Most people with tennis elbow have never held a racquet, and most golfer’s elbow belongs to people who have never swung a club. The names describe locations, not causes. Tennis elbow is pain at the bony point on the outside of the elbow, where the forearm muscles that lift the wrist and fingers attach. Golfer’s elbow is the mirror image on the inside, at the attachment of the muscles that curl the wrist and grip. In real life the culprits are keyboards and mice, tools, lifting, racquet sports sometimes, any repeated gripping and wrist work that outpaces the tendon.
What is happening in the tendon
Like other tendinopathies on this site, the problem is less inflammation and more a tendon that has become disorganised and sensitive under load it cannot currently handle. That is why gripping a coffee mug, turning a door handle, or shaking hands can hurt out of proportion to any visible problem, the tendon complains at loads it once managed silently.
The trial that should shape your expectations
A rigorous randomised trial in JAMA (Coombes and colleagues, 2013) assigned 165 people with chronic tennis elbow to corticosteroid injection, placebo injection, physiotherapy, or combinations, and followed them for a year. The steroid groups felt better fast, at four weeks, injections looked like the win. At one year the picture reversed: the corticosteroid group had significantly worse outcomes and a 54% recurrence rate, versus 12% with placebo injection. Physiotherapy patients recovered somewhat faster early on and, critically, did not pay for it later.
The takeaway we give patients: if you need to be pain-free for one specific week, an injection has a logic. If you want the elbow fixed, the injection can actively work against you, and the slow road, load management plus progressive exercise, is the treatment.
What the program involves
- Load detective work: which grips, tools, and tasks flare it; modifying technique, handle size, and work pacing rather than simply stopping everything
- Isometrics and slow heavy loading for the wrist extensors (tennis) or flexors (golfer’s), progressed over eight to twelve weeks, grip strength is both the casualty and the target
- The whole arm: shoulder and upper-back strength matter more than people expect; the elbow often pays for work the shoulder should share
- Neck screen: elbow pain is occasionally referred from the neck, and the treatment diverges, worth ruling in or out at assessment
- Patience with the timeline: this condition is notorious for taking months and flaring with premature full-speed returns; most cases settle substantially over three to six months of consistent work, and the large majority within a year
Seek assessment if
The elbow locks or will not fully straighten, there is numbness into the hand (the ulnar nerve runs beside the golfer’s elbow site), pain followed a fall or injury, or you have a hot, swollen joint, those are different problems wearing similar clothes.
References
- 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 randomized controlled trial. JAMA. 2013;309(5):461–469. PMID 23385272
- Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine. 2009;43:409–416. doi:10.1136/bjsm.2008.051193
General information only, not medical advice. Persistent elbow pain deserves an in-person assessment to confirm the source.