Tennis and golfer's elbow: causes and treatment
Tennis elbow and golfer's elbow are common elbow tendinopathies caused by irritated tendon attachments around the elbow. Tennis elbow affects the outside of the elbow, usually with gripping and wrist extension. Golfer's elbow affects the inside, often with gripping, wrist flexion or forearm rotation. The fix is usually not total rest or one injection, but reducing the irritating load, rebuilding tendon capacity and checking for nerve, neck or joint problems when the pattern does not fit.12
Key facts
- NHS guidance describes tennis elbow as pain around the outside of the elbow, often worse with gripping, lifting or twisting movements.1
- Golfer's elbow, or medial epicondylitis, causes pain on the inside of the elbow and forearm, often linked with repeated wrist flexion, gripping, throwing or forearm rotation.26
- Neither condition requires tennis or golf. Lifting, DIY, typing setup, childcare, climbing, racquet sports, cooking, manual work and sudden gym changes can all be enough.
- The 2022 lateral elbow pain guideline supports education, pain-free grip testing, resisted wrist extension testing, exercise and mobilisation-with-movement approaches for lateral elbow tendinopathy.3
- Corticosteroid injections may help short term but can have worse intermediate or long-term outcomes in tennis elbow, so they should not be treated as a simple cure.45
Tennis vs golfer's elbow
Tennis elbow is lateral elbow tendinopathy. The painful area is around the outside bony point of the elbow, where the wrist and finger extensor tendons attach. It often hurts when gripping a kettle, shaking hands, lifting a bag, using a screwdriver, typing with a tense wrist, or doing pull-ups, rows or racquet sports.
Golfer's elbow is medial elbow tendinopathy. The painful area is around the inside bony point of the elbow, where the wrist flexor and pronator tendons attach. It often hurts with gripping, wrist curls, throwing, climbing, pull-ups, golf, racket sports, carrying heavy bags or rotating the forearm under load. StatPearls describes the mechanism as chronic repetitive loading of the flexor-pronator musculotendinous unit during wrist and finger flexion, forearm pronation and valgus stress.6
| Feature | Tennis elbow | Golfer's elbow |
|---|---|---|
| Pain location | Outside of elbow | Inside of elbow |
| Provoked by | Gripping, lifting, resisted wrist extension | Gripping, resisted wrist flexion or pronation |
| Common work triggers | Mouse use, tools, lifting, repetitive gripping | Tools, carrying, climbing, throwing, forceful gripping |
| Nerve symptoms | May mimic radial tunnel or neck referral | Can overlap with ulnar nerve symptoms to ring and little fingers |
When it is not simple tendinopathy
The diagnosis should be questioned if symptoms are mainly numbness, tingling, hand weakness, neck pain, widespread arm pain, elbow locking, swelling, deformity, fever, unexplained weight loss, severe night pain, or pain after a fall or direct blow. Tennis elbow can be mimicked by radial tunnel syndrome, neck nerve irritation, elbow arthritis or joint injury. Golfer's elbow can overlap with cubital tunnel syndrome, where the ulnar nerve causes numbness or tingling in the ring and little fingers.
Red flags are uncommon, but important. Seek prompt review if you cannot move the elbow after injury, the elbow is hot and swollen, there is spreading redness, fever, major weakness, new hand clumsiness, or symptoms are getting worse despite reducing load. If pain is linked with chest pain, breathlessness, sweating or jaw pain, treat that as a possible heart symptom rather than an elbow injury.
Why it happens
The old word "epicondylitis" implies inflammation, but many persistent cases behave more like tendinopathy: the tendon has become sensitive and less tolerant of load. This often happens after a spike in grip, volume, intensity, tool use, sport, lifting, gardening, climbing or desk tension. The tendon is not weak forever. It needs the right dose of loading to become less reactive and more capable.
Common triggers include a new gym programme, more pull-ups or rows, tennis or padel volume, golf practice, heavy DIY, repetitive screwdriver use, long mouse sessions with a tense wrist, carrying children, using a heavy pan, or suddenly increasing climbing or dead hangs. Grip width, tool handle size, wrist position and shoulder capacity can all change elbow load.
What helps
The first step is relative rest: reduce the most provocative load, but do not immobilise the arm indefinitely. Total rest can make the tendon less prepared for normal life. Instead, identify the worst trigger and temporarily lower the dose: fewer sets, lighter weight, neutral wrist, shorter tool sessions, breaks, two-handed lifting, or using straps or supports where appropriate.
NHS self-care advice for tennis elbow includes resting the injured arm, stopping the activity causing pain, using cold packs, taking painkillers such as paracetamol or ibuprofen if suitable, and seeing a GP if pain is not improving after a few weeks.1 MedlinePlus golfer's elbow advice similarly starts with avoiding the activity that causes symptoms, icing, pain relief where appropriate, and exercises or therapy to stretch and strengthen the forearm muscles.2
Rehab usually progresses from calming pain to rebuilding capacity. Early options may include isometric holds, gentle range, grip modification and taping or a counterforce strap for short-term symptom relief. Later work often includes progressive wrist extension or flexion loading, pronation and supination work, grip strengthening, shoulder and upper-back strength, and gradual return to the specific task or sport.
| Lever | Best use | Common mistake |
|---|---|---|
| Load reduction | Calming a flared tendon | Stopping everything for weeks, then returning at full dose |
| Counterforce strap or taping | Short-term help during work or sport | Using support instead of rebuilding capacity |
| Progressive strengthening | Restoring tendon tolerance and grip capacity | Chasing soreness every session |
| Technique and ergonomics | Reducing repeated wrist extension, flexion or gripping strain | Changing the desk but ignoring sport or tool load |
| Physiotherapy | Diagnosis check, progression, manual therapy, return-to-work or sport plan | Expecting passive treatment alone to fix load tolerance |
The 2022 JOSPT guideline for lateral elbow pain gives strong support for using patient-rated outcome measures and pain-free grip strength to track progress, and includes resisted wrist extension testing, education, mobilisation with movement and exercise interventions.3 This is the practical takeaway: measure function, not just tenderness, and progress load gradually.
Injections and procedures
Steroid injections are tempting because they can reduce pain quickly. The problem is durability. A BMJ Open systematic review comparing corticosteroid injections with non-electrotherapeutic physiotherapy found steroid injection tended to be favourable in the short term, but physiotherapy was favoured in the intermediate and long term for lateral epicondylitis.4 A review of corticosteroid injection literature for tennis elbow also describes the pattern of strong short-term improvement but concerns about recurrence and poorer longer-term outcomes.5
That does not mean injections are never useful. They may be considered when pain is severe, diagnosis is clear, work demands are high and the person understands the trade-off. But using the pain-free window to return immediately to the same workload is a common route to recurrence. PRP, autologous blood, shockwave, dry needling and surgery are more specialist discussions, usually after a proper progressive rehab attempt and diagnosis review.
Safety point: if an injection is offered, ask what diagnosis it targets, what short-term benefit is expected, what the recurrence risk is, and what loading plan follows it. Pain relief without a loading plan is fragile.
A practical plan
For two weeks, reduce the biggest flare trigger by about half rather than stopping life completely. Modify grip, use two hands for heavy lifts, keep the wrist more neutral, split tool sessions, reduce pull-up or row volume, and avoid repeated painful end-range gripping. If pain settles, begin graded loading below flare threshold.
Track pain during activity, pain the next morning, grip strength, work tolerance and sport tolerance. A useful rule is that mild discomfort during rehab can be acceptable if it settles and does not worsen the next day. If pain is escalating session by session, the dose is too high or the diagnosis needs checking.
The health library can help compare elbow pain with neck nerve pain, inflammatory arthritis, shoulder problems and work-related tendon pain. Use start here to prepare a short timeline, insights to weigh injection or device claims, and the stack builder if painkillers, anti-inflammatories or supplements are piling up.
- Does the location and resisted testing fit tennis elbow, golfer's elbow, nerve pain, arthritis or neck referral?
- Do numbness, tingling, weakness, swelling, injury history or night pain change the plan?
- Would physiotherapy help me build a graded loading plan for work, gym or sport?
- Should I use a counterforce strap, taping or ergonomic changes temporarily while strength rebuilds?
- If considering injection, what are the short-term benefits and longer-term recurrence risks?
References
- NHS, 2025. Tennis elbow. link
- MedlinePlus, 2023. Medial epicondylitis - golfer's elbow. link
- Lucado AM, Dale RB, Vincent J, Day JM, 2022. Lateral elbow pain and muscle function impairments: clinical practice guidelines. Journal of Orthopaedic and Sports Physical Therapy. link
- Olaussen M, Holmedal O, Lindbaek M, Brage S, Solvang H, 2013. Treating lateral epicondylitis with corticosteroid injections or non-electrotherapeutical physiotherapy: a systematic review and meta-analysis. BMJ Open. link
- Wolf JM, Ozer K, Scott F, Gordon MJ, Williams AE, 2010. Corticosteroid injection for tennis elbow or lateral epicondylitis: a review of the literature. Journal of Hand Surgery. link
- Naqvi U, Sherman AL, 2025. Medial Epicondylitis. StatPearls. link
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This article is educational and does not constitute medical advice, diagnosis, or a treatment recommendation. Medication uses described as “off-label” are not licensed for that purpose in the UK and should only be considered under qualified clinical supervision. Always speak to your GP, pharmacist, or a registered specialist before starting, stopping, or changing any treatment. If you have severe or alarm symptoms - unintentional weight loss, blood in your stool, difficulty swallowing, persistent vomiting, a fever, or severe pain - seek urgent medical care.