Understanding Golfer’s Elbow and Tennis Elbow

What Are They?

At its simplest, they both involve inflammation of a tendon—a tough, fibrous tissue that connects muscles to bones, allowing movement at the joints.

1. Golfer’s Elbow (Medial Epicondylitis)

   • Inflammation or tendinopathy of the tendons attaching to the inner elbow (medial epicondyle)

   • Common in golf due to repetitive wrist flexion and forearm pronation

   • Symptoms include pain and tenderness on the inside of the elbow, sometimes radiating down the forearm

2. Tennis Elbow (Lateral Epicondylitis)

   • Similar tendinopathy, but affecting the outer elbow (lateral epicondyle)

   • Often caused by repetitive wrist extension and gripping activities

   • Symptoms include pain on the outside of the elbow, which can worsen with gripping or lifting

3. How to Tell the Difference?

   • Location of pain: inside elbow (golfer’s elbow) vs. outside elbow (tennis elbow)

   • Movement tests: pain with resisted wrist flexion/pronation suggests golfer’s elbow, while pain with wrist extension/supination suggests tennis elbow

   • Functional history including golf swing mechanics, racket use, or occupational activities

4. Physiotherapy Assessment

   • Detailed history of pain onset, aggravating factors, and activity levels

   • Palpation of medial and lateral epicondyles to identify tenderness

   • Specific resisted muscle tests: wrist flexion/pronation for golfer’s elbow, wrist extension/supination for tennis elbow

   • Assessment of grip strength, elbow range of motion, and shoulder/scapular function

   • Movement analysis of golf or tennis swing where possible

5. Rehabilitation Timeline and Approach

   • Phase 1: Pain control and load management through relative rest and activity modification

   • Phase 2: Gradual strengthening focusing on eccentric exercises—these involve lengthening a muscle under tension, which helps tendon healing and strengthens the muscle-tendon unit more effectively than concentric (shortening) exercises alone. For example, slowly lowering a dumbbell during a wrist curl rather than just lifting it.

   • Phase 3: Functional training focused on sport-specific movements and return to activity

6. Example Exercises

   • Golfer’s Elbow:

     • Eccentric wrist flexor exercise: Hold a light dumbbell with your palm facing up, use your other hand to help lift the weight, then slowly lower the dumbbell over 3-5 seconds using just the affected arm.

     • Forearm pronation strengthening: Hold a racket, club, or dumbbell vertically and rotate your forearm so your palm faces down, then slowly back up.

     • Grip strengthening: Squeeze a soft ball or hand gripper for controlled repetitions.

   • Tennis Elbow:

     • Eccentric wrist extensor exercise: Hold a light dumbbell with your palm facing down, use your other hand to lift the weight, then slowly lower it over 3-5 seconds using just the affected arm.

     • Forearm supination strengthening: Hold a racket, club, or dumbbell vertically and slowly rotate your forearm so your palm faces up, then back down.

     • Grip strengthening: Similar to above, with controlled squeezes.

Both conditions benefit from scapular stabilization and shoulder strengthening exercises, such as scapular retractions and shoulder external rotations with resistance bands, to improve overall arm mechanics and reduce elbow strain.

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Why See a Physiotherapist?

If you experience persistent elbow pain, a physiotherapist can provide a detailed assessment, develop a personalised rehab plan, and guide you safely through recovery to reduce pain and return you to your sport stronger and pain-free.