Pilates guide
No trial has tested Pilates for golfer's elbow (medial epicondylitis), and golfer's elbow itself has been studied far less than tennis elbow. What's prescribed is loading the muscles that bend the wrist, with still holds, slow lowering and a gentle stretch, for 6 to 12 weeks, and patience: most people get better with time. Pilates fits alongside that loading, with a light grip and your weight off flat, bent-back hands.
This guide covers what golfer's elbow is and how long it lasts, why grip and weight on your hands matter, the forearm exercises, which mat and reformer moves to change, the ulnar nerve, what the evidence shows for exercise and injections, the warning signs, and a 25-minute class with a 10-minute wrist flexor block to do every day.
We found no Pilates trial in golfer's elbow, published or registered. The only Pilates elbow trial was in tennis elbow, in 17 people, and found no significant extra benefit. So Pilates is a way to keep exercising, not a treatment for the tendon.
NHS inform's leaflet gives a stretch, 4 holds of 20 seconds, 3 times a day, and slow-lowering wrist curls, 3 sets of 12 once a day; US surgeons' handout says to keep it going for 6 to 12 weeks. That advice is borrowed from tennis elbow and hardly tested: 5 small studies (143 people) give low-certainty evidence. So our class puts a daily wrist flexor block first, with Pilates around it.
Most golfer's elbow comes from repeated, forceful gripping at work or home. In workers in repetitive jobs, 81% had recovered at 3 years, and an expert review says nine in ten improve with conservative care. Think in months, not weeks.
In push-up studies, load on the inner elbow rose with the hands placed further forward, one-handed or turned out, and fell with a straight, neutral wrist. No study has measured a Pilates position, so this is our reading: while it's sore, use your forearms or fists, keep your hands under your shoulders, grip lightly, and bring flat-hand moves back in steps.
Some discomfort during forearm exercises is fine. Keep it mild: no more than about 3 to 4 out of 10. It should settle within an hour or so, and your elbow should be no worse the next morning.
US surgeons' handout puts it this way: "You should not feel pain during an exercise, however, some degree of discomfort is normal."
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Arm pain with pressure across your chest needs 999, and an elbow that looks out of shape after a fall needs A&E. Tingling in the ring and little fingers is the ulnar nerve, which irritates about 1 in 5 people with golfer's elbow. The full list, in the words of our elbow guides, is below.
Golfer's elbow is a sore tendon where the muscles that bend the wrist and turn the palm down attach to the bony bump on the inside of the elbow. It hurts when you bend the wrist or turn the palm down against resistance, and it can weaken your grip. US surgeons say it "usually occurs in adults between the ages of 40 and 60", builds "over weeks to months", and "can usually be treated successfully without surgery". An NHS Borders leaflet adds: "This condition shouldn't cause any lasting damage and doesn't lead to arthritis."
NHS England has no golfer's elbow page, and its tennis elbow page doesn't mention it; the UK health-service advice is in NHS leaflets from Scotland. Our golfer's elbow guide has the full picture.
About 0.4% to 0.6% of adults have it at any one time, most often in their 40s and 50s, men and women alike. In Finland, "Smoking, obesity, repetitive movements, and forceful activities" were each linked with it, and in the UK, bending and straightening the elbow repeatedly for more than an hour a day went with about five times the odds. Hard gripping for long periods, heavy loads and vibrating tools are the work factors that come up again and again.
A medical review says "most cases arise in non-athletes, particularly those engaged in repetitive, forceful gripping and manual labor." In amateur golfers, pain on the outside of the elbow is reported more often than on the inside, a 2022 review says. Inner-elbow pain in golfers is usually in the trailing arm and linked with hitting the ground hard, and amateurs used one of the inner forearm muscles about twice as hard as professionals. Our Pilates for golfers guide covers the swing.
No study has followed untreated golfer's elbow the way tennis elbow has been followed. In workers in repetitive jobs, the outlook "was good with a 3-year recovery rate at 81%"; in the injection trial, both groups improved over a year, which the authors put down mainly to the natural history; and an expert review says "Conservative management may improve nine out of ten patients". Heavy physical work, awkward wrist positions and pain in the dominant arm went with a slower recovery.
"Concomitant ulnar neuritis can be seen in 20% of patients": the ulnar nerve runs behind the inner elbow, and numbness or tingling in the ring and little fingers is usually its first sign, often brought on by leaning on the elbow or keeping it bent. In throwers, inner-elbow pain with a slower throw points to the ligament. In one clinic, 55 of 102 people with a pinched nerve in the neck also had golfer's elbow, so the neck is worth checking. Our ulnar nerve, elbow ligament and pinched nerve guides cover each.
These are lab studies, in push-ups and gripping rather than Pilates moves, in people without elbow pain. What they mean for Pilates is our reading.
With your hands flat and your weight on them, the wrist is bent back, which stretches the sore wrist flexors under load; our golfer's elbow guide lists this among the things to avoid while it's sore. In push-ups, about 45% of body weight went along the forearm with the hands in the usual place, and the force on the inner elbow ligament rose with the hands further forward and with one-handed support (by 42%). A turned-out hand raised inner-elbow load by 50% in one-handed push-ups, and a neutral wrist, on fists or handles, lowered elbow load. No study has measured inner-elbow load in a Pilates position.
In a lab study of 10 people gripping under a load on the inner elbow, the pronator teres (the muscle that turns the palm down) worked at 40.9% of its maximum with the palm down, against 3.6% with the palm up. Golfers with golfer's elbow used their wrist flexors more, and a forearm brace or oversized grips didn't change that.
Weight on flat, bent-back hands: the knee hover, plank, leg pull front and back, push-up, side bend, the swan pressed up and the kneeling side kick, and on the reformer, the elephant, long stretch and knee stretches. Gripping: holding your ankles in rocking, the open-leg rocker, the seal and the crab, the hand clasp in the double-leg kick, squeezing a ring between your palms, and straps and handles on the reformer. Most lying, side-lying and seated mat work, and reformer footwork, ask little of the inner elbow.
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Treatment follows the tennis elbow pattern, a review says: ease the activities that hurt, then load the muscles. NHS inform's leaflet gives a stretch with the wrist back and the elbow straight, "Hold for 20 seconds. Repeat 4 times. Do this 3 times per day.", and palm-up wrist curls with slow lowering, "Do 3 sets of 12, once a day." NHS Borders starts with stretches, forearm turns and elbow bends, then still holds and slow lowering with a tin of beans: "Move onto this exercise when Stage 1 is pain-free." US surgeons' handout: "This exercise program for epicondylitis should be continued for 6 to 12 weeks". This is specialist and health-service advice: no trial has tested it in golfer's elbow.
In 20 people, mostly competitive athletes, whose golfer's elbow hadn't improved with earlier treatment, adding a slow-lowering exercise with a flexible bar (3 sets of 15, about 5 seconds per lowering, 60 seconds' rest between sets) cut a disability score from 34.7 to 7.9 over about 6 weeks. There was no comparison group, and other treatments ran at the same time, so it is encouraging, not proof.
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Some discomfort during forearm exercises is fine. Keep it mild: no more than about 3 to 4 out of 10. It should settle within an hour or so, and your elbow should be no worse the next morning.
Tingling is the exception: stop any exercise or position that brings on pins and needles or numbness in your hand, especially in the ring and little fingers, and avoid holding the elbow fully bent while it settles.
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Our golfer's elbow guide sets the loading out in stages: settle, build, then strengthen and return. The forearm doses on this page and in our class are that guide's, so the two agree. Do the forearm block once a day, and the whole class 2 or 3 times a week.
Our searches of PubMed, Europe PMC and ClinicalTrials.gov in October 2026 found no Pilates trial in golfer's elbow, published or registered. In 17 people with tennis elbow, adding Pilates-based core, posture and flexibility work to occupational therapy gave no significant extra improvement. A 2025 review of Pilates for arm and leg problems (11 studies, 444 people) found less pain and disability, but rated the evidence very low certainty and doesn't say which conditions it pooled.
A review of exercise and mobilisation for both conditions found "One review and 12 RCTs, all studying lateral epicondylitis": tennis elbow. A 2026 review of slow-lowering exercise for golfer's elbow found 5 small studies (143 people) of mixed design; one randomised trial showed a difference between groups, and "the overall certainty of evidence remains low". That the evidence is thin is clear; the advice rests on experts and on tennis elbow.
In a double-blind trial (58 people, 60 elbows), a steroid injection eased pain at 6 weeks, but "the groups did not differ with regard to pain at three months and at one year". US surgeons say an injection "may lengthen the rehabilitation process".
No randomised trial of platelet-rich plasma (PRP) injections for golfer's elbow was found; in one look back at 33 stubborn cases, 80% did well after PRP and 94% after surgery, a difference that could be chance. Evidence for straps and braces is "only very limited", and in golfers a forearm brace or oversized grips didn't change how hard the wrist flexors worked.
Within the elbow pain rule. Wrist and forearm flow to warm up, 10 slow reps each direction; wrist curls held still, palm up, the wrist level and the forearm supported, 5 holds of 30 to 45 seconds, once a day; then lifting and slow lowering, 3 sets of 10 to 15, once a day, lowering over 3 to 6 seconds; dumbbell forearm rotation, 3 sets of 10; ball squeeze, 5 to 10 squeezes of 5 seconds, only as firm as you can without more pain; band finger extension, 2 sets of 15; reverse wrist curl for the other side of the forearm, 2 sets of 12 to 15; wrist flexor stretch after the loading, 4 holds of 20 seconds, up to 3 times a day (NHS inform's dose) (our golfer's elbow guide's plan, for each). If you have a flexible bar, the reverse Tyler twist, "3 sets of 15, about 5 seconds per release, with 60 seconds' rest between sets, for about 6 weeks."; elbow bend and straighten, "10 slow repetitions, up to 4 times a day" (the move page's dose for each).
3D demoWrist & forearm flowBeginner · No equipment
3D demoWrist curlsBeginner · A dumbbell
3D demoReverse Tyler twist (flexible bar, for golfer's elbow)Beginner · Other / check instructions
3D demoDumbbell forearm rotationBeginner · A dumbbell + A bench or box
3D demoBall squeezeBeginner · Other / check instructions
3D demoBand finger extensionBeginner · A band
3D demoElbow bend and straighten (elbow range of motion)Beginner · No equipment
3D demoWrist flexor stretchBeginner · A wall
3D demoReverse wrist curlBeginner · A dumbbell + A bench or boxHands open and resting, never gripping or pressing. Lateral breathing, "5 to 8 breaths at the start of every session"; knee fold, "2 sets of 5 to 10 each side, every other day"; the hundred, hands open, "50 beats to start, building to 100 (the classical count)"; single-leg circle, "5 circles each direction, each leg"; single-leg stretch, hands resting lightly on your shins, "6 to 10 each side"; side kick, head on a cushion with your lower arm out straight if your little finger tingles, "8 to 10 each side"; swimming, arms by your sides if reaching forward pulls on the elbow, "2 to 3 sets of 20 to 30 seconds"; single-leg kick, on your forearms with your hands open and not leaning on the inside of the elbow, "6 to 8 each leg"; spine twist, "3 to 4 each side"; mermaid, supporting hand resting lightly or sitting on a chair, "3 each direction, each side" (the move page's dose for each). Pelvic tilts then bridges, 8 of each, and clamshell, 10 each side (our Pilates for tennis elbow class).
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoKnee foldBeginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoHundred (Pilates)Intermediate · No equipment
3D demoSingle-leg circle (Pilates one leg circle)Beginner · No equipment
3D demoSingle-leg stretch (Pilates one leg stretch)Intermediate · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoSwimming (Pilates)Intermediate · No equipment
3D demoSingle-leg kick (Pilates one leg kick)Beginner · No equipment
3D demoSpine twist (Pilates)Beginner · No equipment
3D demoMermaid (Pilates seated side bend)Beginner · No equipmentY-T-W raises with your thumbs up and hands open, 5 of each shape, and wall angels, 8 slow reps (our Pilates for tennis elbow class); band row with a neutral, thumb-up grip and the lightest band, 2 to 3 sets of 12 to 15 (our golfer's elbow guide).
The order is our suggestion, from the push-up load studies (measured in push-ups, not Pilates moves) and our golfer's elbow guide's swap, push-ups on a bench or with dumbbells as handles. The forearm plank dose is editorial; the wall push-up dose is from our Pilates for shoulder pain class; the incline push-up dose is from our golfer's elbow guide; the knee hover, push-up, side bend and leg pull front doses are the move pages' doses.
See the movement on the 3D figure: Forearm plank
Our suggestions, agreeing with our Pilates for tennis elbow and golfer's elbow guides, unless a move's own caution is quoted. Bring the moves back in steps once gripping and pressing are comfortable.
The knee hover, plank, leg pull front and back, push-up, side bend, the swan pressed up and the kneeling side kick: do them on your forearms or fists, or leave them out, and build back as above. The moves' own lines: the knee hover, "If your wrists hurt, make fists or work on the forearms."; the leg pull front, "If your wrists hurt, use fists or the forearm version."
Wrist rocks on all fours and the kneeling forearm stretch wait. Their own cautions: "Leave it while golfer's elbow is irritable, and stop if it brings on tingling in the fingers." and "skip it with carpal tunnel symptoms, a recent wrist injury or fracture, wrist or thumb arthritis, or irritable golfer's elbow, and use the wrist flexor stretch against a wall instead."
Holding your ankles in rocking, the open-leg rocker, the seal and the crab; the hand clasp in the double-leg kick (hold a towel instead); squeezing a ring hard between your palms (hold it between your knees instead); wrist weights; and heavy palm-down or wrist-curling work with weights. Our golfer's elbow guide lists "Curling the wrist or turning the palm down against heavy resistance, hard and often" among the things to ease off. The ball squeeze's own caution: "With tennis or golfer's elbow, squeeze only as firmly as you can without increasing your pain."
Don't lean on the inside of your elbow, don't rest your head on a fully bent arm in side-lying work, and stop any position that brings on tingling in your ring and little fingers. The elbow bend and straighten's own caution: "With tingling in the ring and little fingers, skip long holds at full bend, which squeeze the ulnar nerve."
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Gripping straps, handles and the footbar loads the forearm: rowing, pulling straps, arm springs, and the elephant and long stretch with your hands on the bar. Put the loops round your forearms where the equipment allows, use the lightest spring, or leave them out for now. Footwork, leg springs, bridging and side-lying work are fine.
Fewer balls or shots per session, and technique advice, as our golfer's elbow guide suggests. Build sessions up over weeks.
Ease back into gripping and weight on your hands gradually, and follow your clinician's advice. The benefit lasted about 6 weeks in the trial.
Our 25-minute class starts with a 10-minute wrist flexor block to do every day, then grip-free mat work and shoulder-blade moves; its order and doses are editorial, from our golfer's elbow guide and our Pilates for tennis elbow class. The wrist and forearm routine suits the later stages: it includes wrist rocks on all fours. The tennis elbow class has the same mat work, but its forearm block works the other side of the forearm. The forearm workout is for later, to build strength.
A 25-minute Pilates class for golfer's elbow: a 10-minute wrist flexor loading block to do daily, then grip-free mat work and shoulder-blade moves.
25 minBeginner16 movesA dumbbell, A bench or boxWrist mobility and forearm strength for desk work, climbing, push-ups and handstands.
10 minBeginner7 movesA wall, A dumbbellA 25-minute Pilates class for tennis elbow: a 10-minute forearm loading block to do daily, then grip-free mat work and shoulder-blade moves.
25 minBeginner17 movesA dumbbell, A bench or boxA 25-minute forearm size workout with dumbbells: hammer, reverse and Zottman curls for the big muscle on the thumb side, then wrist curls and a carry.
25 minBeginner7 movesA dumbbell, A kettlebellThese are the same warning signs as our elbow pain, golfer's elbow and ulnar nerve guides, word for word. This is general information, not a diagnosis. A&E means accident and emergency; in the US, call 911 for 999, and use your doctor's urgent line or urgent care for NHS 111.
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Some discomfort during forearm exercises is fine. Keep it mild: no more than about 3 to 4 out of 10. It should settle within an hour or so, and your elbow should be no worse the next morning.
Tingling is the exception: stop any exercise or position that brings on pins and needles or numbness in your hand, especially in the ring and little fingers, and avoid holding the elbow fully bent while it settles.
Call 999 if:
Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.
You feel any pain or become unwell, as the NHS advises for its Pilates videos, and especially for chest pain or pressure, unusual breathlessness, dizziness or fainting. If you have a health problem, an injury or any symptoms, get advice from a healthcare professional, such as a GP, before you start.
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The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.
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Every UK and US leaflet we read keeps the arm working within comfort, with stretches, still holds and slow lowering, and NHS inform says "Most symptoms do settle with time." This is health-service advice rather than a trial result.
Most cases arise in people who grip hard and often at work or home, and in amateur golfers, outer elbow pain is the commoner elbow problem.
No Pilates trial exists for golfer's elbow, and a typical class doesn't load the wrist flexors at all. That is why our class adds a forearm block.
Less pain at 6 weeks, no difference at 3 months or a year, and US surgeons say it may lengthen rehabilitation.
In golfers with golfer's elbow, a forearm brace or oversized grips didn't change how hard the wrist flexors worked, and evidence for straps is very limited.
Flat-hand planks and push-ups put weight through the forearm with the wrist bent back: about 45% of body weight went along the forearm in an ordinary push-up. A neutral wrist, on fists or handles, lowered elbow load.
It's the ulnar nerve, irritated in about 1 in 5 people with golfer's elbow, and it changes what to avoid: see the warning signs.
It isn't a treatment for it: no Pilates trial exists. You can keep doing Pilates with a light grip and your weight off flat, bent-back hands, alongside the wrist flexor exercises that are prescribed for it.
Yes, with changes: do hands-down moves on your forearms or fists, don't grip hard, and keep forearm discomfort to about 3 to 4 out of 10, settling within an hour or so and no worse the next morning. Stop anything that brings on tingling in your ring and little fingers.
While it's sore: the knee hover, plank, leg pulls, push-up and side bend on flat hands, holding your ankles in rocking, the open-leg rocker and the seal, hand clasps, hard ring squeezes, and gripped straps or the footbar on the reformer. Bring them back in steps once gripping and pressing are comfortable.
Exercises for the muscles that bend the wrist: still holds, then slow lowering with a light weight, forearm turns and a gentle stretch, for 6 to 12 weeks. A flexible-bar version helped 20 people in a small study without a comparison group. Our class starts with this block.
Footwork, leg springs, bridging and side-lying work are fine. Moves that grip straps, handles or the footbar, such as rowing, arm springs and the elephant, load the forearm: use the lightest spring, put the loops round your forearms where possible, or leave them out for now.
No study links them. Repeated hard gripping and weight on bent-back hands load the inner elbow, though, so lots of planks, push-ups and gripped straps could aggravate a sore one (our reading).
Flat-hand planks put weight through the forearm with the wrist bent back, stretching the sore tendon under load. In push-up studies, hands placed further forward or turned out raised the load on the inner elbow. Use your forearms or fists, with your hands under your shoulders.
Tingling or numbness in the ring and little fingers points to the ulnar nerve, which is irritated in about 1 in 5 people with golfer's elbow. Stop positions that bring it on, and see the warning signs for when to get it checked.
Months rather than weeks: in workers, 81% had recovered at 3 years, and most people improve with conservative care. Keep the forearm loading going for 6 to 12 weeks.
It may ease pain during a move that hurts, but there's little evidence it helps beyond that, and in golfers a brace didn't change how hard the forearm muscles worked.
Lighten heavy gripping and wrist curling for now and build back gradually. Our golfer's elbow guide has the staged plan, including when heavier curls, carries and hangs return.
Call 999 for arm pain with pressure or tightness across your chest, and go to A&E if your elbow looks out of shape after a fall. Get same-day help for a hot, swollen elbow with a high temperature. See a GP or physiotherapist if it hasn't gone after a few weeks, or for constant numbness in the ring and little fingers.
Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.
