Tennis & Golfer’s Elbow
Tennis elbow and golfer’s elbow are overload injuries of the forearm tendons at the elbow — painful, stubborn, and very treatable. The key is the right loading at the right time, not rest, and steering clear of the quick fixes that make it worse in the long run.
Tennis & golfer’s elbow: a tendon problem, not inflammation
Tennis elbow is pain on the outer side of the elbow, where the tendons of the muscles that lift the wrist attach (the common extensor origin). Golfer’s elbow is the same problem on the inner side (the common flexor origin). Despite the “-itis” names, both are now understood as a tendinopathy — a change in the tendon’s structure from being overloaded, with little true inflammation. They come from repetitive gripping, lifting and wrist use — in work, DIY, the gym and keyboards, not just racquet and club sports.
What it feels like
Pain and tenderness right over the bony point of the elbow, which flares with gripping, lifting, shaking hands, turning a key or carrying a bag. It usually builds gradually on one side, and the grip can feel weak because it hurts to hold.
Who gets it
Most common between the ages of 40 and 60, in anyone who grips and loads the forearm repeatedly — manual and trade workers, racquet and club sports, climbers, and people at a keyboard or mouse all day.
What is actually going wrong at the tendon
The forearm muscles share a common tendon origin on the bony point of the elbow — the extensors on the outer side (tennis elbow) and the flexors on the inner side (golfer’s elbow). In a healthy tendon the collagen fibres run in tight, parallel bundles (left of the inset). With repeated overload those fibres become disorganised, thickened and frayed (right of the inset), with new blood vessels and nerve endings growing in. This is tendinopathy — a structural change, not simple inflammation — which is why rest alone rarely fixes it and progressive loading does.
Load it — don’t just rest it
The forearm tendon responds to the right kind of loading. A progressive strengthening programme — starting gently and building — together with tweaking the activities that aggravate it, is the backbone of recovery. Most cases settle over a number of months.
Progressive loading first
Graded strengthening of the wrist and forearm (isometric holds to begin with, then heavier work) gradually builds the tendon’s tolerance. We pair it with grip and activity changes so you keep using the arm without constantly re-flaring it.
Be cautious with steroid injections
A cortisone injection can ease pain for a few weeks, but the best evidence shows worse recovery at one year and higher recurrence than physiotherapy or simply letting it settle (Coombes et al., 2013; Bisset et al., 2006). We use injections selectively, not as a first move.
Sources & further reading
Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomised controlled trial. JAMA 2013;309(5):461–469. jamanetwork.com
Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ 2006;333(7575):939. bmj.com
Physiotherapy assessment for tennis & golfer’s elbow
Your first appointment is a proper assessment, in two parts:
Subjective assessment
A detailed discussion about how it started, what makes it better or worse, how it is affecting your work, training and daily life, and your goals — including any event you are building towards.
Objective assessment
A hands-on examination — strength, movement, loading and specific tests — to pin down the diagnosis and what is driving it. Where it will change your plan, we can arrange diagnostic ultrasound scanning in-house.
Book your elbow assessment
Whether it’s a fresh flare or a long-standing elbow that won’t settle, a specialist assessment gives you a clear diagnosis, a loading plan and realistic timelines.