Golfer's Elbow vs. Tennis Elbow: What's Actually Going On

By Dr. Michael Minenna D.C., B.Sc., SFMA, FMS

Golf season is back in Manitoba, and with it comes a familiar complaint: a deep ache on the inside or outside of the elbow that flares with every swing, every grip, every time you lift a coffee mug the wrong way. People often arrive convinced they've "done something" to the joint. In most cases, the elbow is the messenger, not the culprit.

Two names, one underlying problem

Tennis elbow (lateral epicondylalgia) involves the tendons on the outside of the elbow that extend your wrist. Golfer's elbow (medial epicondylalgia) involves the tendons on the inside that flex the wrist and grip. Despite the sporty names, most cases have nothing to do with tennis or golf — they show up in tradespeople, new parents, gardeners, and anyone whose forearm load changed faster than the tendon could adapt.

The tissue itself is rarely "inflamed" in the way the old "-itis" label suggested. Decades of research describe these conditions as a tendinopathy: a breakdown in the tendon's normal collagen structure when the demand placed on it outpaces its capacity to repair.^1,2 That distinction matters, because it changes the treatment. You don't calm a capacity problem with rest alone — you rebuild capacity.

Why the elbow is usually the victim, not the villain

This is where regional interdependence — looking at the whole kinetic chain rather than just the sore spot — earns its keep. The forearm tendons don't work in isolation. A stiff wrist, a weak grip, poor shoulder-blade control, or a backswing that loads the arm instead of the trunk all funnel extra strain into that one tendon. Treat only the elbow and you've ignored the reasons it got overloaded in the first place.

In the clinic we routinely find that the painful elbow sits at the end of a chain that started higher up: a shoulder that doesn't rotate well, a thoracic spine that's locked from a winter of desk work, a grip strategy that white-knuckles the club. Address those, and the tendon finally gets a chance to settle.

Loading is the medicine

The most reliable treatment for these tendinopathies is progressive loading — controlled, gradually increasing exercise for the affected tendon and the muscles that support it.^1,3 Isometric holds, slow wrist curls and extensions, and grip work, dosed correctly, give the tendon a reason to remodel and get stronger. Done too aggressively, the same exercises flare it up, which is exactly why supervision and progression matter.

This is the heart of a principle we come back to constantly: there are no bad exercises, only too much too soon.⁴ A wrist curl isn't dangerous. A wrist curl at triple the load your tendon is ready for, the week you also added two rounds of golf, is asking for trouble. The skill is in the dosage.

What a sensible plan looks like

Early on, the goal is to keep the tendon working without stirring it up — gentle isometrics, activity modification, and a look at grip and swing mechanics. As symptoms calm, load increases steadily: heavier, slower resistance work for the forearm, plus strengthening for the shoulder and mid-back so the whole arm shares the job. Most people can keep playing through this with smart modifications rather than shutting down completely.

Recovery from tendinopathy is measured in weeks to months, not days, and that's normal. The encouraging part is that these conditions respond very well to a structured approach that respects the tendon's timeline.

When to get it looked at

If elbow pain is lingering past a couple of weeks, waking you at night, or coming with numbness, tingling, or weakness in the hand, it's worth a proper assessment to rule out nerve involvement and to build a loading plan matched to where you actually are. At Boreal Spine & Sport we assess the whole chain — wrist to shoulder blade — rather than treating the elbow as an island, because that's usually where the answer lives.

References

1. Coombes BK, Bisset L, Vicenzino B. Management of lateral elbow tendinopathy: one size does not fit all. J Orthop Sports Phys Ther. 2015;45(11):938-949.
2. Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409-416.
3. Stasinopoulos D, Stasinopoulos I. Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. J Hand Ther. 2017;30(1):13-19.
4. Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50(5):273-280.