Tennis Elbow & Golfer's Elbow

Pain on the outside of the elbow. Pain on the inside. Both are common, both are frequently mismanaged, and both respond well to the right clinical approach. Despite the names, you don't need to play tennis or golf to develop either condition — and understanding what's actually driving them is the first step toward lasting recovery.

What's the Difference?

Both conditions are tendinopathies — load tolerance failures at the point where forearm muscles attach to the elbow. The distinction is which side is affected:

  • Tennis elbow (lateral epicondylalgia) — pain on the outer elbow where the wrist extensor muscles attach. Aggravated by gripping, lifting, and extending the wrist.
  • Golfer's elbow (medial epicondylalgia) — pain on the inner elbow where the wrist flexor muscles attach. Aggravated by gripping, throwing, and flexing the wrist.

Both are driven by the same underlying mechanism — repetitive load exceeding the tendon's capacity to adapt — and both respond to similar treatment principles.

Why They Develop

Elbow tendinopathies develop when cumulative load outpaces recovery. Common contributors include:

  • Sudden increases in gripping, lifting, or repetitive forearm activity
  • Poor technique in sport or manual work placing excessive demand on the elbow
  • Reduced shoulder and thoracic mobility forcing the forearm to compensate
  • Weak rotator cuff altering load distribution through the arm
  • Prolonged computer use with sustained wrist extension
  • Inadequate recovery between high-demand sessions

Why They Persist

Elbow tendinopathies are notorious for lingering. The reasons are well understood clinically:

  • Tendons have poor blood supply and heal slowly without appropriate loading
  • Complete rest leads to tendon deconditioning, making it more vulnerable on return
  • Protective muscle guarding around the elbow alters mechanics and maintains load on the tendon
  • The pain-avoidance cycle — reducing all activity — prevents the graded loading needed for recovery

Rest reduces pain temporarily but doesn't restore tendon capacity. That requires progressive loading.

How Remedial Massage Helps

Hands-on treatment addresses both the local tissue drivers and the broader mechanical contributors:

  • Releasing tension in the forearm flexors and extensors to reduce tendon load
  • Improving tissue glide between fascial layers in the forearm
  • Reducing protective muscle guarding around the elbow joint
  • Addressing shoulder, neck, and thoracic restrictions that alter arm mechanics
  • Improving circulation to the poorly-perfused tendon attachment
  • Restoring full elbow and wrist range of motion

Treatment of the forearm alone rarely produces lasting results. The shoulder and thoracic spine are almost always involved and need to be addressed as part of the same clinical picture.

The Role of Graded Loading

Progressive tendon loading is the most evidence-supported intervention for elbow tendinopathy. The key principles are:

  • Start with isometric exercises — sustained contractions with no movement — to reduce pain and begin loading
  • Progress to isotonic loading — slow, controlled concentric and eccentric movements
  • Gradually increase load, speed, and sport-specificity over weeks
  • Monitor symptoms — mild discomfort during loading is acceptable, significant pain is not

This process takes time — typically 8–12 weeks for meaningful tendon adaptation. But it produces results that rest alone never will.

What Helps Between Sessions

  • Wrist extensor stretching — gentle, sustained, several times daily
  • Forearm self-massage with a firm ball
  • Isometric wrist extension or flexion holds to manage pain and begin loading
  • Temporary modification of aggravating activities — reduce load, not eliminate it
  • Review of grip technique in sport or manual work
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