The names are misleading. Most people I treat for tennis elbow have never picked up a racquet, and most with golfer’s elbow have never played a round. They’re tradies who grip tools all day, gym-goers who’ve ramped up their pulling, and office workers who spend eight hours on a mouse. The sport names stuck; the actual causes are far broader.
Both conditions are stubborn, both get mismanaged, and both respond well to the right treatment once you understand what’s actually going on. Here’s the breakdown.
What they actually are
Both are tendinopathies — problems with the tendons that attach your forearm muscles to the bony bumps on either side of your elbow. The difference is simply which side.
- Tennis elbow (lateral epicondylalgia) — pain on the outsideof the elbow. It involves the tendons of the muscles that extend your wrist and fingers (the ones that pull your hand backwards). Aggravated by gripping, lifting with the palm down, and wrist extension.
- Golfer’s elbow (medial epicondylalgia) — pain on the insideof the elbow. It involves the tendons of the muscles that flex your wrist and fingers (the ones that curl your hand forwards and grip). Aggravated by gripping, lifting with the palm up, and wrist flexion.
Tennis elbow is far more common, but the principles for treating both are nearly identical — it’s the same problem on opposite sides of the joint.
Why the tendon got irritated
Tendinopathy develops when the load going through a tendon exceeds what it can tolerate and recover from. It’s not usually a tear or an acute injury — it’s a gradual overload problem. The tendon becomes painful, loses some of its capacity, and gets sensitised. The common triggers:
- Sustained or repetitive gripping — the single biggest cause. Every time you grip, the forearm tendons load. Tradies using tools all day, repetitive assembly work, and prolonged mouse use all drive this.
- A sudden increase in load— a big DIY weekend, a renovation, ramping up pull-ups or deadlifts, taking up a new racquet sport. The tendon didn’t get time to adapt to the new demand.
- Vibrating tools — power tools transmit load and vibration straight through the gripping muscles.
- Poor load distribution up the chain — weak or stiff shoulder and neck function can leave the forearm doing more than its share. This is why a good assessment looks above the elbow, not just at it.
Why it doesn’t just settle on its own
The instinct is to rest it. Rest reduces the load, so the pain eases — but the tendon’s capacity doesn’t improve with rest. The moment you go back to gripping at the level that caused the problem, it flares again. People can spend months in this cycle: rest, feel better, return to work, flare, rest again.
Tendons don’t recover by being left alone — they recover by being loaded progressively, in a controlled way that builds capacity without overloading. That’s the core of what fixes tennis and golfer’s elbow, and it’s the part that pure rest, bracing, or anti-inflammatories never address.
What treatment actually involves
Progressive loading — the actual fix
The strongest evidence for both conditions supports progressive strengthening of the affected tendon — typically starting with isometric holds (loading the muscle without moving the joint, which often reduces pain) and building to controlled, heavier loading over weeks. This rebuilds the tendon’s capacity so it can handle the demands of your work or training again. It’s not optional and it’s not quick, but it’s what produces lasting results.
Hands-on treatment and dry needling
Tennis elbow has some of the strongest evidence of any condition for dry needling — the forearm muscles hold trigger points that refer pain into the elbow, and releasing them reduces pain and improves grip strength. Manual therapy to the elbow, forearm, and often the neck and wrist reduces pain and improves tolerance, opening a window to do the loading work effectively. More on the dry needling evidence by condition →
Load management — not total rest
You usually don’t need to stop working entirely — you need to modify how you load the tendon while it recovers. Padded grips, lighter tools where possible, breaking up sustained gripping with micro-breaks, and temporarily reducing the heaviest aggravating activities. The goal is keeping load below the flare threshold while the strengthening rebuilds capacity.
Where shockwave fits
For stubborn cases that haven’t responded to loading and hands-on treatment, shockwave therapy is a reasonable addition — the evidence supports it as part of a combined programme for lateral epicondylalgia, though not as a standalone fix. More on what shockwave therapy treats →
What about braces, injections, and scans?
Elbow straps/braces— the counterforce brace worn just below the elbow can reduce pain during activity by offloading the tendon attachment. Useful as a short-term aid that lets you keep working, but it’s a bridge, not a cure — it doesn’t rebuild the tendon.
Corticosteroid injections — worth being cautious here. They can give good short-term pain relief, but the research consistently shows worselong-term outcomes than exercise-based treatment — higher recurrence and slower eventual recovery. They’re not a first-line option for these conditions.
Scans— usually unnecessary. The diagnosis is clinical. Imaging is reserved for atypical presentations or when symptoms don’t respond to proper treatment.
How long does it take
Tendinopathy is slow to fix — there’s no way around that. A case caught reasonably early, with good load management and consistent strengthening, often improves meaningfully over six to twelve weeks. A long-standing case that’s been flaring for a year takes longer — three months or more — because you’re rebuilding capacity that eroded over a long time.
The people who recover fastest are the ones who commit to the progressive loading and modify their aggravating load early. The ones who take longest are the ones who keep resting and hoping, or who get an injection that masks the pain and lets them overload the tendon further. If you grip for a living, this is worth getting assessed and treated properly rather than waiting out. More on the common injuries that bring tradies unstuck →