Elbow pain can make everyday activities such as lifting objects, gripping, typing, playing sports, or carrying shopping uncomfortable. Two common causes of elbow pain are tennis elbow and golfer’s elbow.
Although both conditions affect the tendons around the elbow, they typically cause pain in different areas and may be aggravated by different movements. Understanding the differences between tennis elbow and golfer’s elbow can help you recognise your symptoms and understand which treatment options may be appropriate.
Whether your elbow pain started after playing sport, spending time in the gym, performing repetitive tasks at work, or carrying out everyday activities, physiotherapy can help you manage your symptoms and work towards restoring strength and function.
In this article, we’ll explore tennis elbow and golfer’s elbow, their common symptoms, key differences, potential causes, physiotherapy treatment options, and when you should consider seeing a physiotherapist.
Key Takeaways
- Tennis elbow typically causes pain on the outside of the elbow, while golfer’s elbow usually causes pain on the inside.
- Both conditions involve the tendons that help control wrist and forearm movement.
- You don’t have to play tennis or golf to develop either condition.
- Repetitive gripping, lifting, wrist movements, and sudden increases in activity can contribute to elbow pain.
- Physiotherapy can help improve tendon capacity, grip strength, and the ability to perform everyday activities.
- Exercise-based rehabilitation is often an important part of recovery.
- Complete rest isn’t always necessary, but activities that significantly aggravate your symptoms may need to be modified.
- Persistent, worsening, or severe elbow pain should be assessed by a healthcare professional.
What Is Tennis Elbow?
Tennis elbow, medically known as lateral elbow tendinopathy, is a condition that causes pain around the outside of the elbow.
It commonly involves the tendons that attach the forearm muscles responsible for extending the wrist and fingers.
These muscles help you perform activities such as gripping objects, lifting items, using tools, and controlling your wrist during exercise.
Tennis elbow can develop when the demands placed on these tendons exceed their current capacity to tolerate the load.
This may happen gradually through repetitive activity or following a sudden increase in workload.
Despite its name, tennis elbow isn’t limited to tennis players. It can affect people from a wide range of backgrounds, including those who work at a desk, perform manual labour, lift weights, or carry out repetitive tasks at home.
Common Symptoms of Tennis Elbow
Symptoms can vary between individuals, but common signs include:
- Pain on the outside of the elbow
- Tenderness around the bony prominence on the outer elbow
- Pain when gripping objects
- Discomfort when lifting a kettle, bag, or other household item
- Pain when extending the wrist against resistance
- Reduced grip strength
- Discomfort when using tools or performing repetitive tasks
- Pain during certain gym exercises
- Symptoms that worsen with repeated wrist or forearm movements
Some people initially notice only mild discomfort during specific activities. However, symptoms can become more persistent if the elbow continues to be exposed to loads it struggles to tolerate.
What Is Golfer’s Elbow?
Golfer’s elbow, medically known as medial elbow tendinopathy, causes pain around the inside of the elbow.
It typically involves the tendons associated with the forearm muscles responsible for bending the wrist and helping turn the forearm.
These muscles contribute to gripping, lifting, pulling, and controlling the wrist during everyday activities.
Like tennis elbow, golfer’s elbow can develop when repetitive or excessive loading places more demand on the tendons than they can currently manage.
Although golfer’s elbow is often associated with golf, it can affect people who participate in many different sports and activities.
Weight training, throwing sports, racket sports, manual work, and repetitive gripping can all place demands on the muscles and tendons around the inside of the elbow.
Common Symptoms of Golfer’s Elbow
Symptoms may include:
- Pain on the inside of the elbow
- Tenderness around the bony prominence on the inner elbow
- Discomfort when gripping objects
- Pain when bending the wrist against resistance
- Pain when turning the palm downwards against resistance
- Reduced grip strength
- Discomfort when lifting or carrying objects
- Pain during pulling exercises or weight training
- Symptoms aggravated by repetitive wrist and forearm movements
In some cases, golfer’s elbow can also be associated with irritation of the ulnar nerve, which passes behind the inner elbow. If you experience tingling or numbness in your ring finger or little finger, it’s important to have your symptoms assessed rather than assuming they are caused by tendon pain alone.
Tennis Elbow vs Golfer’s Elbow: What Is the Difference?
The main difference between tennis elbow and golfer’s elbow is the location of the pain and the tendons involved.
Both conditions can affect grip strength and make everyday activities uncomfortable, but they typically involve different groups of forearm muscles.
Tennis Elbow
Tennis elbow affects the outside of the elbow.
The tendons involved are generally associated with wrist and finger extension.
Activities that may aggravate symptoms include:
- Lifting objects with the palm facing downwards
- Repetitive gripping
- Extending the wrist against resistance
- Using tools or carrying shopping
- Certain racket sports
- Repetitive manual tasks
Golfer’s Elbow
Golfer’s elbow affects the inside of the elbow.
The tendons involved are generally associated with wrist flexion and forearm rotation.
Activities that may aggravate symptoms include:
- Bending the wrist against resistance
- Repetitive gripping
- Pulling exercises at the gym
- Certain throwing or racket sports
- Lifting objects repeatedly
- Repetitive manual work
Quick Comparison
| Feature | Tennis Elbow | Golfer’s Elbow |
| Pain location | Outside of the elbow | Inside of the elbow |
| Medical term | Lateral elbow tendinopathy | Medial elbow tendinopathy |
| Tendons commonly involved | Wrist and finger extensor tendons | Wrist flexor and forearm pronator tendons |
| Common aggravating movements | Wrist extension and gripping | Wrist flexion, forearm rotation, and gripping |
| Can affect non-athletes? | Yes | Yes |
| Physiotherapy approach | Individualised loading and strengthening | Individualised loading and strengthening |
Although these differences can help you understand your symptoms, they don’t confirm a diagnosis. Other conditions can cause pain around the elbow, so an assessment may be useful if your symptoms persist.
What Causes Tennis Elbow and Golfer’s Elbow?
There isn’t always one single cause of elbow tendinopathy.
Both conditions can develop when the muscles and tendons around the elbow are exposed to repetitive loading, sudden increases in activity, or demands that exceed their current capacity.
Common contributing factors may include:
- Repetitive gripping and lifting
- Sudden increases in exercise intensity or training volume
- Weight training involving the wrist and forearm
- Repetitive manual work
- Prolonged use of hand tools
- Racket sports or throwing activities
- Returning to exercise after a period of inactivity
- Changes in work duties or daily activity levels
- Previous elbow or forearm problems
For example, someone may develop tennis elbow after increasing their weight training volume or spending several days carrying out repetitive DIY tasks.
Similarly, golfer’s elbow may develop after an increase in golf practice, pulling exercises, or repetitive gripping at work.
However, elbow pain can also develop without an obvious change in activity.
The relationship between activity, tendon capacity, recovery, and symptoms can be complex. An individual assessment can help identify which factors may be contributing to your particular problem.
How Is Tennis Elbow or Golfer’s Elbow Diagnosed?
A physiotherapist will usually begin by taking a detailed history of your symptoms.
This may include asking about:
- When your elbow pain started
- Whether symptoms developed gradually or followed an injury
- The precise location of your pain
- Which movements aggravate your symptoms
- Your work and daily activities
- Your sporting or gym routine
- Previous elbow, wrist, or shoulder problems
- Whether you have noticed weakness, tingling, or numbness
Your physiotherapist may then assess your elbow, wrist, and forearm movement, grip strength, and response to specific resisted movements.
They may also assess how your symptoms respond to activities that are important to you, such as lifting, gripping, or performing sport-specific movements.
The aim is to understand the overall pattern of your symptoms rather than relying on one individual test.
Tennis elbow and golfer’s elbow can often be identified through a clinical assessment. Imaging, such as an ultrasound scan or MRI, isn’t routinely required in every case but may be appropriate when the diagnosis is unclear, symptoms are unusual, or further investigation is needed.
Physiotherapy Treatment for Tennis Elbow
Physiotherapy treatment for tennis elbow depends on your symptoms, physical assessment, daily activities, and goals.
There isn’t one exercise or treatment that is suitable for everyone.
Your physiotherapist may recommend a combination of:
- Exercise-based rehabilitation
- Progressive wrist and forearm strengthening
- Grip-strengthening exercises
- Activity modification
- Load management
- Education and self-management advice
- Manual therapy where appropriate
- Temporary changes to work or sporting activities
- Gradual return to exercise and sport
The main aim is to help the affected tendons tolerate the demands placed on them while improving strength and function.
Exercise Therapy for Tennis Elbow
Exercise is often an important part of rehabilitation for tennis elbow.
A physiotherapist may prescribe exercises designed to improve wrist extensor strength, grip strength, forearm control, and overall tolerance to loading.
The programme can begin with relatively light resistance before progressing as your symptoms and strength improve.
Wrist Extension Exercises
Wrist extension exercises target the muscles commonly involved in tennis elbow.
These may involve holding a light weight and slowly raising and lowering the wrist in a controlled manner.
The resistance, movement range, and number of repetitions can be adjusted to suit your current ability.
Isometric Wrist Exercises
Isometric exercises involve contracting a muscle without significant movement at the joint.
For tennis elbow, this may involve gently pushing the wrist against resistance while keeping it still.
These exercises can be useful for some people when moving the wrist against resistance is uncomfortable, although the response varies between individuals.
Grip Strengthening
Grip-strengthening exercises can help improve your ability to hold and carry objects.
Depending on your symptoms, these may involve squeezing a soft ball or using other forms of controlled resistance.
The level of resistance should be appropriate for your current capacity rather than causing a significant increase in pain.
Progressive Forearm Strengthening
As your symptoms improve, your physiotherapist may gradually increase the resistance, repetitions, and functional demands of your exercises.
The aim is to build the capacity needed for your normal activities, whether that involves working with tools, lifting weights, or playing sport.
Physiotherapy Treatment for Golfer’s Elbow
Physiotherapy treatment for golfer’s elbow follows similar principles to tennis elbow, but the exercises and loading strategies are selected to reflect the tendons and movements involved.
Treatment may include:
- Progressive wrist flexor strengthening
- Forearm pronation exercises
- Grip-strengthening exercises
- Activity modification
- Load management
- Movement and technique advice
- Manual therapy where appropriate
- Gradual return to sport or exercise
The objective is to improve the ability of the affected tendons and surrounding muscles to tolerate the demands of everyday life.
Exercise Therapy for Golfer’s Elbow
Exercise rehabilitation is often an important component of managing golfer’s elbow.
Your physiotherapist can select exercises according to your symptoms, current strength, and functional goals.
Wrist Flexion Exercises
Wrist flexion exercises target the muscles involved in bending the wrist.
These may involve holding a light weight and slowly bending and lowering the wrist through a comfortable range of movement.
Resistance can be increased gradually as your tolerance improves.
Forearm Rotation Exercises
The forearm muscles also help rotate the palm upwards and downwards.
Controlled forearm rotation exercises may therefore form part of a rehabilitation programme, depending on your assessment and symptoms.
These exercises can initially be performed with little or no resistance before progressing when appropriate.
Grip Strengthening
Grip exercises may help improve the ability to hold, carry, and control objects.
As with tennis elbow, the starting resistance should reflect your current capacity.
If gripping causes significant discomfort, your physiotherapist may initially recommend reducing the resistance or modifying the exercise.
Progressive Strength Training
As your symptoms improve, strengthening can gradually become more challenging.
Your physiotherapist may progress your programme towards heavier resistance, functional lifting, pulling exercises, or sport-specific movements.
The aim is to help you return to the activities you enjoy without unnecessarily overloading the affected tendons during recovery.
Should You Stop Exercising If You Have Tennis Elbow or Golfer’s Elbow?
Not necessarily.
Complete rest may not always be the best approach to managing persistent tendon pain.
In many cases, it is possible to remain active while temporarily modifying activities that significantly aggravate your symptoms.
For example, you may need to:
- Reduce the weight used during gym exercises
- Perform fewer repetitions
- Temporarily reduce repetitive gripping
- Modify pulling or lifting movements
- Change your technique when appropriate
- Take additional recovery time between demanding activities
- Temporarily reduce the duration of racket sports or golf sessions
- Gradually rebuild your previous training volume
The appropriate level of activity will depend on your symptoms and how your elbow responds to loading.
Some discomfort may occur during rehabilitation, but exercises should not produce a substantial or sustained worsening of your symptoms.
Your physiotherapist can help you find an appropriate balance between maintaining activity and allowing your elbow to recover.
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How Long Does Tennis Elbow or Golfer’s Elbow Take to Improve?
Recovery time varies considerably between individuals.
Some people experience improvement over several weeks, while more persistent tendon problems may take several months to settle.
Factors that can influence recovery include:
- How long you’ve had symptoms
- The severity and irritability of your pain
- Your current strength and functional ability
- The physical demands of your job
- Your sporting and exercise activities
- How frequently the elbow is exposed to aggravating loads
- Previous elbow problems
- How your symptoms respond to rehabilitation
- Your ability to modify activities during recovery
It’s important to recognise that tendon recovery doesn’t always follow a straight line. Symptoms may fluctuate as activity levels change.
Rather than focusing only on a specific recovery timeframe, it can be more useful to monitor improvements in pain, grip strength, lifting ability, and your capacity to return to normal activities.
If symptoms aren’t improving or continue to worsen, a further assessment may be appropriate.
Managing Elbow Pain at Home
There are several steps you can take to help manage tennis elbow or golfer’s elbow symptoms.
Modify Aggravating Activities
If a particular activity consistently increases your elbow pain, consider whether you can temporarily reduce its intensity, duration, or frequency.
For example, you might reduce the weight used during a gym session or break up repetitive tasks into shorter periods.
The aim isn’t necessarily to avoid every movement that causes discomfort, but to manage the overall demands placed on your elbow.
Keep Moving Where Comfortable
Avoiding all movement can make it harder to maintain strength and confidence using the affected arm.
Where appropriate, continue with comfortable daily activities while modifying movements that significantly aggravate your symptoms.
Gradually Rebuild Strength
Once your symptoms allow, gradually reintroducing strengthening exercises can help improve the capacity of the muscles and tendons around the elbow.
Starting with an appropriate level of resistance and progressing gradually can help you avoid making too much of a sudden change to your activity levels.
Review Your Work or Exercise Routine
Consider whether your symptoms may be related to repetitive gripping, prolonged tool use, lifting, or recent changes in your training routine.
Small adjustments to workload, technique, exercise selection, and recovery time may help reduce unnecessary aggravation.
Don’t Ignore Persistent Symptoms
If your elbow pain continues despite modifying your activities, or if your symptoms are getting worse, it may be worth seeking professional advice.
An assessment can help clarify the likely cause of your pain and identify an appropriate management plan.
Warning Signs You Shouldn’t Ignore
Most cases of tennis elbow and golfer’s elbow can be managed without emergency treatment. However, not all elbow pain is caused by tendon problems.
You should seek prompt medical assessment if you experience:
- Severe or rapidly worsening elbow pain
- Significant swelling, redness, or warmth around the joint
- Fever or feeling generally unwell alongside elbow pain
- A sudden loss of movement or inability to use the arm
- A visible deformity following an injury
- Significant pain following a fall or direct impact
- New or progressive numbness or weakness in the arm or hand
If your elbow pain is associated with persistent tingling in the ring or little finger, this may indicate irritation of the ulnar nerve and should be assessed.
If you are unsure about your symptoms, seek appropriate medical advice rather than assuming they are caused by tennis elbow or golfer’s elbow.
When Should You See a Physiotherapist?
You don’t have to wait until your elbow pain becomes severe before seeking physiotherapy.
An assessment may be useful if you are:
- Experiencing persistent elbow pain
- Struggling to grip or lift objects
- Finding everyday activities increasingly difficult
- Unable to complete your usual gym exercises
- Experiencing pain during tennis, golf, or other sports
- Noticing reduced grip strength
- Having difficulty performing your normal work duties
- Experiencing recurring elbow problems
- Unsure which exercises are appropriate
- Finding that your symptoms aren’t improving
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