Elbow pain can significantly impact daily activities, from typing on a computer to lifting groceries. Two common conditions causing elbow discomfort are golfer’s elbow and tennis elbow. Despite their sport-specific names, these conditions affect people from all walks of life, not just athletes. This article examines the differences between these conditions, their causes, symptoms, and treatment options.
What Are Tennis Elbow and Golfer’s Elbow?
Both conditions are forms of tendinopathy—disorders affecting the tendons that connect muscles to bones. They share similarities but differ in key aspects.
Tennis Elbow (Lateral Epicondylitis): This condition affects the outside (lateral) part of the elbow, where tendons that extend the wrist attach to the bone. The condition develops when these tendons experience small tears from overuse or repetitive strain.
Golfer’s Elbow (Medial Epicondylitis): This condition affects the inside (medial) part of the elbow, where tendons that flex the wrist attach to the bone. Like tennis elbow, it involves small tears in the tendon from overuse.
Location and Anatomy
The primary difference between these conditions lies in their location and the specific tendons affected.
Tennis Elbow: Pain occurs on the outside bump of the elbow (lateral epicondyle). The affected tendon is primarily the extensor carpi radialis brevis, which helps extend and stabilise the wrist when gripping objects.
Golfer’s Elbow: Pain occurs on the inside bump of the elbow (medial epicondyle). The affected area is the common flexor tendon, which connects the muscles that allow you to grasp and rotate your forearm.
Causes and Risk Factors
Despite their names, both conditions can affect anyone who performs repetitive arm movements, not just golfers or tennis players.
Tennis Elbow Causes: Repetitive extension of the wrist against resistance, such as hitting backhand shots in tennis, using screwdrivers, painting, cutting meat, or extensive computer mouse use.
Golfer’s Elbow Causes: Repetitive flexion of the wrist and pronation of the forearm, such as swinging a golf club, throwing sports, climbing, lifting weights with improper form, or using certain tools.
Shared Risk Factors: Age (both conditions are most common between ages 30-50), poor technique in sports or work activities, inadequate equipment, and certain occupations requiring repetitive arm movements. Physiological factors such as muscle imbalances or weakness in the forearm can also predispose individuals to these conditions. Additionally, sudden increases in activity level without proper conditioning can overwhelm the tendons’ capacity to adapt, making weekend warriors particularly susceptible.
Recognising the Symptoms
Although both conditions cause elbow pain, there are distinct differences in how they present.
Tennis Elbow Symptoms: Pain and tenderness on the outside of the elbow, which may radiate down the forearm. Pain worsens when extending the wrist against resistance, lifting objects with the palm facing down, or performing actions like turning doorknobs, shaking hands, or holding a cup.
Golfer’s Elbow Symptoms: Pain and tenderness on the inside of the elbow, which may extend along the inner side of the forearm. Pain increases when flexing the wrist against resistance, gripping objects tightly, or lifting with the palm facing upward.
Shared Symptoms: Weakened grip strength, stiffness in the elbow, and pain that worsens with specific movements or activities.
Diagnostic Assessment
Physical Examination: The doctor will examine the painful area and may apply pressure or ask you to move your wrist, elbow, and fingers in various ways to pinpoint the source of pain.
Medical History: Information about your occupation, hobbies, and when symptoms began helps determine the likely cause. The pattern of pain development—whether gradual or sudden—along with activity correlation provides valuable diagnostic clues. A detailed account of previous injuries or conditions affecting the arm can also influence the assessment and treatment approach.
Imaging Tests: While rarely necessary, X-rays may rule out other conditions like arthritis or bone spurs, while ultrasound offers real-time visualisation of the tendons and can identify inflammation or tears. MRI may be used to assess tendon damage in severe or persistent cases, providing detailed images of soft tissue that can reveal the extent of degeneration and help guide treatment decisions.
Treatment Approaches
Rest and Activity Modification: Avoiding activities that worsen pain allows the tendons to heal. This does not mean complete immobilisation but rather modifying activities to reduce strain. For tennis elbow, this may involve changing your grip when lifting objects, using your other arm for certain tasks, or taking breaks during repetitive activities. For golfer’s elbow, consider adjusting your technique or temporarily reducing activities that require gripping or twisting movements.
Ice and Heat Therapy: Applying ice to reduce inflammation, particularly after activity, or heat to improve blood flow and assist healing. Cold therapy works best for acute pain and swelling—apply ice wrapped in a thin cloth for 15-20 minutes several times daily. Heat therapy, through warm towels or heat packs, helps relax tight muscles and increase circulation, making it beneficial before stretching exercises or when pain has become more chronic.
Pain Management: Over-the-counter anti-inflammatory medications like ibuprofen may help manage pain and reduce inflammation. These medications can provide temporary relief while the healing process takes place. However, they should be used according to proper directions and not relied upon as the sole treatment approach for long-term management.
Physical Therapy: Specific stretching and strengthening exercises tailored to the affected tendons. Tennis elbow exercises focus on wrist extensors, while golfer’s elbow exercises target wrist flexors. The wrist extensor exercises for tennis elbow typically include gentle stretching of the forearm with the palm facing down, whereas wrist flexor exercises for golfer’s elbow involve stretching with the palm facing up. These exercises progressively build strength and flexibility to aid recovery.
Braces and Supports: Tennis elbow braces apply pressure on the forearm muscles to reduce tension at the lateral epicondyle, while golfer’s elbow braces provide similar relief for the medial side. These counterforce braces are designed to absorb some of the forces that would otherwise be transmitted to the injured tendon. They are particularly helpful during activities that may aggravate symptoms, allowing for continued participation in daily activities or a gentle return to sports while healing continues.
Advanced Treatments: For persistent cases, treatments may include corticosteroid injections to reduce inflammation, platelet-rich plasma therapy which uses components from your own blood to promote healing, or extracorporeal shockwave therapy that uses sound waves to stimulate blood flow and healing. Surgery is rarely needed but may be considered for cases that do not respond to conservative treatment after 6-12 months. Surgical options include both open surgery and less invasive techniques to remove damaged tissue and reattach healthy tendon to bone.
Prevention Strategies
Proper Technique: Whether playing sports or performing work activities, using correct form reduces stress on tendons. For golfers, this means maintaining a relaxed grip and allowing the larger muscles of the shoulders and torso to drive the swing rather than the arms and wrists. For tennis players, proper backhand technique with engagement of the shoulder and core muscles helps distribute forces away from the elbow. In work settings, positioning tasks directly in front of you rather than off to the side can reduce elbow strain.
Equipment Considerations: Using properly fitted equipment with appropriate grip size can reduce strain. For racquet sports, a looser string tension and larger grip size may help prevent tennis elbow. The weight and balance of tools matter; lighter tools with ergonomic grips can reduce strain during repetitive tasks. Anti-vibration dampeners on racquets or power tools can also decrease the transmission of forces to the tendons.
Strength and Flexibility: Regular forearm stretching and strengthening exercises build resilience in the tendons. Gentle wrist curls with light weights, grip strengthening with soft balls, and forearm stretches performed daily can maintain muscle balance and improve tendon health. Starting with 5-10 repetitions and gradually increasing to 15-20 as strength improves allows for steady progress without overloading healing tissues. These exercises should feel challenging but not painful.
Gradual Progression: Incrementally increasing activity intensity or duration allows tendons to adapt to increased demands. When returning to sports or activities, begin at 25% of your normal intensity and add no more than 10-15% per week. For example, golfers may start with putting practice before progressing to short irons, then gradually working up to full swings with drivers. Tennis players could begin with gentle rallies before attempting more demanding strokes like serves and overheads.
Ergonomics: Proper workspace setup and tool design can reduce strain during repetitive tasks. Maintain neutral wrist positions when using the keyboard and mouse, with forearms parallel to the floor. Consider ergonomic tools with larger, padded handles that reduce grip force requirements. For sports equipment, appropriate grip size matters—a grip that is too small or too large forces the forearm muscles to work harder. Taking 2-3 minute breaks every 30 minutes during repetitive activities also gives tendons time to recover.
When to Seek Medical Advice
While many cases improve with self-care, consult a specialist if your pain persists despite two weeks of home treatment, appears suddenly or severely, or if your elbow looks deformed. Similarly, inability to bend or straighten your elbow, or signs like fever, redness, and warmth around the joint indicate a need for prompt assessment, as these could suggest more serious underlying conditions requiring specific treatment.
Conclusion
While tennis elbow and golfer’s elbow share similarities as overuse injuries affecting the elbow tendons, they differ in location, affected muscles, and specific movements that trigger pain. Recognising these differences aids in diagnosis and treatment. Most people recover fully with appropriate care and preventive measures, returning to their regular activities without limitations.
If you’re experiencing persistent elbow pain that interferes with daily activities, schedule a consultation today to receive a proper diagnosis and personalised treatment plan.