Distal Biceps Tendonitis and Golfer's Elbow: Prevention, Warm-Ups, and Rehab

Golfer’s elbow from lifting is a tendon irritation at the inside of the elbow, and in most gym cases you do not need to stop training to improve it. The usual plan is to calm the aggravating lifts, then load the wrist flexors progressively and slowly. The research supports that idea, but it is thinner than most people assume.

If your pain comes from curls and chin-ups, you are in the right place. This is a supporting guide to our complete arm and forearm training guide, focused on the inner elbow. I will also cover the distal biceps tendon at the front of the elbow, because the two get mixed up all the time.

One honest note up front. This is education, not a diagnosis. Elbow pain has several causes, and a physio or sports doctor can examine you in ways an article cannot.

Is it golfer’s elbow or distal biceps tendonitis?

Two different structures, two different spots.

Golfer’s elbow (medial epicondylitis) sits on the bony bump on the inside of the elbow, where the wrist flexors and forearm pronators attach. A 2026 review describes it as a tendinopathy of the flexor-pronator origin that is less studied than tennis elbow (See et al., 2026).

Distal biceps tendon pain is felt deeper, at the front of the elbow crease, and tends to flare with heavy supinated curls, chin-ups or turning a palm up against load.

What the research says about golfer’s elbow rehab

Here is the uncomfortable part. Nearly all the tendon research is on the outside of the elbow.

A 2013 systematic review looked for exercise and mobilisation trials in both medial and lateral epicondylitis. It found one review and 12 RCTs, and all of them studied lateral epicondylitis. The authors still concluded the results support the belief that strength training reduces symptoms in tendinosis, though not conclusively (Hoogvliet et al., 2013).

The medial-specific picture arrived later. A 2026 systematic review of eccentric exercise for medial epicondylitis included only five studies (143 patients). Eccentric exercise was linked with within-group reductions in pain and better function, but between-group superiority appeared in just one RCT. The authors rate the certainty as low and call for larger trials (See et al., 2026).

So the fair summary: loading probably helps, but nobody can promise you a specific protocol will work.

The Tyler Twist: what it is and what it showed

The Tyler Twist is the FlexBar exercise most people mean when they search for golfer’s elbow rehab. The good hand twists a rubber bar by flexing its wrist. The sore wrist then lets the bar untwist slowly, so the flexors work eccentrically (lengthening under load).

The 2014 study behind it enrolled 20 patients (average age 49) with chronic medial epicondylosis who had already failed treatment such as physical therapy, cortisone, PRP or NSAIDs. They added the bar exercise (3 x 15, twice daily) to standard care. Worth knowing for lifters: 14 of the 20 were golfers and only one named weightlifting as the trigger. DASH disability scores fell from 34.7 to 7.9, and treatment lasted about 6 weeks on average (Tyler et al., 2014).

Impressive on paper. But it was a single-group case series, with no control group, and patients also received stretching, ultrasound, massage, heat and ice. Natural recovery, the other treatments and expectation could all play a part. I would use it as a low-cost, low-risk option, not as proof the bar is the cure.

How I would set it up

• Start easy. Use the lightest bar or a light dumbbell. A pain of about 3/10 that settles within a day is a common practical ceiling.
• Go slow on the lowering. A 3-4 second lowering phase is a coaching choice, not a tested number.
• Be consistent. The 2014 patients did sets twice daily, but a meta-analysis of tendinopathy dosing found greater effects with lower frequencies (less than daily) than with daily or more, so more is not automatically better (Pavlova et al., 2023). Many lifters do well with a few sessions a week, which also fits around training.
• Progress the load. In that same 110-study analysis, higher-intensity programs with added external resistance did better than bodyweight-only ones, across tendinopathy sites including the lateral elbow. Once the light version is calm, add weight gradually.

Swap grips, keep training: gym changes that actually help

You do not need a perfect rehab plan to make a difference. Often the biggest early win is reducing what irritates the tendon while the loading work does its job.

Practical swaps that many lifters find helpful:

• Straight bar curls to EZ-bar or neutral grip. A neutral grip often gives the inner elbow an easier time. We cover the wrist angle trade-offs in barbell vs EZ-bar curls.
• Hammer curls instead of supinated curls. A neutral hand position can feel kinder on the forearm attachments.
• Wide pronated lat pulldown and pulls with straps. Straps let you pull without a hard crush grip, which reduces flexor demand. Drop or reduce chin-ups if they spike the pain, and use a pulling day structured around your elbow.
• Shorter range on stretched curls. Preacher-style work can stress the front of the elbow, so cut the bottom few degrees if the crease complains.
• Trade grip-heavy sets for lighter ones. Hold volume steady while the elbow settles, then rebuild.

Direct forearm work matters too, but the order matters. Reintroduce wrist work with the slow loading above before you chase size, and see wrist curls and forearm hypertrophy once the elbow is calm.

A four-stage ladder back to normal lifting

This is an illustrative structure, not a trial-tested protocol. Move up only when the current stage feels calm the next morning.

1. Calm. Remove the one or two lifts that clearly flare it. Keep training everything else.
2. Load. Start slow wrist flexor and pronator work at light weight, every other day or three times a week.
3. Rebuild. Raise the weight slowly, then bring back curls and pulls with neutral grips.
4. Return. Bring straight-bar and supinated work back at reduced loads. Add volume over weeks.

A review of progressive tendon exercise found pain was the most common criterion for adjusting loads, though it could not say which progression rule is best, and the certainty was low (Ortega-Castillo et al., 2022). That matches how I would coach it: pain-guided, patient, boring.

If your pain is on the outside of the elbow instead, or you want the heavy slow resistance approach for both sides, our guide to golfer’s and tennis elbow in lifters covers that ground.

This also fits the logic in our guide to good pain versus bad pain and the broader piece on tendon vs muscle adaptation.

Warm-ups and prevention for the inner elbow

I do not have trial evidence that a specific warm-up prevents golfer’s elbow. What I can offer is sensible coaching logic.

• Do a short ramp. A few light sets before heavy curls and pulls is a normal practice. Our 7-minute dynamic warm-up is a good base.
• Add forearm work to the ramp. One or two gentle sets of wrist flexion and extension raise blood flow to the area before gripping hard.
• Change volume gradually. The classic trigger is a sudden jump in curls, chin-ups or rows, often paired with a heavier grip. Add sets slowly.
• Mix your grips. Rotating between EZ-bar, dumbbell and neutral-grip variations spreads the stress.
• Do not forget sleep and general recovery. Tired lifters grip harder and rep sloppier.

Do cortisone shots and other options work?

Injections are a common question. The Lancet review of injection trials found corticosteroid injections reduced tennis elbow pain in the short term, with a large effect against no intervention. But the effect reversed at intermediate and long-term follow-up, where no intervention did better (Coombes et al., 2010). That evidence is again from the lateral elbow.

I would not tell anyone what to do here. If you are considering an injection, ask your doctor about the trade-off and pair any decision with a loading plan.

When to see a doctor

Book an appointment if:

• you felt a pop or tearing sensation, or you see new bruising in the elbow crease
• the biceps looks different in shape or you cannot curl or turn your forearm normally
• you notice numbness or tingling in the ring and little fingers
• the pain wakes you at night or keeps worsening
• you see no improvement after several weeks of sensible changes

The bottom line

Golfer’s elbow from lifting is usually a loading problem you can manage: calm the aggravating lifts, then rebuild tolerance with slow, progressive wrist flexor work. The medial-specific evidence is low in certainty, the Tyler Twist rests on a 20-person case series, and heavier loading with sensible frequency has the strongest general tendon support.

Keep the arm work you can do, change the grips that hurt, and be patient. If it is not improving, get it examined rather than guessing. To keep the rest of your week on track, use the free training plans and set your daily protein with the protein calculator.