Tennis Elbow & Golfer’s Elbow: Why It Won’t Go Away
One of the biggest misconceptions I see is that tennis elbow only happens to tennis players and golfer's elbow only happens to golfers.
In reality, most people I treat for these conditions don't regularly play either sport.
I've seen it in golfers, tennis players, pickleball players, weightlifters, mechanics, construction workers, desk workers, and even parents carrying around young kids.
The common denominator isn't the sport or activity itself.
It's repetitive stress.
And once these injuries develop, they have a frustrating tendency to stick around.
Many people try resting, wearing a brace, getting a massage, or taking anti-inflammatory medications. Sometimes those things help temporarily, but the pain often returns as soon as activity picks back up.
The reason is simple: the tendon hasn't actually become more resilient.
What's the difference between tennis elbow and golfer's elbow?
Both conditions involve irritation of the tendons around the elbow.
The difference is where the pain occurs.
Tennis elbow, also known as lateral epicondylitis or lateral elbow tendinopathy, causes pain on the outside of the elbow and is commonly aggravated by gripping, lifting, typing, or racquet sports.
Golfer's elbow, also known as medial epicondylitis or medial elbow tendinopathy, causes pain on the inside of the elbow and is often aggravated by gripping, pulling, carrying, or swinging activities.
While the location is different, the underlying problem is often very similar.
The tendon has been exposed to more stress than it can currently tolerate.
Why do these injuries linger for so long?
This is where many people get frustrated.
Unlike a muscle strain that may heal relatively quickly, tendon injuries tend to move at their own pace.
Research has shown that chronic tendon pain is often less about inflammation and more about changes within the tendon structure itself.
Over time, the tendon becomes less efficient at handling load.
That's why simply reducing inflammation doesn't always solve the problem.
A systematic review published in The British Journal of Sports Medicine found that progressive loading programs remain one of the most effective treatment approaches for chronic tendinopathies.
In other words, tendons don't simply need rest.
They need the right type of stress.
What causes tennis elbow and golfer's elbow?
Most people assume these injuries occur because they did something wrong.
Usually that's not the case.
More often, it's an accumulation of stress over time.
Some common contributing factors include:
Sudden increases in activity
Repetitive gripping
Weight training volume changes
Racquet sports
Poor recovery
Weakness in the forearm muscles
Shoulder and scapular weakness
One thing that surprises many patients is how often the shoulder plays a role.
If the shoulder isn't contributing efficiently during movement, the elbow often has to absorb more stress.
That's one of the reasons I rarely treat the elbow in isolation.
How I treat tennis elbow and golfer's elbow
One of the first things I evaluate is the entire chain above and below the elbow.
I'm looking at:
Grip strength
Forearm strength
Shoulder strength
Scapular stability
Mobility restrictions
Activity volume
Once we identify the contributing factors, treatment becomes much more targeted.
Depending on the patient, treatment may include:
High velocity thrust manipulation to joints of the elbow
Dry needling
Shockwave therapy
Soft tissue treatment
Progressive tendon loading
Grip strengthening
Forearm strengthening
Shoulder and scapular strengthening
Activity modification when appropriate
Shockwave therapy has become one of my favorite tools for chronic elbow tendinopathies because the research supporting it is quite strong.
Several studies have demonstrated improvements in pain and function, particularly in stubborn cases that have failed to respond to more traditional treatments.
That said, shockwave is never the entire solution.
The tendon still needs to become stronger.
Why braces and straps only get you so far
Many patients show up wearing a counterforce brace.
And to be clear, there's nothing wrong with that.
Braces can help reduce symptoms during activity.
The problem is that they don't actually improve the tendon's capacity.
Think of it like turning down the volume on a smoke alarm without putting out the fire.
The symptoms may be quieter, but the underlying issue is still there.
The real goal is making the tendon more resilient so it can tolerate the demands you're placing on it.
The bottom line
Tennis elbow and golfer's elbow can be incredibly stubborn, but they don't have to become chronic problems.
The key is addressing the factors that caused the tendon to become overloaded in the first place and then progressively rebuilding its capacity.
At Modern Movement Physical Therapy in Scottsdale, I combine hands-on treatment, dry needling, shockwave therapy, strengthening, and movement analysis to help patients get back to lifting, golfing, playing pickleball, working, and living without constant elbow pain.
Because avoiding the activities you enjoy isn't a solution.
Building a stronger, more resilient tendon is.
Take good care of your body, it's the only one you have.
Yours in health,
Dr. Michael Price