-term pain but do not fix the underlying issue. What fixes it is progressive loading.

How Did You Get It?

Common causes in the Malaysian gym setting:

• Heavy deadlifts with a mixed grip (the supinated hand is at highest risk)
• High-volume chin-ups and pull-ups
• Barbell curls with excessive wrist flexion
• Gripping too hard during rows
• Sudden increases in training volume
• Poor forearm strength relative to the loads you are moving

If you recently added a lot of pulling volume or jumped up in weight on deadlifts, that is likely your culprit.

Phase 1: Acute Pain Management (Week 1-2)

During the acute phase, the goal is reducing pain to a manageable level. This does not mean complete rest - total rest actually delays healing for tendinopathies.

Isometric wrist flexion holds: Hold a light dumbbell (2-5kg) with your forearm resting on a bench, palm up. Curl your wrist up halfway and hold for 30-45 seconds. The isometric load helps reduce pain immediately in many people. Perform 4-5 sets, three times daily.

Modify your training: Drop exercises that cause sharp pain. You can usually still train, but you need to work around the elbow. Switch from barbell to neutral-grip dumbbell rows. Use straps for deadlifts to reduce grip demand. Avoid chin-ups temporarily. Replace barbell curls with hammer curls, which are usually pain-free.

Ice after training: 10-15 minutes of ice on the medial elbow after any training session. Not because ice heals the tendon, but because it helps manage acute pain.

Phase 2: Eccentric Loading (Week 3-6)

Eccentric exercises are the gold standard for tendon rehab. The controlled lengthening under load stimulates tendon remodelling and builds tensile strength.

Eccentric wrist curls: Rest your forearm on a bench with your palm facing up and wrist hanging off the edge. Use your other hand to help curl a dumbbell up (this is the concentric part - skip the hard part). Then slowly lower the dumbbell over five seconds using only the affected arm. That slow lowering is the eccentric portion.

Start with 2-3kg. Perform 3 sets of 15 reps, twice daily. It should be mildly uncomfortable - around a 3-4 out of 10 on the pain scale. If it is a sharp 7-8, reduce the weight.

Eccentric pronation: Hold a hammer or a dumbbell weighted on one end. Start with your palm facing up. Slowly rotate your forearm to palm-down over five seconds, resisting the weight. Reset with the other hand. 3 sets of 15 reps.

Tyler Twist with FlexBar: If you can get a TheraBand FlexBar (available on Shopee for around RM60-90), the Tyler Twist protocol is excellent. Hold the bar vertically, twist with the unaffected hand, then grip with the affected hand and slowly untwist. Studies show this protocol reduces pain by 81 percent over eight weeks. 3 sets of 15, once or twice daily.

Phase 3: Progressive Strengthening (Week 6-12)

By now, daily pain should be significantly reduced. Time to rebuild the tendon's capacity to handle load.

Wrist curls - full range: Standard wrist curls with a dumbbell, palm up, 3 sets of 12-15 reps. Gradually increase weight week by week. Start at 3-5kg and progress slowly.

Reverse wrist curls: Palm down, same setup. This strengthens the opposing muscles and balances forearm development. 3 sets of 12-15.

Towel wringing: Soak a towel and wring it out forcefully. This dynamic grip exercise strengthens the forearm in a functional pattern. Do this for 60 seconds, three times.

Farmer's carries: Grab two dumbbells or kettlebells and walk. Start light - 12-15kg per hand - and progress. This rebuilds grip strength in a functional way. Walk for 30-40 metres per set, 3-4 sets.

Phase 4: Return to Full Training (Week 12+)

Reintroduce exercises gradually. Here is a sensible progression:

Week 12-13: Add neutral-grip chin-ups. Start with 2-3 sets of 5 reps. Monitor for pain the following day.

Week 14-15: Return to barbell rows. Keep the weight moderate - 60-70 percent of your previous working weight.

Week 16+: Gradually reintroduce deadlifts without straps and standard chin-ups. Increase volume by no more than 10-15 percent per week.

If pain returns above a 3/10 during any exercise, scale back and spend another week at the previous level.

Exercises to Avoid During Rehab

• Barbell curls with heavy weight
• Behind-the-neck pull-downs (these should be avoided permanently)
• Mixed-grip deadlifts on the affected side
• Preacher curls at full extension
• Any exercise that produces sharp pain above 4/10

Long-Term Prevention

Once you are pain-free, do not just go back to what you were doing before. The tendon failed because your training exceeded its capacity. You need to build capacity ahead of demand.

Keep forearm work in your programme permanently. Wrist curls, reverse wrist curls, and farmer's carries two to three times per week prevent recurrence.

Use lifting straps strategically. There is no shame in using straps for heavy deadlifts and rows. They reduce tendon load and let you train your back without overloading your elbow. Save raw grip work for dedicated forearm training days.

Warm up your forearms. Before any pulling session, do 2 sets of 20 light wrist curls and 20 reverse wrist curls. This takes two minutes and primes the tendons for heavier work.

Manage training volume. Do not jump from 10 sets of pulling per week to 20 sets overnight. Increase gradually - two to three extra sets per week maximum.

When to See a Professional

If pain persists beyond twelve weeks of consistent rehab exercise, see a sports physiotherapist. In Malaysia, a session typically costs RM80-200 depending on the clinic. Places like Gleneagles, Pantai Hospital, and SDMC have sports medicine departments. Some physiotherapy clinics in KL like PhysioActive and Rehamed also specialise in sports injuries.

Persistent cases may benefit from shockwave therapy or PRP injections, but these should be considered only after conservative rehab has been given a proper chance.

The Honest Timeline

Most lifters want golfer's elbow gone in two weeks. The reality is that tendon rehab takes eight to sixteen weeks of consistent work. Tendons have poor blood supply and remodel slowly. There are no shortcuts.

The good news: you can train around it the entire time. You do not need to stop lifting. You need to modify, rehab consistently, and be patient. Every client I have worked with who followed this protocol returned to full training, usually stronger than before because they finally addressed their forearm weaknesses.