Last updated: July 14, 2026 | By Richard Hale
Tennis elbow and golfer’s elbow are both tendon overuse injuries at the elbow — but they affect opposite sides and require different rehabilitation exercises. Confusing them, or treating one with the approach designed for the other, is one of the most common reasons these conditions become chronic. Understanding which you have is the necessary starting point.
This content is for educational purposes only and is not medical advice. Elbow pain with numbness or weakness in the hand, or that does not respond to conservative care within 6-8 weeks, warrants clinical evaluation to exclude other diagnoses.
Table of Contents
- Elbow Anatomy: Lateral vs. Medial
- Tennis Elbow (Lateral Epicondylitis)
- Golfer’s Elbow (Medial Epicondylitis)
- Why These Conditions Take So Long to Heal
- Treatment: What the Evidence Supports
- Injections and Medical Options
- Frequently Asked Questions
Elbow Anatomy: Lateral vs. Medial
The elbow joint has two bony prominences on either side of the joint: the lateral epicondyle (the bony bump on the outside/thumb side of the elbow) and the medial epicondyle (the bony bump on the inside/little-finger side, which is the one you feel sharply when you hit your “funny bone”).
The tendons of the wrist extensor muscles (which lift the wrist and fingers upward) originate at the lateral epicondyle. The tendons of the wrist flexor muscles (which bend the wrist downward) originate at the medial epicondyle. These distinct anatomical points are what separates the two conditions mechanically and defines the different loading patterns that cause each.
Tennis Elbow (Lateral Epicondylitis)
Tennis elbow affects the tendon of the extensor carpi radialis brevis (ECRB) — the most loaded of the wrist extensors — at its attachment to the lateral epicondyle. The ECRB is under eccentric load during the backhand stroke in racquet sports (the wrist extends to load the racquet, then is stabilized during impact), which is the original mechanism that gave the condition its name. However, 95% of tennis elbow cases occur in people who do not play tennis.
Common non-tennis causes include: prolonged computer use (sustained wrist extension position); repetitive tool use (screwdrivers, paintbrushes, pruning shears); heavy gripping activities with the forearm in a pronated (palm-down) position; and any repetitive wrist extension under load.
Identifying symptoms: pain on the outside of the elbow, specifically at or just below the lateral epicondyle. The pain is reproduced by: pressing on the lateral epicondyle with moderate pressure; resisting wrist extension with the elbow straight (the examiner pushes the wrist down while you resist); gripping while the forearm is pronated; and carrying objects with the elbow extended and forearm turned down. A cup of coffee, a briefcase, or a pot carried with a straightened arm can provoke the pain characteristic of tennis elbow.
Golfer’s Elbow (Medial Epicondylitis)
Golfer’s elbow affects the flexor-pronator tendon group — the tendons of the wrist flexors and pronators that originate at the medial epicondyle. In golf, the wrist and forearm pronation during the downswing loads these tendons eccentrically — hence the name. As with tennis elbow, non-golfers account for the majority of cases.
Common causes include: overhead throwing sports (baseball, javelin, cricket — the valgus extension overload at the medial elbow stresses the flexor-pronator tendons); weightlifting with gripping exercises (heavy deadlifts, cable rows); repetitive wrist flexion under load; computer work with prolonged wrist flexion; and any work requiring sustained gripping with the forearm supinated (palm up).
Identifying symptoms: pain on the inside of the elbow, at or just below the medial epicondyle. The pain is reproduced by: pressing on the medial epicondyle; resisting wrist flexion; forearm pronation against resistance; and sustained gripping. A distinguishing feature: medial epicondylitis can be associated with ulnar nerve symptoms (numbness or tingling in the ring and little fingers) because the ulnar nerve runs in close proximity to the medial epicondyle. If nerve symptoms accompany medial elbow pain, clinical evaluation is warranted to distinguish medial epicondylitis from cubital tunnel syndrome (ulnar nerve entrapment).
Why These Conditions Take So Long to Heal
Both tennis elbow and golfer’s elbow are now understood as tendinopathies rather than tendinitis — a distinction with significant treatment implications. Tendinitis implies acute inflammation; tendinopathy describes the degenerative collagen changes (disorganized collagen matrix, neovascularization, failed healing response) that characterize chronic tendon overuse injury.
Tendinopathic tissue has essentially stopped mounting an effective healing response — it is in a state of chronic failed repair rather than acute inflammation. This is why anti-inflammatory measures (ice, cortisone, NSAIDs) provide temporary symptom relief but do not resolve the underlying structural problem. The tissue needs mechanical stimulus — specifically, controlled progressive loading — to stimulate the collagen remodeling that constitutes actual repair.
The tendons at the elbow have relatively poor blood supply compared to muscle, which already slows healing. Add the repeated daily loading of normal forearm use that prevents complete rest, and it becomes clear why elbow tendinopathies are notorious for persisting for 12-18+ months without appropriate rehabilitation.
Treatment: What the Evidence Supports
Eccentric loading exercises (the primary treatment): the evidence base for eccentric loading in tendinopathy is the strongest of any non-surgical intervention. For tennis elbow: wrist extensor eccentric exercises — hold a light dumbbell (0.5-2kg to start), use the other hand to lift the wrist into extension, then slowly lower (eccentric phase) back to flexion under control over 3-5 seconds. Three sets of 15 repetitions daily. The eccentric loading stimulus drives collagen remodeling in tendinopathic tissue in a way that concentric loading does not.
For golfer’s elbow: wrist flexor eccentric exercises — use the other hand to bring the wrist into flexion, then slowly lower (eccentric) back to extension. The same protocol of 3 sets of 15 daily applies.
Some pain during eccentric exercises is expected and acceptable (3-5/10 on a pain scale) — this is different from the “pain means stop” advice for acute injuries. Tendinopathy rehabilitation requires loading to a level that stimulates adaptation. Starting with very light resistance and progressing over 6-12 weeks is the standard approach.
Activity modification (not complete rest): avoid the specific activities that most provoke the pain during the acute-to-subacute phase, while maintaining general activity. Complete rest leads to tendon further weakening without the stimulus for remodeling. Identify the specific movements that load the involved tendon maximally and modify those while maintaining the loading provided by daily activities and rehabilitation exercises.
Counterforce bracing: a forearm strap worn just below the elbow redistributes the load along the forearm muscles rather than concentrating it at the epicondyle attachment. Several RCTs confirm modest pain reduction during activity with counterforce bracing. It is appropriate during the early rehabilitation phase to allow continued daily function while the eccentric loading program takes effect — not as a permanent solution.
Isometric exercises for pain control: sustained isometric contractions (pushing against a fixed resistance, no movement) reduce tendon pain acutely — an effect confirmed in recent tendinopathy research. Wrist extension isometrics (pushing the hand against a wall for 30-45 seconds, 5 repetitions) can be used for pain management during flares and as a warm-up before eccentric loading sessions.
Injections and Medical Options
Corticosteroid injections: produce strong short-term pain relief (4-8 weeks) but multiple RCTs have shown that cortisone-injected groups have worse outcomes at 6-12 month follow-up than groups treated with physiotherapy or wait-and-see. The anti-inflammatory effect reduces pain but impairs collagen synthesis, potentially delaying tissue repair. Cortisone injections are most appropriate for severe acute pain management that prevents participation in rehabilitation — not as a primary or repeated treatment.
PRP (platelet-rich plasma): emerging evidence suggests PRP injections may produce better long-term outcomes than cortisone for lateral epicondylitis — the growth factors in PRP stimulate the collagen synthesis that cortisone suppresses. A 2022 systematic review found PRP superior to corticosteroid at 6-month and 12-month follow-up in multiple RCTs. PRP is more expensive than cortisone and not universally covered by insurance, but it is a mechanistically rational treatment that aligns with the tendinopathy biology better than anti-inflammatory approaches.
Surgery: considered for cases that have failed 12+ months of appropriate conservative treatment and have confirmed structural tendon changes on imaging. Surgical debridement or open tendon release procedures have good outcomes in appropriately selected patients, but surgery is rarely the first step in otherwise healthy adults who have not completed a rehabilitation program.
Frequently Asked Questions
How do I know if I have tennis elbow or golfer’s elbow?
Location of pain is the primary distinguishing feature. Tennis elbow (lateral epicondylitis) hurts on the outside of the elbow — the side toward the thumb when the arm hangs naturally. Golfer’s elbow (medial epicondylitis) hurts on the inside — the side toward the little finger. A specific test: resist wrist extension with the elbow straight (pain on the outside = tennis elbow); resist wrist flexion with the elbow straight (pain on the inside = golfer’s elbow). The activities that provoke each also differ — backhand movements and screwdriver-type activities for tennis elbow; gripping with the palm up or throwing for golfer’s elbow.
Can I still exercise with tennis elbow or golfer’s elbow?
Yes, with modification. Lower body exercise (cycling, walking, running) can typically continue without significant load on the elbow. Upper body exercises that do not load the involved tendon can continue. The rehabilitation eccentric exercises are themselves the primary exercise prescription for these conditions. Exercises to modify or temporarily avoid are those that maximally load the affected tendon: heavy pulling exercises for golfer’s elbow, heavy gripping and wrist extension exercises for tennis elbow. A physiotherapist can identify which specific exercises to modify for your activity level and preferences.
What is the main difference between tennis elbow and golfer’s elbow?
Tennis elbow (lateral epicondylitis) involves the tendons on the outside of the elbow and produces pain on the outer elbow radiating into the forearm with gripping and lifting with the palm facing down. Golfer’s elbow (medial epicondylitis) involves the flexor tendons on the inside of the elbow and produces inner elbow pain radiating down the forearm with gripping and lifting with the palm facing up. Both are tendon overuse conditions, not acute injuries, and both respond to similar treatment — eccentric loading, activity modification, and gradual return to the aggravating activities.
How long does it take tennis elbow or golfer’s elbow to heal?
Both conditions typically take 6 to 24 months to fully resolve, which is longer than most people expect. Short periods of pain reduction from rest are achievable in weeks, but tendon remodelling that restores normal load capacity takes months of progressive loading. The most effective long-term approach is eccentric exercise — loading the tendon in the lengthening phase — progressively increasing load over 8 to 12 weeks. Returning to the aggravating activity too soon is the most common reason these conditions become chronic. Physiotherapy guidance is more effective than rest alone for long-term outcomes.
Can I keep working with tennis elbow?
Modified activity rather than complete rest is recommended. Identify and reduce the specific gripping, twisting, or repetitive wrist movements that provoke the worst pain, and work within a pain threshold where pain does not exceed a 4 out of 10 during activity and resolves within 24 hours after. A counterforce brace worn just below the elbow can reduce tendon strain enough to allow continued moderate activity during rehabilitation. Complete rest allows symptoms to settle but does not address underlying tendon quality — gradual progressive loading is what restores normal function and prevents recurrence.
About the author: Richard Hale is an independent health writer focused on mobility, joint health, and active aging research. He is not a licensed medical professional. All content on VitalMove40 is for educational purposes only and is not a substitute for advice from a qualified healthcare provider.
