Tennis Elbow vs. Golfer’s Elbow: Identifying and Treating Stubborn Forearm Pain

Important Disclaimer: The information provided in this article is for educational and informational purposes only and does not constitute direct medical advice. Every musculoskeletal injury is unique. Always consult with a licensed healthcare practitioner for a proper clinical diagnosis and personalized treatment plan before beginning any physical rehabilitation program.

Tennis Elbow vs. Golfer’s Elbow: Identifying and Treating Stubborn Forearm Pain

You are in the middle of a heavy deadlift set, swinging a golf club on the weekend, or perhaps just typing away at your desk in Burnaby, when you feel it: a sharp, nagging ache radiating from your elbow down into your forearm. At first, you try to shake it off. You stretch your wrist, rub the joint, and push through the activity.

But as the weeks go by, the pain doesn’t fade. It intensifies. Soon, simple daily tasks become agonizing. Turning a doorknob, gripping a coffee mug, or shaking someone’s hand sends a jolt of pain up your arm. You realize your grip strength has completely plummeted.

If this sounds familiar, you are likely dealing with one of the two most common tendon issues of the upper body: Tennis Elbow (Lateral Epicondylitis) or Golfer’s Elbow (Medial Epicondylitis).

Despite their names, you do not need to play tennis or golf to develop these conditions. In fact, at Strike Recovery & Performance, we see these injuries constantly in weightlifters, rock climbers, construction workers, and office professionals.

While both conditions cause intense forearm and grip pain, they affect completely different anatomical structures and require distinct rehabilitation strategies. In this comprehensive guide, we will break down the clinical differences between tennis elbow vs. golfer’s elbow, explain why the traditional “rest and ice” approach rarely works, and outline how our multidisciplinary Burnaby clinic rebuilds tendon capacity so you can get back to your active lifestyle.

Anatomy 101: Understanding the Epicondyles

To understand the difference between these two conditions, we need to take a quick look at the bony anatomy of your elbow.

Run your hand down your upper arm bone (the humerus) until you reach the elbow joint. On the very bottom of the humerus, there are two distinct bony bumps on either side of the joint. These bumps are called epicondyles, and they serve as the crucial anchor points for the muscles of your forearm.

• The Lateral Epicondyle: This is the bony bump on the outside of your elbow (the side facing away from your body when your palms are facing forward). The muscles that extend your wrist (bending your hand backward) and extend your fingers all merge into a single, thick tendon that attaches to this outside bump.
• The Medial Epicondyle: This is the bony bump on the inside of your elbow (the side closest to your ribs). The muscles that flex your wrist (bending your hand forward) and allow you to grip objects tightly merge into a tendon that attaches to this inside bump.

When these forearm muscles are subjected to repetitive stress, mechanical overload, or sudden trauma, the tendons attaching to these bony bumps become damaged, painful, and structurally compromised.

What is Tennis Elbow (Lateral Epicondylitis)?

Tennis elbow is by far the most common of the two conditions. It is characterized by a sharp, burning pain on the outside of the elbow that often radiates down the back of the forearm toward the wrist.

The Mechanism of Injury

Tennis elbow is an overuse injury of the wrist extensors—specifically a muscle called the extensor carpi radialis brevis (ECRB). This muscle is responsible for stabilizing your wrist when your elbow is straight.

While a faulty backhand in tennis is the classic cause, we most frequently see this injury in functional fitness athletes who perform high volumes of gripping exercises while the wrist is extended. For example, gripping a heavy barbell during power cleans, holding a front rack position, or performing high-rep pull-ups places massive eccentric load on the lateral tendon. It is also incredibly common in manual laborers who frequently use screwdrivers, or office workers who type with their wrists cocked upward for eight hours a day.

Common Symptoms of Tennis Elbow

• Point tenderness directly on the bony bump on the outside of the elbow.
• Pain that worsens when you extend your wrist backward against resistance.
• A weak, painful grip, especially when holding your arm out straight in front of you (e.g., pouring a kettle of water).
• Morning stiffness in the outer elbow that takes a few hours to warm up.

What is Golfer’s Elbow (Medial Epicondylitis)?

Golfer’s elbow is less common but equally debilitating. It is characterized by pain and tenderness on the inside of the elbow that often shoots down the inside of the forearm toward the pinky and ring fingers.

The Mechanism of Injury

Golfer’s elbow is an overuse injury of the wrist flexors and the pronator teres muscle (the muscle that turns your palm face down).

The classic mechanism is trailing the club too much during a golf swing, causing the wrist to violently snap forward upon impact. However, in our Burnaby sports clinic, we frequently treat golfer’s elbow in rock climbers, baseball pitchers, and athletes who perform heavy pulling movements. Exercises like chin-ups, heavy rows, and deadlifts require massive wrist flexion and grip stabilization. If the load exceeds the capacity of the medial tendon, micro-tearing occurs.

Common Symptoms of Golfer’s Elbow

• Point tenderness directly on the bony bump on the inside of the elbow.
• Pain that flares up when you flex your wrist forward or squeeze a hard object.
• Pain when trying to turn a doorknob or open a tight jar (resisted pronation).
• Occasional numbness or tingling radiating into the ring and pinky fingers (as the ulnar nerve runs directly behind the medial epicondyle and can become irritated by the surrounding inflammation).

The “Itis” vs. “Osis” Myth: Why Your Tendon Isn’t Healing

For decades, doctors treated tennis and golfer’s elbow as inflammatory conditions. The suffix “-itis” literally means inflammation. The standard medical advice was to take anti-inflammatory painkillers (NSAIDs), ice the elbow aggressively, and completely rest the arm for six weeks.

There is just one massive problem: current clinical research shows that chronic epicondylitis is rarely an inflammatory condition.

While there may be a brief period of acute inflammation in the first few days of the injury, if you have been dealing with elbow pain for more than a few weeks, the inflammation is largely gone. Instead, the condition has transitioned into tendinosis—a state of cellular degeneration.

When a tendon is repeatedly overloaded, the collagen fibers that make up the tendon begin to break down. If the body doesn’t have enough time or the right mechanical environment to repair them, the collagen fibers heal in a disorganized, chaotic, and weakened web. The tendon actually thickens, degenerates, and loses its structural integrity. It becomes highly sensitive to even the smallest amounts of stress.

Why Complete Rest is the Enemy

If your tendon is degenerating, complete rest is the absolute worst thing you can do. Tendons are avascular, meaning they have a very poor blood supply compared to muscles. They rely on mechanical loading and movement to pump fluids, nutrients, and oxygen in and out of the tissue.

If you put your arm in a sling or completely stop using your grip for a month, the tendon will literally starve. The healthy collagen fibers will weaken further. When you finally try to return to the gym or the golf course, the now-weaker tendon will immediately flare up again, starting the frustrating cycle all over.

Tendons need load to heal. They just need the right kind of load.

How Strike Recovery Rebuilds Your Elbow

Successfully treating tennis elbow or golfer’s elbow requires a shift in mindset. You cannot simply rub the elbow, pop an ibuprofen, and hope it goes away. You have to actively rebuild the tissue’s capacity to handle heavy loads.

At Strike Recovery & Performance, our multidisciplinary team uses an integrated approach to heal the degenerated tissue, restore range of motion, and rebuild functional grip strength.

1. Manual Soft Tissue Therapy (RMT)

When an elbow tendon is damaged, the massive muscles of the forearm often go into a state of chronic, protective spasm. A Registered Massage Therapist (RMT) will utilize deep tissue mobilization, myofascial release, and trigger point therapy to release the tension in the extensor or flexor muscle bellies. By releasing the muscle tension, we drastically reduce the constant, pulling strain where the tendon attaches to the bone.

2. Instrument Assisted Soft Tissue Mobilization (IASTM)

For chronic, stubborn tendinosis, we often employ IASTM (sometimes referred to as Graston technique). Practitioners use ergonomic, stainless steel instruments to effectively “scrape” the skin over the damaged tendon. This controlled micro-trauma stimulates a localized inflammatory response, tricking the body into restarting the stalled cellular healing process and helping break down disorganized scar tissue.

3. Shockwave Therapy

Extracorporeal Shockwave Therapy is one of the most effective, evidence-based treatments for chronic tendinopathy. A clinical device delivers high-energy acoustic soundwaves directly into the degenerated epicondyle tendon. These shockwaves break down calcifications, stimulate the formation of new blood vessels (angiogenesis), and trigger the proliferation of new, healthy collagen fibers. For patients who have suffered from tennis elbow for months or years, Shockwave is often the ultimate game-changer.

4. Cervical Spine and Shoulder Mechanics (Chiropractic Care)

The body is an interconnected kinetic chain. Your elbow does not exist in a vacuum. The nerves that power your forearm muscles originate in your cervical spine (neck) and travel down through your shoulder. If you have poor posture, a restricted thoracic spine, or nerve entrapment in your shoulder, the neural signaling to your forearm is compromised. A Chiropractor will assess your entire upper extremity, ensuring that spinal restrictions or shoulder instability are not secretly driving your elbow pain.

5. Eccentric Loading and Heavy Slow Resistance (Physiotherapy)

This is the most critical phase of your recovery. A Physiotherapist will guide you through a highly specific loading protocol to rebuild the tendon’s architecture.

For tendon degeneration, eccentric exercises are the gold standard. An eccentric contraction occurs when the muscle is lengthening under tension (for example, slowly lowering a dumbbell during a wrist curl). Eccentric loading applies the precise mechanical stress needed to force the chaotic collagen fibers to reorganize into strong, parallel lines.

As your pain decreases, your physio will transition you into Heavy Slow Resistance (HSR) training. By lifting heavier weights at a very slow, controlled tempo, we increase the stiffness and load capacity of the tendon, bulletproofing your grip for when you return to heavy deadlifts or aggressive racket sports.

What Can You Do at Home Right Now?

If you are waiting for your clinical assessment, here are a few immediate steps you can take to manage the irritation:

• Modify Your Grip: Do not stop gripping altogether, but change the mechanics. If pulling a heavy barbell hurts, switch to a neutral-grip dumbbell (palms facing each other) to take the stress off the medial and lateral epicondyles.
• Use a Counterforce Brace: An elbow strap worn tightly around the thickest part of the forearm (about two inches below the painful elbow bump) can provide temporary relief. The brace acts as a false anchor point, dispersing the tension before it reaches the damaged tendon. (Note: This is a temporary band-aid for pain management, not a cure).
• Check Your Ergonomics: If you work at a desk, ensure your keyboard and mouse are positioned so your wrists are completely neutral. If your wrists are cocked upward to type, you are constantly straining the tennis elbow tendon.
• Isometric Holds: If dynamic movement is too painful, try isometric holds. Hold a light dumbbell with your wrist perfectly straight and maintain that position for 30 to 45 seconds. This provides the tendon with a safe mechanical load and often creates an analgesic (pain-relieving) effect.

Don’t Let Elbow Pain Ruin Your Training

Whether you are suffering from the outer-elbow burn of lateral epicondylitis or the inner-elbow ache of medial epicondylitis, the reality remains the same: degenerated tendons do not heal on their own through passive rest. They require precise, progressive, and active rehabilitation.

Do not let a stubborn elbow injury force you to abandon your sport, drop your lifting numbers, or suffer through your workday in Burnaby. Our integrated team of sports rehabilitation experts knows exactly how to diagnose the root cause of your pain, treat the damaged tissues, and build a grip that is stronger than ever.

Ready to get a handle on your elbow pain? Head to our booking portal and schedule a comprehensive assessment with the Strike Recovery & Performance team today.

References:

• Bisset, L., et al. “A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia.” British Journal of Sports Medicine.
• Coombes, B. K., et al. “Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials.” The Lancet.
• Mani-Babu, S., et al. “The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review.” American Journal of Sports Medicine. (Note: Mechanics parallel upper limb applications).
• Tyler, T. F., et al. “Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial.” Journal of Shoulder and Elbow Surgery.
• OrthoInfo – American Academy of Orthopaedic Surgeons. “Tennis Elbow (Lateral Epicondylitis)” and “Golfer’s Elbow (Medial Epicondylitis).”

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