Part of Golfer's elbow
Why golfer's elbow is not getting better
Warning signs, and when to get help
Why is golfer's elbow not getting better?
In the clinic, golfer's elbow not getting better almost always has a findable reason, and it is usually one of three. The tendon is still being provoked for most of the day. The tendon has never been loaded in a way it could adapt to. Or the inner elbow pain is coming from something other than the tendon.
Two of those are about load, and they pull in opposite directions, which is why most stalled elbows have done only one of them. Hospital for Special Surgery puts the mechanism plainly: tendons used over and over with inadequate periods of rest do not get the time to adapt and heal, and they become disorganized and degenerated. The same page describes chronic golfer's elbow as owing more to a failed healing response in an overloaded tendon than to an inflammatory process. Konarski and colleagues describe the same thing from the mechanics end, with repeated forearm turning and wrist bending putting stress on the tendon beyond what it can take and producing recurrent microtears (Konarski and colleagues, 2023).
Read that twice and you get both instructions at once. Take the provocation out, and give the tendon something to adapt to. Do only the first and you get a quiet arm that falls over at the first hard grip. Do only the second and you are adding loading sessions on top of a day that was already too much for it.
There is one more honest thing to say before the detail. This condition has been studied much less than tennis elbow, which the golfer's elbow program sets out with the research attached. That matters here: nobody can hand you a tested protocol for a stalled medial elbow, so what follows is reasoning you can check against your own week rather than a rule.
Is rest the thing keeping it going?
Often, yes, and this is the single most common pattern we see on an elbow that has been sore for months. The reader has stopped their sport, stopped the gym, stopped carrying things on that side, and the elbow still hurts when they grip. They conclude the rest is not working and rest harder.
Complete rest is not what the sources advise. The Royal Orthopaedic Hospital leaflet suggests giving the elbow and wrist a break between spells of activity, and taking a few weeks off sport, which is a very different instruction from putting the arm away. It also asks you to look at the activity that causes the pain and change it where you can. Konarski and colleagues put two things at the base of any treatment: changing your activities, and keeping away from the arm movements that hurt (Konarski and colleagues, 2023). OrthoInfo, the patient site of the American Academy of Orthopaedic Surgeons, describes exercise as the main treatment, in a set order: stretching to get full, pain-free wrist movement first, then strengthening for wrist bending and turning the palm down.
So rest has a job, and the job is to make room for loading rather than to replace it. Months of a guarded arm leave you with a weak forearm on top of a sore tendon, and then even ordinary life is more than it can handle. The parent page names the guarding habit for what it is, and it is worth reading if the lifting in your house has quietly all moved to the other hand.
The second half of the rest question is the one people are really asking. If I have rested it for three months and it is unchanged, is it ever going to get better on its own? The leaflet's own answer is quoted on the golfer's elbow program: it says the condition will settle on its own, but that this could take months or years. Reading that as permission to wait is a choice. Reading it as a reason to get the tendon loaded is the better one.
Has the tendon had enough load, often enough, for long enough?
This is the audit worth doing before anything else changes, and it takes ten minutes with a calendar. Four questions, in order of how often they turn out to be the answer.
Have you actually done it? Not intended to, not done it for a week in February. A loading program that has been done twice a week when it was written for most days has not been tested yet.
Are you at the right stage? The golfer's elbow program sets out three, and the mistake runs in both directions. People start at stage 2 or 3 because stage 1 looks too easy, flare the elbow, and conclude that exercise makes it worse. Others stay on isometric wrist flexion for two months because it is comfortable, which tells the tendon nothing new.
Is the setup right? This sounds like a detail and it is often the whole answer. In the wrist curl the forearm has to be supported with the wrist just past the table edge, or the load goes somewhere other than the muscles you are trying to reach. In forearm pronation with a band the anchoring hand creeps toward the working hand and the tension disappears without you noticing. The parent page has a whole section on those two setups, which exists because they are the errors we correct most often.
And are you judging it over the right window? Base progression on pain-free grip and the 24-hour response rather than a fixed sheet. Day-to-day pain in a tendon moves around for reasons you will never identify; the next morning is the signal. The pain monitoring model is the longer version of that idea. The numbers themselves, sets, repetitions and how often, live on the parent page and are not repeated here, because this page is about why a program stalls rather than about what the program is.
There is some comfort in the only study that has looked at elbows like yours. Tyler and colleagues treated 20 people whose medial elbow pain had gone on for more than 6 weeks and who had already tried other things, and adding a specific slow lowering exercise to their physical therapy improved their arm function scores substantially (Tyler and colleagues, 2014). No comparison group, and six weeks of follow-up, so treat it as a direction rather than proof. The direction is that a stalled elbow often responds to better-aimed load, not to more of it.
What happens in the hours between sessions
Three sets of something takes a few minutes. The other fifteen waking hours are where a medial elbow tendon is usually kept angry, and they are invisible from inside a program sheet.
The pattern to look for is a firm grip while the wrist or forearm is working at the same time. A toolbag carried by the handle, a stiff car door, wringing out a cloth, a toddler lifted under the arms, a mouse gripped rather than rested on. The Royal Orthopaedic Hospital leaflet gives you the two cheapest changes available: use the smallest amount of force the job needs, or make the grip bigger, and spread the load to the larger muscles of the shoulder and upper arm. Thicker handles on tools, a wider pen, two hands on the kettle. None of it feels like treatment and all of it reduces the number of times a day the tendon gets loaded.
Then there is the elbow held bent for hours, at a desk, with a phone against your ear, or in bed. That position has nothing to do with the tendon and a lot to do with the ulnar nerve behind it. OrthoInfo's cubital tunnel page says bending the elbow compresses and stretches the nerve and reduces its blood supply, and that leaning on the elbow for long periods puts pressure on it too. If your fingers tingle as well as your elbow hurting, that habit is worth breaking before you change anything else about your loading. The night version of it, and what a position can and cannot do, is on sleeping position and night pain with golfer's elbow.
Gym and lifting deserve their own treatment, because they are a common reason a medial elbow stalls and the easiest thing to half-fix. What to change before you drop an exercise is on gym, lifting and grip work with golfer's elbow. If the pain only shows up with weights in your hands, start there.
Is it the problem you think it is?
Sometimes a tendon program is not working because the problem is not a tendon. Four alternatives account for most of it, and none of them is diagnosed from a page like this one.
The nerve behind the elbow. Konarski and colleagues divide medial epicondylitis into two subtypes, one without ulnar nerve involvement and one with it (Konarski and colleagues, 2023), and OrthoInfo notes that some people with this condition also get numbness and tingling in the ring and little fingers. Tingling, numbness or a hand that feels clumsy belongs on the warning list below, not in a set. Where the line between the two actually falls is covered in golfer's elbow or a trapped nerve at the elbow, and the nerve condition itself has its own page at cubital tunnel syndrome.
The ligament on the inner side. In throwers especially, inner elbow pain can come from the ulnar collateral ligament rather than the tendon, and that changes what can be loaded and when. Golfer's elbow or a UCL injury covers how the two differ. A pop on the inside of the elbow during a throw is a same-day warning sign below and not a question for a program.
The neck. Pain that travels down from the neck, or inner elbow pain that changes when you turn or tilt your head, points away from the elbow, and a nerve root irritated in the neck can produce arm pain a long way from where the trouble is. Those pages are cervical radiculopathy and neck pain.
The joint itself, or something that was never a tendon problem. An elbow that locks, catches or gives way, or one that is hot, red and swollen, is on the warning list below with a time frame attached. If you are not sure the pain is even in the right place for this diagnosis, where golfer's elbow hurts and where it spreads is the page that maps it.
Does slow mean something is torn?
This is the fear under most of the question, so it gets a straight answer: a slow recovery is not evidence of a tear.
What is true is that the tissue changes. The microtears Konarski and colleagues describe are real, and so is the disorganized, degenerated tendon Hospital for Special Surgery describes in a tendon used hard without enough recovery. Neither is the same as the kind of tear you feel let go, and neither can be read off how long you have been sore. Tendon pain that has lasted months with no single moment of injury is the ordinary presentation of this condition, not a sign of damage accumulating week by week.
The one thing worth taking seriously is continued hard use of an elbow that keeps hurting. Konarski and colleagues warn that carrying on using the affected arm without limits can do further damage where the tendon attaches (Konarski and colleagues, 2023). That is an argument for changing the load, not for stopping everything.
Whether you need a scan is a decision for whoever assesses you, and it usually depends on whether the result would change the plan. This page cannot make that call and will not pretend to. Surgery sits a long way down the road: OrthoInfo describes it as considered only when symptoms have not improved after several months of appropriate non-surgical treatment, and the parent page carries that answer alongside the injection evidence.
What a reassessment should actually cover
If you have been doing the right things for weeks and the elbow is unchanged, the next step is not a new exercise. It is a pair of fresh eyes.
A useful reassessment goes back to the diagnosis before it touches the program. It should include an examination of the inner elbow itself, a look at the ulnar nerve for sensation, strength and any wasting in the hand, a check of the ligament on the inner side in anyone who throws, and a screen of the neck. Konarski and colleagues list the history worth taking as repetitive elbow use, gripping, valgus stress or a one-off blow (Konarski and colleagues, 2023), and a one-off blow is the item patients forget to mention. Grip is worth measuring rather than guessing at, because pain-free grip is the thing that usually moves first when a program starts working.
Then the program. The stage, the setup, the frequency, what you are doing in the other fifteen hours, and what you are actually trying to get back to. If you already have a program and it is not helping after several weeks, a physio can check the diagnosis and change the load. The warning signs below need prompt medical attention.
If you have had surgery on the elbow, follow the program your surgeon or physio gives you rather than this one. And if you are waiting for an appointment, what to do while you wait for physiotherapy is written for that gap. In the United States that assessment usually comes from a physical therapist or a PT; elsewhere from a physio or physiotherapist.
One more thing for anyone recognizing themselves in all of this. The same questions, asked of a different tendon, are on why Achilles pain is not getting better, and plenty of readers find the pattern easier to see in a tendon that is not their own.
When slow is a reason to be checked rather than waited out
Most of this page is about an elbow that is behaving like a stubborn tendon. Some elbows are not doing that, and the difference matters more than anything else here.
The warning list below is sorted by how fast to act and carries the exact wording. The short version: any sign of a stroke, and an elbow injury that has left the arm misshapen or the hand numb, cold or pale, are emergencies. A pop on the inside of the elbow during a throw, a pop at the front of the elbow, an elbow that is hot, red and swollen or comes with feeling feverish, and a hand whose weakness is worsening day by day all need medical advice the same day. So do pins and needles in the arm or hand that do not go away after you stop, and part of the arm or hand going numb.
Tingling that settles within a few minutes of stopping the exercise, a hand that is getting weaker or clumsier, a visibly thinner muscle in the palm, an elbow that locks or gives way, and arm pain that travels from the neck all need a clinician within a few days rather than another month of exercises. For symptoms in the ring and little fingers that come and go, OrthoInfo's threshold is severe symptoms, or milder symptoms lasting more than 6 weeks.
Pain at night or at rest that keeps getting worse has three tiers of its own in the list, and the one that applies to you depends on your own health history. Read them rather than averaging them.
Outside all of that, the NHS position on elbow and arm pain is simply to see a doctor if it has not gone away after a few weeks. If you have been at this for months, that threshold passed a while ago, and an assessment is a better use of the next month than another cycle of the same program.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: any sign of a stroke, even if it goes away. That means a face that droops on one side, an arm you cannot lift or keep up, slurred or muddled speech, weakness or numbness on one side of your body or face, sudden blurred vision, double vision or loss of sight, trouble swallowing, sudden dizziness with unsteadiness or falling over, a sudden severe headache, or a sudden fall where your legs give way but you do not black out (a drop attack). Call emergency services straight away.
- Chest pain or tightness, which may spread to your arm, neck or jaw, or shoulder or arm pain that comes with shortness of breath, sweating or feeling sick. This can be a heart attack. Call emergency services straight away.
- Emergency: after a fall or a blow to the elbow, the arm has changed shape or sits at an odd angle, a bone is showing through the skin, a cut is bleeding heavily, or the hand has gone numb or tingly or turns cold, pale or blue. Go to an emergency department or call emergency services straight away, and do not drive yourself.
- Your arm, hand or fingers turn cold, pale, blue or gray compared with the other side. Call emergency services or go to an emergency department straight away, and do not drive yourself. The blood supply to the arm may be blocked.
- The pain started with a fall or a blow to the elbow, and the pain is severe, you heard a snap, the elbow is swollen or bruised, or you cannot bend or straighten the arm. Go to an urgent care center or emergency department the same day.
- A sudden pop or snap at the front of your elbow, sudden sharp pain there, or the muscle at the front of your upper arm bunches up or changes shape. Stop and go to an urgent care center or emergency department the same day, even if you can still bend the elbow, as this can be a torn biceps tendon.
Get help today
- Same day: you throw, and you heard a pop or felt a sudden snap on the inside of the elbow, followed by pain, a throw you could not finish, or an elbow that feels loose or unstable. Stop throwing straight away and get the elbow checked the same day, because the ligament on the inner side of the elbow (ulnar collateral ligament) may be injured, and in a thrower who is still growing the same pop can be a piece of bone pulled off the inside of the elbow. If the thrower is a child or teenager, go to an urgent care center or emergency department the same day, because that needs an X-ray.
- Pins and needles in your arm or hand that do not go away after you stop, or part of your arm or hand goes numb. Get medical advice the same day. If one side of your face or body suddenly goes numb or weak, or your speech becomes slurred or muddled, call emergency services, even if it goes away.
- The elbow is hot, red and swollen, or you have elbow pain with a high temperature or feel hot, cold or shivery. Get medical advice the same day, and go to an emergency department if you feel very unwell. This can be a sign of infection in the joint, which needs treatment quickly.
- The pain is there at night or at rest and keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Your hand is getting weaker, you keep dropping things, your fingers feel clumsy, or the web of muscle between your thumb and index finger, or the little finger side of your palm, looks thinner or hollow compared with your other hand. This can mean the nerve behind the elbow is being squeezed. See a doctor within a few days. If the weakness is getting worse from day to day, get medical advice the same day.
- You have numbness, tingling or pins and needles in your hand or fingers, most often the ring and little fingers. Stop any exercise that brings it on and see a physio or doctor. For the ring and little fingers, OrthoInfo advises seeing a doctor if the symptoms are severe, or if milder symptoms have lasted more than 6 weeks.
- Pain spreads from your neck down the arm, or turning or tilting your neck brings on the arm pain. See a physio or doctor, because the problem may be in the neck rather than the elbow.
- The elbow locks, catches or keeps giving way in everyday use, without a pop from throwing. See a physio or doctor rather than pushing on with the exercises.
- The pain is there at night or at rest and keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- The pain is there at night or at rest and keeps getting worse. See your doctor within a few days.
Common questions
Why is my golfer's elbow not getting better with rest?
Because rest takes the irritation away without changing what the tendon can handle. The Royal Orthopaedic Hospital, an NHS hospital in Birmingham, does suggest resting the wrist and elbow in the gaps between activity, plus a few weeks away from sport, and that often helps the pain. What it does not do is rebuild the forearm. OrthoInfo puts exercise at the center of treatment instead: stretching to get full, pain-free wrist movement first, then strengthening for wrist bending and for turning the palm down, and it adds that slow lowering (eccentric) exercise is thought to be particularly useful. Hospital for Special Surgery makes the same point from the tissue side, describing chronic golfer's elbow as more a failed healing response in an overloaded tendon than an inflammation sitting there waiting to settle. So complete rest tends to buy a quiet fortnight and a weaker arm. The version that works is taking the provoking load out of your day while you load the tendon on purpose.
Will golfer's elbow ever go away?
Most people do get there, and the honest version of the timing sits on the main page rather than here. The Royal Orthopaedic Hospital leaflet says the condition will settle on its own but that this could take months or years, and in the steroid injection trial quoted on the golfer's elbow program both groups improved over a year. Nobody can tell you where in that range your own elbow sits. What is in your hands is whether the tendon is being loaded in a way it can adapt to, and whether the diagnosis has been checked by someone who actually examined the arm.
Is chronic golfer's elbow treated differently?
Not fundamentally, and the evidence we have comes from people in exactly that position. Tyler and colleagues treated 20 people whose medial elbow pain had lasted more than 6 weeks and who had already tried other treatment: most had taken anti-inflammatory medicine, and several had had physical therapy or a cortisone injection without lasting benefit. A slow lowering exercise for the wrist with a flexible bar was added to their physical therapy, and their scores for arm function improved a great deal (Tyler and colleagues, 2014). There was no comparison group, and the authors say the follow-up ran only six weeks from the start of treatment, so it does not prove the bar did it. The useful direction is still there: an elbow that has not responded yet is not an elbow that cannot respond. What changes with a long-standing elbow is usually the care taken over the stage, the setup and the rest of the day, not the existence of some other program.
Does golfer's elbow getting worse mean the tendon is tearing?
Not on its own. The tissue change is real enough. Konarski and colleagues describe repeated forearm turning and wrist bending loading the tendon beyond what it can take and producing recurrent microtears (Konarski and colleagues, 2023), and Hospital for Special Surgery describes a tendon used hard without enough recovery becoming disorganized and degenerated. Neither of those is the same thing as a tear you would feel go. Pain that is getting worse is more often a load problem than a structural one, and the way to separate them is an examination rather than a web page. The patterns that need a clinician quickly are in the warning list below, and a sudden pop on the inside of the elbow during a throw is one of them.
References
- American Academy of Orthopaedic Surgeons. Medial epicondylitis (golfer's elbow). OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/medial-epicondylitis-golfers-elbow/
- Royal Orthopaedic Hospital NHS Foundation Trust. Golfer's elbow/medial epicondylitis. https://roh.nhs.uk/services-information/therapy/golfers-elbow
- Hospital for Special Surgery. Golfer's elbow (medial epicondylitis). https://www.hss.edu/condition-list_golfers-elbow.asp
- Konarski W, Poboży T, Poboży K, Domańska J, Konarska K. Current concepts of natural course and in management of medial epicondylitis: a clinical overview. Orthopedic Reviews. 2023;15. https://doi.org/10.52965/001c.84275
- Tyler TF, Nicholas SJ, Schmitt BM, Mullaney M, Hogan DE. Clinical outcomes of the addition of eccentrics for rehabilitation of previously failed treatments of golfers elbow. International Journal of Sports Physical Therapy. 2014;9(3):365-370. https://pmc.ncbi.nlm.nih.gov/articles/PMC4060314/
- American Academy of Orthopaedic Surgeons. Cubital tunnel syndrome (ulnar nerve entrapment at the elbow). OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/ulnar-nerve-entrapment-at-the-elbow/
- NHS. Elbow and arm pain. Page last reviewed 26 January 2024. https://www.nhs.uk/symptoms/elbow-and-arm-pain/
- NHS. Septic arthritis. Page last reviewed 3 September 2026. https://www.nhs.uk/conditions/septic-arthritis/
- NHS. Symptoms of a stroke. Page last reviewed 12 September 2024. https://www.nhs.uk/conditions/stroke/symptoms/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-18.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.