Elbow Pain Keeping You Off the Course? How Shockwave Therapy Can Help Golfers
Golfers ask a lot from their elbows.
Every swing requires you to grip the club, control the clubface, accelerate through impact, and then decelerate the club after the ball is gone. Multiply that by a bucket of range balls, 18 holes, and a few practice swings, and the tendons around your elbow can absorb a surprising amount of repetitive stress.
When those tendons become irritated, golfers often try the same things first:
Rest for a couple of weeks. Ice it. Stretch the forearm. Wear an elbow strap. Take some anti-inflammatories.
Sometimes that works.
But when elbow pain has been hanging around for months and keeps coming back every time you start swinging again, the problem may no longer be something that simply needs more rest.
That’s where treatments like focused shockwave therapy can become useful.
First: “Golfer’s Elbow” Isn’t the Only Elbow Problem Golfers Get
The name can actually be a little misleading.
Golfer’s elbow, or medial epicondylalgia, causes pain along the inside of the elbow where several of the wrist and finger flexor tendons attach.
But golfers can also develop lateral epicondylalgia, commonly called tennis elbow, which occurs on the outside of the elbow.
Both can be aggravated by golf because gripping and controlling the club requires repetitive loading through the muscles of the forearm.
So rather than assuming every golfer with elbow pain has “golfer’s elbow,” the first step should be determining which tissue is actually involved and why it is being overloaded.
Things I commonly look at include:
Which side of the elbow hurts
Grip strength
Wrist and forearm strength
Shoulder strength and mobility
How the golfer is loading the arm during the swing
Recent increases in practice or playing volume
Whether symptoms occur during the swing, after the round, or during normal daily activities
That matters because shockwave isn't a replacement for figuring out the cause.
It's a tool we can use to help a stubborn tendon respond better to the rehabilitation process.
What Happens in Chronic Tendon Pain?
One of the misconceptions around chronic tendon problems is that the tendon is simply “inflamed.”
Early irritation can certainly involve an inflammatory response, but persistent tendinopathy is more complicated.
Over time, the tendon can develop changes in collagen organization, cellular activity and its ability to tolerate load.
The problem becomes a mismatch:
The tendon isn't currently capable of handling the amount of stress you're asking it to tolerate.
That's why taking two weeks off may make the elbow feel better, only for the pain to return as soon as you start hitting balls again.
Rest reduced the demand.
It didn't necessarily rebuild the tendon.
So What Does Shockwave Actually Do?
Focused shockwave therapy delivers short mechanical pressure waves into a targeted area of tissue.
Despite the name, it isn't an electrical shock.
And we're not trying to “break up scar tissue.”
The more interesting effect happens at the cellular level through a process called mechanotransduction.
Mechanotransduction is essentially the way cells respond to mechanical stimulation.
Research examining the biological effects of extracorporeal shockwave therapy has found changes associated with:
Increased activity of tendon cells
Collagen production and remodeling
Signaling involved in new blood-vessel formation
Changes in inflammatory signaling
Changes in local pain signaling
Remodeling of the tendon extracellular matrix
In other words, we're giving the tissue a mechanical stimulus designed to encourage a biological response.
That is very different from simply trying to temporarily numb the painful area.
What Does the Research Show for Elbow Tendinopathy?
Lateral elbow tendinopathy is one of the more researched applications of shockwave therapy.
A systematic review and meta-analysis including 13 randomized trials and more than 1,000 patients found that extracorporeal shockwave therapy improved pain and grip strength in people with lateral elbow tendinopathy.
More recent research has continued to look specifically at focused shockwave.
A 2024 randomized clinical trial compared focused shockwave with therapeutic ultrasound in people who had experienced lateral elbow pain for at least three months.
Twelve weeks after treatment, the focused shockwave group experienced substantially greater improvements in pain and elbow-related function.
Interestingly, improvement wasn't immediate.
Pain and function continued to improve during the weeks after the treatment series was finished.
That makes sense when you understand the mechanism.
We're not simply trying to turn the pain off for a few hours.
We're trying to change the environment of the tissue while progressively rebuilding its ability to tolerate stress.
Why Shockwave Alone Isn't Enough
This may be the most important part.
I don't want a golfer to feel better for three weeks.
I want their elbow to be able to tolerate golf again.
Shockwave can help create an environment where a chronic tendon may respond more favorably, but the tendon still needs to regain capacity.
That's where rehabilitation comes in.
Depending on the golfer, treatment may include:
Progressive wrist flexor or extensor strengthening
Grip-strength training
Forearm pronation and supination strengthening
Shoulder and rotator cuff strengthening
Scapular control
Gradual return to hitting balls
Adjustments to practice volume
Golf-specific strengthening and power work
The shockwave treatment and exercise program work toward two different parts of the same goal.
Shockwave helps stimulate the tissue.
Progressive loading teaches the tissue to handle golf again.
What Does a Typical Shockwave Program Look Like?
At Back Nine Physical Therapy, I typically plan around a five-treatment series, with treatments generally spaced approximately one week apart.
The exact plan depends on the condition, how long you've been dealing with it, and how you're responding.
A treatment itself is relatively quick.
Focused shockwave is applied directly over the involved tendon while the intensity is progressively adjusted based on the tissue and your tolerance.
Most patients describe it as uncomfortable in the painful area, but very manageable.
You may have some mild soreness afterward, but there is generally no significant downtime.
And in most cases, I don't want golfers completely shutting down their activity during treatment.
Instead, we modify how much you're doing while gradually increasing what the elbow can tolerate.
Can You Golf While You're Getting Shockwave?
Often, yes.
This depends on irritability and severity, but complete rest usually isn't the end goal with tendinopathy.
We may temporarily modify:
Number of holes played
Range volume
Consecutive golf days
How aggressively you're practicing
Strength-training volume
Then we gradually build those things back.
The goal isn't simply to get you through five shockwave treatments.
The goal is to finish treatment with an elbow that's becoming more capable, not more protected.
How Do You Know if Shockwave Makes Sense for You?
Shockwave is most interesting for the golfer who says something like:
“I've had this for months. It settles down when I stop playing, but every time I start golfing again it comes right back.”
That pattern often tells us that simply waiting longer isn't solving the underlying capacity problem.
That doesn't automatically mean you need shockwave.
But it does mean the elbow deserves a better assessment than another round of rest and ice.
At Back Nine Physical Therapy, we combine focused shockwave therapy with individualized physical therapy and golf-specific rehabilitation to determine what's driving the problem and build a plan to get you back on the course.
Because the real goal isn't just making your elbow hurt less.
It's being able to swing a golf club without having to think about your elbow at all.
References
Yao G, Chen J, Duan Y, Chen X. Efficacy of Extracorporeal Shock Wave Therapy for Lateral Epicondylitis: A Systematic Review and Meta-Analysis. BioMed Research International. 2020.
Król P, et al. Focused shock wave and ultrasound therapies in the treatment of lateral epicondylitis – a randomized control trial. Scientific Reports. 2024.
Zhang et al. Extracorporeal Shock Wave Therapy Versus Local Corticosteroid Injection for Chronic Lateral Epicondylitis: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Orthopaedic Surgery. 2024.
Poenaru D, et al. Biological effects of extracorporeal shockwave therapy in tendons: A systematic review. 2023.
