“Tennis elbow” and “golfer’s elbow” are two of the most recognizable injury names in sports medicine - and two of the most commonly confused with each other by people who have neither played tennis nor golf.
They share the same underlying mechanism. They occur on opposite sides of the elbow. And they’re both frequently mismanaged, because elbow pain is one of those presentations where people tend to either rest until it goes away (it often doesn’t) or stretch and massage the painful area (which usually doesn’t help either).
Here’s what’s actually happening - and why it matters for how these conditions are treated.
The Shared Mechanism: Tendinopathy at the Elbow
Both conditions are tendinopathies, or degenerative changes in tendon tissue at the point where forearm muscles attach to the elbow. The same principles that govern Achilles tendinopathy or patellar tendinopathy apply here: repetitive loading beyond the tendon’s capacity to recover leads to tissue change, pain, and functional limitation.
Neither condition is primarily an inflammatory problem, despite the fact that the older names - lateral epicondylitis and medial epicondylitis - end in “-itis.” The “-itis” terminology implies acute inflammation, which is not the dominant pathology in most chronic presentations. This distinction matters because treatments aimed at reducing inflammation, such as ice, anti-inflammatory medication, and corticosteroid injections address a mechanism that isn’t primarily responsible for the ongoing symptoms, and often provide only temporary relief.
The treatment that produces durable results is progressive loading - the same principle that governs tendinopathy rehabilitation everywhere else in the body.
Lateral Epicondylalgia: Tennis Elbow
Lateral epicondylalgia, or tennis elbow, involves the tendons of the wrist extensor muscles, primarily the extensor carpi radialis brevis, at their attachment on the lateral epicondyle: the bony prominence on the outer side of the elbow.
Pain location: Outer side of the elbow, sometimes radiating into the forearm.
What provokes it: Gripping, particularly with the elbow extended. Lifting a kettle, turning a doorknob, using a computer mouse, shaking hands - all classic provocations. The pain with lifting a simple object is disproportionate to the load and often shocking to patients who didn’t expect something so minor to hurt so much.
Who gets it: Despite the name, most people with tennis elbow don’t play tennis. It’s common in any occupation or activity involving repetitive gripping, pinching, or wrist extension - painters, plumbers, desk workers who use a mouse heavily, musicians, and manual laborers are all well represented.
What doesn’t work: Passive rest, stretching the wrist extensors, and repeated corticosteroid injections. Injections can provide short-term pain relief but have been shown to produce worse long-term outcomes than exercise-based rehabilitation in multiple studies.
What does work: Progressive tendon loading, beginning with isometric wrist extension exercises and building through isotonic and eventually functional loading. Addressing contributing factors, such as grip patterns, workstation ergonomics, and technique in sport alongside the tendon rehabilitation.
Medial Epicondylalgia: Golfer’s Elbow
Medial epicondylalgia, or golfer’s elbow, involves the tendons of the wrist flexor muscles at their attachment on the medial epicondyle: the bony prominence on the inner side of the elbow.
Pain location: Inner side of the elbow, sometimes into the inner forearm or the ring and little fingers.
What provokes it: Gripping combined with wrist flexion or forearm pronation - the motion of swinging a golf club, throwing, or many manual handling tasks. The distinction from tennis elbow is the movement direction that provokes pain: wrist extension for lateral, wrist flexion for medial.
Who gets it: Golfers, baseball pitchers, and throwing athletes, but also - as with lateral - many people whose sport involvement is minimal. Heavy manual work, climbers, and anyone with repetitive gripping and forearm rotation loads are susceptible.
An important additional consideration: The ulnar nerve runs very close to the medial epicondyle, and medial elbow pain is sometimes accompanied by tingling or numbness in the ring and little fingers - a sign that the ulnar nerve is also involved. This coexistence is common enough that it should be specifically assessed rather than assumed to be absent.
What works: The same progressive loading approach as lateral epicondylalgia, with attention to the specific movements and activities that load the flexor tendons.
Why Both Conditions Become Chronic
The most common reason tennis and golfer’s elbow become chronic is the cycle of pain avoidance and tendon deconditioning. The tendon hurts when loaded, so loading is avoided. The tendon becomes less capable of tolerating load. When loading is resumed - whether that be at work, in sport, or in daily life - even normal demands exceed the tendon’s reduced capacity, and symptoms flare.
Breaking that cycle requires progressive loading that builds tendon capacity back up to meet the demands being placed on it. It requires patience, as tendon remodeling is slow. And it requires calibration to the individual: the right starting load, the right progression, the right management of flare-ups during the process.
At Aureum Physio, elbow tendinopathy is a presentation we see regularly and manage well. If your elbow pain has been lingering despite rest and conservative self-treatment, a proper loading-based rehabilitation program is almost certainly what it needs.
Elbow pain that persists for months is telling you something specific about what the tendon needs. Come in and let us build a program that actually addresses it.
