Golfers Elbow Unpacked: Common Mistakes in Rehab + what not to miss
Golfer’s elbow symptoms are on the inner part of the elbow, however many climbers will often feel increased tightness through the muscle bellies of their flexor muscles with which they grip with (the region of focus in the photo).
The topic of golfer’s elbow comes up quite a lot in climbing circles, we all have that one friend who seems to be constantly massaging their elbow or it might be your elbow that’s niggly and seems to return at the most inconventient times. Rather than going over specific drills to rehab the elbow, I think it’s worthwhile to go over the principles of how to approach the rehab. There’s a bit of nuance in treating this condition as often the aggrvating movements for 1 climber say the top position of a weighted pull may be painful but be completely fine for another. Or the orientation of the forearm at which the pain comes on can be completely different think chin ups, pull ups and neutral grip.
We also need to consider all the other things that could be happening around the elbow that can masquerade as golfer’s elbow as well!
Now first things first, the name can be a little misleading as not only golfers get this, climbers can too! And anyone really that takes part in a lot of gripping in their day to day work if you’re on the tools or other sports especially if they involve gripping i.e. BJJ. The elbow doesn’t know whether you’re gripping plastic on the climbing wall, gripping a gi at training or if you’re doing leg day and gripping the barbell, it just knows there’s load.
The Golfer’s elbow is aka medial epicondyle tendinopathy. The common culprit area that’s sore is where all of the flexor tendons that you grip with originate from (on the inner aspect of the elbow). This injury comes on gradually over time especailly around times of increased training loads.
First things first it’s important to understand what can irritate a Golfer’s elbow injury to better manage it. Tendons often don’t like 2 things:
Change
Compression
Change can be things like
- going away on holiday for several weeks and coming back to the same level of on + off the wall training as you were doing pre-trip
- adding in an extra session or 2 in the week without adjusting the length of the others so your overal weekly volume spikes up all of a sudden
- adding in more dynamic shock loading exercises that are often seen in power blocks of your training i.e. campusing, muscle ups etc. Which are not culprits themselves but given they’re often more fun, it can be easy to overdo the volume and intensity on these for sure
*The speed of the exercises matter for Golfer’s elbow too! as often slow + controlled loading is going to be tolerated far better (unless it’s also compressing the sore spot) than quick shock loading (in the early - mid stages). Later on it’s actually important to introduce the quicker dynamic movement's once more to rebuild the capacity of your elbow to these, however not at the very start.
Now let’s move on to the 2nd thing tendons don’t like: compression
This can be from things like
- poking the elbow constantly (we’ve all been guilty of this don’t worry!)
- stretching the area, also a really common one that I see climbers first try it’s just our natural reaction when something is sore, makes sense.
Or it could also look like the top position of weighted pull ups when this area is getting compressed or any deep lock offs usually if this is what you enjoy on the wall. These can be irritating to this injury if over-done.
Now that we are mindful of how a Golfer’s elbow can come about, it’s important to also note a few more key things about tendons:
They are mechanoreceptive tissue (meaning they actually need a little bit of loading to help the area repair + regenerate!). Tendinopathy injuries including Golfer’s Elbow can often experience an analgesic (pain relieving) effect from use. Given the correct exercise and dosage of course. And this is why complete rest for these often isn’t the way.
You’ll often not know if you’ve overdone things until 24-48 hours after your training/ climbing. And this is where it can get really confusing on when to stop your session as the elbow may actually start to feel better and better as you climb! But… this next morning response after a climbing/ training session is key. And something that I get my clients to monitor with clear metrics on what are
acceptable level of symptoms to show that it’s ok to push on, and when to start holding back
often if the symptoms are <3/10 the next day and don’t linger for >24 hours and there is a warm up effect from using the elbow the session has been well tolerated. And this number will decrease over time as you rebuid the capacity around the elbow to be able to withstand shock loading and compression once more.
It is important however to seek the advice of health care professional that understands climbing if the symptoms have been lingering for quite some time, you’ve already modified quite a bit of your climbing and weights gym work and it’s still not getting better as there could be other surrounding areas to consider. This blog is purely for educational purposes to better help you understand this injury.
And these below are just some of the other things that can be happening around this inner elbow region masquerading as a "golfer's elbow”:
The brachialis/ biceps tendon especially if it's more centrally (often from lots of mantle moves)
Some nerve irritation as part of your elbow problem (often may feel tingly/ warm or sending pins and needles down the forearm)
Could even be the elbow joint itself that's causing problems often will also be achy first thing in the morning
Potentially an underlying elbow instability
And many more, but there are the more common ones that I would see in clinic in climbers.
So as you can see, lots to unpack here and having an understanding of what could irritate a tendinopathy in the first place is a good starting point. Then it’s on to unpacking your main triggers: the elbow angle at which you get your symptoms and the forearm orientation that most sets it off. These can then help unpack what grips you may tolerate and how to work around this injury during the rehab process.
