Why Your Golfer’s Elbow Hasn’t Healed Yet

KEY TAKEAWAYS

• Most stubborn golfer's elbow cases behave more like tendon degeneration than simple inflammation, which is why rest, ice, and anti-inflammatories often calm symptoms without holding.
• Steroid injections can lower pain in the short term but in trials of medial epicondylitis the advantage often fades by 4 to 12 months.
• One randomized trial found ultrasound-guided PRP improved pain and function more than shockwave therapy at 6 months, while shockwave is still a useful conservative option when paired with progressive loading.
• Medial elbow pain can mimic or overlap with ulnar nerve irritation, so an accurate diagnosis matters before choosing a treatment.
• The most reliable path is progressive loading to rebuild tendon capacity, with shockwave or other tools layered in to support that, not replace it.

IN THIS ARTICLE

• Why golfer's elbow keeps coming back
• Why rest, a brace, and a cortisone shot did not hold
• What the research actually says
• How treatment works at Unpain Clinic
• What to do at home between visits
• FAQ

INTRODUCTION

If you have already tried rest, ice, a brace, stretches, and maybe even a cortisone shot, and the inside of your elbow still hurts every time you grip, lift, or swing, you are not broken and you are not failing treatment. Golfer's elbow, also called medial epicondylitis, often gets stuck because the tendon never rebuilt the strength it needed, and sometimes because the real diagnosis is not actually golfer's elbow. This article is based on our podcast episode, Why Cortisone Shots May Not Be Your Best Bet, and walks through what really works.

WHY DOES GOLFER'S ELBOW KEEP COMING BACK?

Golfer's elbow keeps coming back because the tendon at the inside of your elbow rarely rebuilds strength on its own. When pain has been around for months, the tissue often shifts from a short-term inflammatory flare to something closer to tendon degeneration, sometimes called tendinosis. That is why a plan based on calming inflammation can leave you feeling better for a while, then back at square one as soon as you grip, swing, or lift again.

This is the loop that traps most people. You rest until it calms down, return to activity, the pain comes back, and you rest again. Tendons do not usually rebuild capacity from rest alone. They need progressive loading that is matched to where the tissue is, not random pushing through pain and not endless avoidance.

There is another reason persistent inside-elbow pain stays stuck. It might not be straight golfer's elbow. Trials in this area highlight the importance of separating medial epicondylitis from ulnar nerve neuropathy and medial collateral ligament instability, because the right plan depends on the right diagnosis. If your symptoms include tingling, numbness, or a buzzing feeling into the ring and little fingers, the issue may also involve ongoing nerve pain or sensitivity, which changes what treatment helps and what makes it worse.

WHY DIDN'T REST, A BRACE, AND A CORTISONE SHOT FIX IT?

Each of those tools can lower pain, but none of them rebuild capacity. A brace can change how force travels through the tendon during activity, but it does not retrain it. A cortisone shot can quiet symptoms early, but trials in medial epicondylitis show the early advantage often fades. In one randomized trial of methylprednisolone plus lidocaine versus saline plus lidocaine, both groups also received anti-inflammatories, splinting, and physical therapy. There was a clear difference at 2 months, no difference at 4 months, and no difference at 12 months, which is why the authors did not recommend the injection as the main treatment. A separate randomized study in sixty elbows reached a similar short-term-only conclusion.

Most people who land on this page recognize the same path. Seeing it written down can be oddly reassuring, because it shows the pattern is common, not personal.

What people usually try, and what it tends to miss:

1. Total rest until pain calms. Misses: does not rebuild tendon capacity, so it returns with activity.
2. Counterforce brace or strap. Misses: reduces strain during use but does not retrain tissue.
3. Cortisone shot. Misses: often helps short term, but trials show no advantage by 4 to 12 months.
4. Ultrasound, TENS, or laser as the main plan. Misses: most randomized trials are for tennis elbow, not golfer's elbow.
5. Stretching only. Misses: can reduce tightness briefly without changing tendon tolerance to load.
6. Ignoring possible ulnar nerve involvement. Misses: wrong diagnosis leads to a plan that may flare the real driver.

WHAT DOES THE RESEARCH ACTUALLY SAY ABOUT TREATMENT FOR GOLFER'S ELBOW?

Honest version first. There is far less research on golfer's elbow than on tennis elbow. Two separate systematic reviews looked for randomized trials in both medial and lateral epicondylitis, and the included trials were all on lateral epicondylitis, which leaves a real evidence gap on the medial side. That is one reason a lot of online advice for golfer's elbow is borrowed from tennis elbow research rather than tested directly.

Among the trials that do focus on medial epicondylitis, two findings matter most for someone whose elbow is not healing. First, steroid injections look short-term, not long-term. The Bahari trial found a clear pain difference at 2 months that disappeared by 4 and 12 months, and the Stahl and Kaufman study in sixty elbows reported a similar short-term-only pattern. Second, regenerative-style options are starting to show meaningful effects. A randomized controlled trial compared ultrasound-guided PRP against shockwave therapy in medial epicondylitis and found both groups improved on pain and the Mayo Elbow Performance Score, but improvement was significantly greater in the PRP group at 12 and 24 weeks. A broader systematic review on shockwave across upper limb soft-tissue conditions, including medial and lateral epicondylitis, concluded that shockwave is generally safe and effective, with outcomes depending on protocol and energy settings.

"The honest takeaway is that injections that quiet pain do not necessarily rebuild a tendon, and tools that stimulate healing only work if the tendon is also being loaded properly. The plan matters more than the gadget." Uran Berisha, PT, RMT, Founder of Unpain Clinic

HOW DOES TREATMENT FOR MEDIAL EPICONDYLITIS WORK AT UNPAIN CLINIC?

At Unpain Clinic in Edmonton, the question we want to answer is not "where does it hurt," it is "why is this still happening." We test the elbow as part of a system that includes the wrist, the shoulder, your grip and swing demands, and the ulnar nerve, because trials show nerve involvement can complicate diagnosis and treatment of medial epicondylitis.

Your first visit is an assessment, not treatment. It usually follows this order.

1. A full history of how the pain started, what aggravates it, what calms it, and what you want to get back to.
2. Orthopedic testing including resisted wrist flexion and pronation, tenderness mapping over the medial epicondyle, and ulnar nerve screening.
3. Motion and load analysis of your wrist, elbow, shoulder, and grip, so we see the full chain instead of only the sore spot.
4. A clear, personalized plan that decides whether focused shockwave therapy is appropriate, and what supportive tools belong in your plan.

From there, treatment sessions are built around a small number of high-leverage tools, with shockwave usually as the main driver in tendon cases.

• Shockwave therapy. Used as the main regenerative tool in most medial epicondylitis cases, supported by both a randomized PRP-versus-shockwave trial in medial epicondylitis and broader upper-limb shockwave reviews.
• EMTT as an adjunct. Useful in selected cases as a complement to shockwave, with grounded expectations. The high-quality evidence base for electrophysical modalities in epicondylitis is stronger for lateral than medial, so we use it as part of a plan, not as a standalone fix.
• NESA neuromodulation when pain feels "revved up." When the system is amplifying signals, neuromodulation can help you tolerate loading again so rehab stops stalling.
• Physiotherapy with progressive loading. The non-negotiable layer. Mobilisation and exercise therapy are part of the evidence base for elbow tendinopathies, even though most trials are in tennis elbow, so we apply the principles and track your response.

If you want a wider view of how this looks across different elbow problems, our guide to shockwave therapy for elbow pain and our overview elbow pain explained, from overuse to injury, walk through the bigger picture. The same logic shows up in our tennis elbow guide on the lateral side.

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WHAT CAN I SAFELY DO AT HOME BETWEEN VISITS?

This is general education, not individual medical advice. If anything causes sharp worsening pain, tingling or numbness into the ring and little fingers, or pain that wakes you at night, stop and get assessed. Those signs can point to ulnar nerve involvement and change what is safe.

For most people, a calm and consistent plan beats a heroic one. The three principles below are the ones that hold up across guidelines.

1. Start with isometrics. Forearm supported on a table, palm up, make a fist, use the other hand to resist wrist flexion so you are pushing but not moving. Hold for 20 to 30 seconds, 3 to 5 rounds. Mild discomfort is fine, sharp spikes are not.
2. Progress to slow strengthening. Once isometrics are tolerable, add light wrist flexion and forearm rotation with a band or small dumbbell. Move slowly. Tendons adapt to gradual load, not sudden jumps.
3. Graded return to golf or work. Do not go from no golf to a long range session in one weekend. That is one of the fastest ways to restart the cycle.

Gentle wrist flexor and extensor stretches can help between sessions, and ice or heat can make you more comfortable, but neither replaces progressive strengthening for a tendon that has been irritable for months.

FREQUENTLY ASKED QUESTIONS

What causes pain on the inside of the elbow?

The most common cause is medial epicondylitis, where the flexor-pronator tendon at the inside of the elbow becomes overloaded and intolerant to gripping and wrist flexion. Trials in this area also stress the importance of distinguishing it from ulnar nerve neuropathy and medial collateral ligament instability, because each one needs a different plan.

What are the symptoms of medial epicondylitis?

Common symptoms include tenderness over the inner bony bump of the elbow, pain with gripping or with resisted wrist flexion and forearm pronation, and reduced tolerance for repetitive use. Trial descriptions emphasize localized tenderness over the flexor-pronator origin and pain reproduced by resisted wrist flexion and pronation.

How do I fix golfer's elbow without giving up everything?

Most people do best with a confirmed diagnosis, smart activity modification, a short-term brace if it helps, and a progressive loading plan that rebuilds tendon capacity. Steroid injections may help short term but rarely hold long term. PRP and shockwave both show promise in randomized research, with one trial showing greater improvement in the PRP group at 6 months.

What is the best brace or support for golfer's elbow?

Most people choose between a counterforce strap that sits an inch or two below the painful bony point and a compressive sleeve. A strap is mainly a symptom-management tool during gripping or sport. It should feel snug, not numb or tingly. If you develop tingling in the ring or little fingers, remove the brace and get assessed, because that pattern can point to ulnar nerve irritation.

Does shockwave therapy hurt?

Most people describe it as an intense tapping or pulsing over the sore area. Discomfort is usually tolerable and adjustable, and your clinician can change the intensity, target area, and pacing. Mild soreness afterward is possible and tends to feel like post-workout tenderness.

Can I keep golfing or working with golfer's elbow?

Often yes, but it depends on severity, irritability, and how well you can modify load. A common mistake is returning at full volume too quickly. Because persistent cases behave more like tendon degeneration than acute inflammation, a graded return tends to be safer than an all-or-nothing approach.

When should I stop self-treating and get assessed?

If pain has lasted more than a few weeks despite smart load changes, keeps coming back, or includes nerve symptoms like numbness or tingling, it is worth getting assessed. Medial elbow pain overlaps with ulnar nerve issues and other diagnoses, and the right plan depends on getting that part correct..

ABOUT THE AUTHOR

Written by Uran Berisha, PT, RMT, Founder of Unpain Clinic and the Medical Shockwave Institute in Edmonton. Medically reviewed by Uran Berisha, PT, RMT. Last reviewed on May 22, 2026. Learn more at Unpain Clinic.

BOOK YOUR INITIAL ASSESSMENT

If you are tired of "rest, repeat, restart" and your golfer's elbow keeps coming back, the next step is a one-on-one assessment where we confirm the diagnosis, screen the ulnar nerve, and build you a clear plan. No referral needed. No long contracts. We will tell you honestly if you are not a good fit for this approach, because that is more useful than a sales pitch. Book your initial assessment.

REFERENCES

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;11(4):338-343. https://www.ijmedicine.com/index.php/ijam/article/view/4017
2. Bahari M, Gharehdaghi M, Rahimi H. Injection of Methylprednisolone and Lidocaine in the Treatment of Medial Epicondylitis: A Randomized Clinical Trial. Archives of Iranian Medicine. 2003. https://www.researchgate.net/publication/242186047
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;48(12):957-965. https://pubmed.ncbi.nlm.nih.gov/23335238/
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. https://pubmed.ncbi.nlm.nih.gov/23709519/
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;9(2):453. https://www.mdpi.com/2077-0383/9/2/453
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 and Joint Surgery. 1997. https://pubmed.ncbi.nlm.nih.gov/9384424/