Tennis and golfer’s elbow: Understanding and treating epicondlylitis. |


Tennis elbow is a painful disorder of the elbow, and occurs in both men and women. Tennis elbow is a condition in which you have pain in the front or outside of the elbow, and it is caused by inflammation of the tendons under the elbow. Tennis elbow can be caused by many different things, and so it is important to rule out other possible causes of elbow pain. Not all elbow pain is tennis elbow, but there are some common causes of tennis elbow that you should know about. This post will outline the causes of epicondylitis (epicondylitis is when your epicondylus (the tendons) are inflamed), and how you can treat it.

Why does tennis elbow occur in the first place? If you have suffered from one, you may have been told that it is caused due to excessive use of the arm. However, in reality, tennis elbow is a condition that is caused by a hyper-flexion of the elbow. Not all tennis players suffer from it, and some even get it from other activities, such as throwing a ball at a dog.

Tennis elbow is not a term you hear often, but it’s a painful condition that is common among triathletes and tennis players. More than 70% of all elbow injuries are due to overuse, and that is exactly what it is! The elbow is where the forearm meets the bony part of the upper arm, and it is a joint that is designed to move in all directions.

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It’s possible that your elbow does not stand out. (In fact, getting a decent look at your own elbow is difficult in the first place.)

Despite this, several muscles, tendons, nerves, and ligaments compete for space in just one small square. While nature’s tight packing job provides stability to the joint, connective tissue congestion can lead to splinters.

Make a fist and wiggle your wrist. Straighten and bend your arm. Try squeezing a tennis ball or opening a jar. Are you experiencing any elbow pain as a result of any of these activities? If that’s the case, you’re not alone.

Tennis or golfer’s elbow affects 1-3 percent of the population. In one survey, as many as 5% of workers said they had taken a sick day due to elbow pain in the previous year.

Tennis and golfer’s elbow affect roughly 29% of those who work in jobs that require repetitive gripping and wrist flexion. Lumberjacks, cooks, professional bodybuilders, and meat processing plant workers are all included.

Tennis and/or golfer’s elbow can also be caused by the following factors:

  • Because women have more joint inflammation and laxity than males, they have more joint inflammation and laxity.
  • The process of aging As we get older, our connective tissues repair less well, and we accumulate a history of cumulative movement stress.
  • Being overweight is a problem. Excess fat tissue secretes inflammatory substances.
  • Smoking This reduces tissue oxygenation and blood flow.
  • Handling loads on a regular basis, especially for prolonged periods of time The stress puts a constant strain on your joints, which they can’t recover from.
  • Bending and straightening the elbow repeatedly Wear and tear is caused by actions such as putting items on a shelf or scanning goods.
  • Getting into a lot of brawls I’m joking… sorta.

What is tennis elbow, often known as golfer’s elbow?

You don’t have to be a golfer or a tennis player to suffer from elbow pain.

The words “tennis elbow” and “golfer’s elbow” merely describe pain that occurs on the outside (lateral) or inside (medial) of the elbow.

Or, in the case of certain unfortunate individuals, both.


Tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis).

Tennis elbow (lateral epicondlylitis) and golfer’s elbow (medial epicondlylitis) are both characterized by a dull aching in the elbow joint that worsens with increased exercise.

The discomfort is usually localized – there’s a specific location that hurts, and gripping and bending and/or straightening the elbow aggravates it.

As more nerves are disturbed, the discomfort might spread down the forearm or up into the biceps and triceps in severe cases. This pain is caused by nerve and soft tissue injury and/or inflammation in the joint.

What are the reasons of elbow pain?

The most common cause of tennis or golfer’s elbow is tendon structural alterations. That shouldn’t come as a surprise, given that tendons are involved in up to 50% of sports injuries.

These structural changes can be caused by a lack of mobility, poor mechanics, overuse, and/or muscle imbalances.

How do tendons function?

Tendons connect muscle to bone and assist the joint develop elastic energy.

Water makes up the majority of them (68 percent), but they also contain connective tissue proteins like type 1 collagen, glycosaminoglycans (which assist absorb shock), and elastin.

A tendon can get shortened, form adhesions, inflame, and break down if it is overused and/or strained.

We also manufacture less connective tissue proteins as we get older. We get stiffer and less supple. As a result, as we get older, we experience more joint pain since we aren’t replacing strained tissues as quickly as a younger person.

Tendons take a long time to mend after they break down due to a lack of blood vessels.

It takes a long time for blood, oxygen, and nutrients to reach connective tissues. In fact, tendon repair might take up to two years following an injury!

The significance of recuperation

It may sound contradictory, but joint health requires regular movement and mobility work. Movement instructs the joint to stay lubricated and produce vital proteins, as well as assisting in the delivery of nutrients to the joints.

However, the nature and loading of the movement must be varied (rather than being always repeated and/or heavy), and the joint’s ability to recover must not be overloaded.

Collagen synthesis and degradation both increase in the first 24 hours following exercise. During this phase, we lose collagen momentarily.

This breakdown, however, reduces over the next 48 hours. Collagen synthesis and regeneration occur. Synthesis is a word that signifies “healing.”

As a result, if we repeatedly hit our tendons with intense exercise, they will be in a constant state of disintegration and will never be able to repair. Pain and dysfunction are unavoidable outcomes.

It kind of enforces the idea of taking a day off in between intense workouts, doesn’t it?

Tendon injuries can range from modest irritation or microtears to full tendon failure, as seen in the chart below.

This is a cumulative process, which means you’ve been overworking your joints and neglecting tiny aches and pains that suggest early stages of injury.

Stages of tendinopathy

Tendonopathies can be treated by eccentric exercise. Strength and Conditioning Journal 2010, Lorenz D., Lorenz D., Lorenz D., Lorenz D., Lorenz D., Lo

What’s the difference between golf and tennis pain?

Sixteen muscles, as well as ligaments, nerves, and blood arteries, cross the elbow joint.

The medial epicondyle is where the muscles that flex your wrist attach (a.k.a. one of the bumps at the end of the bone). The lateral epicondyle is where the muscles that extend your wrist connect.

(A quick note: “medial” refers to items that are closer to your body’s midline, whereas “lateral” refers to things that are farther out.) As a result, the inside of your arm is medial, while the outside is lateral.)

In both cases, the injury is caused by repetitive stress — commonly gripping and either bending or straightening the elbow (as in tennis) (as in golf).

Pain in the middle of the body

A medial collateral ligament injury, ulnar nerve irritation, a bone problem, or issues with the flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), palmaris longus (PL), or pronator teres (PT) muscles can all cause medial elbow pain.

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Pain on the side

Pain in the lateral epicondyle is up to ten times more common than pain in the medial epicondyle. It has been recognized since at least the nineteenth century. Doctors first identified it in persons who played lawn tennis at the time, hence the common name.

Tennis elbow affects inexperienced tennis players more frequently than experienced players, most likely due to over-gripping, a lack of strength in foundational muscles and connective tissues, and poor playing mechanics.

Meanwhile, elderly women who play tennis are more likely to develop tennis elbow if they also do a lot of knitting, macramé, or gardening, all of which place equal stress on the joint.

A lateral collateral ligament injury, radial nerve irritation, arthritis, tissue folds, loose cartilage, or issues with the anconeus (AN), extensor carpi radialis brevis (ECRB), extensor carpi radialis longus (ECRL), extensor carpi ulnaris (ECU), or extensor digitorum (ED) can all cause lateral elbow pain (ED).

For someone suffering from tennis elbow, gripping, twisting the palm towards the face, and attempting to flex the back of the knuckles towards the wrists (for example, when taking the hands off a computer) are all painful activities.

Treatment for elbow discomfort that isn’t surgical

Let’s begin with the most revolutionary therapy method: ice. Ice can be used to reduce inflammation and pain. Tell your buddies that you originally heard it from me.

If ice doesn’t work, your doctor may order an MRI to see how much damage has been done to your ligaments, tendons, muscles, and bones, as well as any changes to the bone itself.

Ultrasound and ECSW (extracorporeal shock wave) therapy may assist to relieve pain and promote tissue regeneration. ECSW appears to be more effective for lateral elbow issues than for medial elbow issues.

Elbow bands appear to aid in the rehabilitation process. Bands distribute stress across more tissues, reducing tension on muscles below where they’re positioned. As a result, a band worn just below the elbow can help relieve pain.

The term “eccentric exercise” refers to the lowering or “negative” part of a movement. (Take the “down” portion of a biceps curl, where you resist the weight just enough to progressively lower it.) Eccentric exercise is frequently suggested for elbow injuries and pain because it promotes tissue remodeling.

Muscles and tendons are put under more strain during eccentric exercise. Meanwhile, it reduces the amount of waste materials produced by the body, which might irritate tissues. This is beneficial to fostering a healing environment. Here’s a link to a video that explains the research on the subject.

Eccentric Exercise Suggestions

If you’re using eccentric motions for tendon rehab, aim for a load that permits you to complete four sets of 15 (or up to 30) repetitions without experiencing any “poor” pain. If you experience any discomfort, take a step back and try again. After a brief warm up, between 3 and 7 total sessions per week should incorporate the rehab activity of choice.

However, throughout an eccentric rehab procedure, do not execute concentric actions. The weight should be returned to the starting position in a passive manner. This may necessitate assisting oneself back to your starting posture. Concentrics can resume whenever you are pain-free and able to do your routine daily activities.

Platelet-rich plasma (PRP) therapy has shown some promise in the treatment of degenerative elbow injuries. Why? Platelets include chemicals that help to initiate and maintain healing. (Platelets migrate to the location of an injury in the body for this reason.)

White blood cells, or WBC, are used in some PRP treatments. It’s unclear whether or not this is useful. While WBCs aid tissue regeneration, they may also cause excessive inflammation at the injury site.

Massage, stretching, and active release treatments (ART) may help with tendonopathy symptoms and rehabilitation.

Compression therapy may aid in the delivery of blood and nutrients to the affected area. An elbow compression sleeve, which delivers both modest compression and proprioceptive (touch) cues that assist patients understand what the joint is doing and may interfere with pain signals, is popular among some people. Others prefer a more severe compression, which involves tightly wrapping the joint (e.g., with elastic banding or a tight cloth bandage) for a minute or two, then unwinding it to allow blood to flow back in.

However, exercise caution. Aggressive compression, according to elbow expert Eric Cressey, could be an issue for patients who have ulnar neuritis or a thoracic outlet presentation. Because of all the nerves exposed in the elbow joint, he advises throwers from utilizing severe compression on their elbows. However, the lower body is a different matter.

Acupuncture and Botox are also mentioned from time to time, although there isn’t a lot of evidence to support their use.

NSAIDs can assist lessen pain in the initial period, but they should not be used to push through pain because this will simply lead to more dysfunction. Long-term usage of NSAIDs might create gastrointestinal problems, which you certainly don’t want to add to your elbow pain.

Corticosteroids are also administered on occasion. These, like NSAIDs, have no direct effect on recovery. They can help with pain relief during rehab, but they can have some negative side effects in the long run, so it’s best not to rely on them.

Nitric oxide may aid in the formation of connective tissue. However, it appears to work best when a patch is applied directly to the wound. It’s difficult to predict whether eating foods and substances that boost nitric oxide production in the body will assist much. (Watermelon, beets, celery, arginine, and garlic are some examples of foods to try.)

A lot of tennis elbow cases, according to Cressey, could be linked to a persistent forward head posture. To be cautious, he recommends that anyone suffering from chronic lateral elbow pain have their neck examined by a chiropractor, physical therapist, or manual therapist.


Surgery is only used as a last option. But it can be employed, and if non-operative treatment fails after a year, it’s probably worth looking into.

Eating for the health of your tendons

Support the health of your connective tissues with a nutrient-rich, low-inflammation diet, regardless of which treatment option you pick.

  • Consume a variety of brightly colored fruits and vegetables.
  • Protein supplies the “building blocks” for tissue regeneration, so eat plenty of it.
  • If you’re lacking in vitamin C, vitamin A, zinc, or copper, consider taking supplements.
  • Consider ginger, turmeric, and/or an omega-3 supplement as anti-inflammatory foods and supplements.
  • Limit inflammatory foods (such sugar and processed foods) as well as any foods you know you’re allergic to.

We also teach how to eat in a way that promotes general health and recovery in PN’s Women’s Coaching, Men’s Coaching, and Certification programs.

What should I do?

Be smart

If your elbow pain lasts longer than a couple of days and ice and rest don’t seem to help, consult your doctor. You realize you need to schedule a meeting. Just go for it.

Examine your repetitive motions, whether they are related to your employment, exercise, or sport. If you’re in pain, you’re probably overdoing it. How many swings, pitches, and other activities do you do each day? How much grip work do you have to do?

You’ll most likely suffer if you repeatedly abuse your tendons.

Work out wisely.

  • To reduce elbow stress, try a safety bar squat or a cross arm (“genie”) front squat instead of standard barbell back squats.
  • Do less biceps and triceps isolated exercises. Instead, concentrate on compound exercises, which have a bigger load and disperse stress over multiple joints.
  • If it hurts, stay away from it. Look for an alternative.
  • Vary your movements and the amount of weight you’re carrying. Between hard workouts, take a day off. Include easy movement and mobility work on recovery days each week. Instead than repeating the same few things over and over, have a wide list of activities.
  • If you like, you can utilize an elbow band during your workouts.
  • To reduce the amount of grasping required for major lifts like this, use lifting straps.
  • Examine your upper body’s general mobility. Elbow pain may be caused by a tight posterior shoulder capsule.
  • Before increasing the speed or resistance with which you accomplish something, be sure you have a good foundation and mechanics. It’s important to keep in mind that connective tissues take a long time to develop and mend.

Live wisely.

  • Examine your PC setup. Change the arrangement if your hands are always in agony.
  • Pain-free strengthening activities (wrist curls, reverse wrist curls, elbow flexion, elbow extension, forearm pronation/supination) should be used during rehab.
  • Gradually return to full-strength activities. Rehabilitation exercises could take up to a year.

Eat smart

To assist moderate inflammation and improve tissue repair, try the following foods and/or supplements:

  • Omega-3 fat-rich foods/supplements include algal oil, flax, chia, hemp, walnuts, leafy greens, fish, and fish and marine oils (e.g. krill and algae)
  • Turmeric, garlic, pineapple, tea, berries, and cocoa are all high in flavanoids.
  • Guava, red bell pepper, broccoli, green bell peppers, strawberries, grapefruit, kohlrabi, papaya, Brussels sprouts, kiwi, mango, oranges are all high in vitamin C.
  • Carrots, pumpkin, sweet potato, spinach, collards, kale, watercress, beets, winter squash, tomatoes, dried apricots, and mango are all high in vitamin A.
  • Mushrooms, spinach, sesame seeds, pumpkin seeds, green peas, baked beans, cashews, whole grains, oysters, chicken, crab, lamb, beef, pork, turkey, lobster, wheat germ, and watermelon seeds are all high in zinc-rich foods.
  • Mushrooms, green leafy vegetables, barley, soybeans, tempeh, sunflower seeds, navy beans, garbanzo beans, cashews, molasses, beef liver, oysters, lobster, crab, chocolate, cocoa powder are all high in copper-rich foods.
  • Supplementing with arginine (7 grams, 2 times per day), HMB (1.5 grams, 2 times per day), and glutamine (7 grams, 2 times per day) may help in collagen deposition and damage repair.

Keep a diet log and note your pain and inflammation symptoms as well.

Examine the data to see if any patterns emerge. Is your discomfort becoming better or worse? Does it appear that certain foods make a difference?

Many people report decreased joint pain when they eliminate inflammatory foods and/or foods to which their bodies react.



It will teach you the optimal diet, exercise, and lifestyle strategies that are specific to you.



To see the information sources mentioned in this article, go here.

Understanding Elbow Pain – Part 1: Functional Anatomy. Cressey E. 9th of May, 2010.

Understanding Elbow Pain, Part 2: Pathology. Cressey E. May 12, 2010.

Understanding Elbow Pain, Part 5: The Truth About Tennis Elbow, Cressey E. 25th of May, 2010.

Understanding Elbow Pain – Part 6: Elbow Pain in Lifters, Cressey E. Tuesday, June 2, 2010.

Cressey E. 13 tips for mighty elbows & wrists. T-nation. September 27th, 2006.

FL Cullinane et al. Is eccentric exercise an effective lateral epicondylitis treatment? A thorough examination. epub July 2013 in Clin Rehabil.

In a large longitudinal study, Descatha A, et al. found a link between self-reported physical exposure and the incidence of medial and lateral epicondylitis. Occupational and Environmental Medicine, vol. 70, no. 6, no. 6, no. 6, no. 6, no. 6, no. 6, no. 6, no. 6, no. 6,

Evidence for the efficiency of electrophysical modalities in the treatment of medial and lateral epicondylitis: a systematic review, Dingemanse R, et al. 0:1-10 in Br J Sports Med.

K. Inagaki, K. Inagaki, K. Inagaki, K. Inagaki, K. Inagaki, K. Inagaki, K. Inagaki, K J Orthop Sci, vol. 18, no. 1, pp. 1–7, 2013.

The importance of platelet-rich plasma in musculoskeletal tissue repair, Halpern BC, et al. HSSJ, vol. 8, no. 2, pp. 137-145, 2012.

Work-related risk factors for lateral epicondylitis in a large working population, Herquelot E, et al. Published August 2013 in Scand J Work Environ Health.

Does the efficacy of exercise therapy and mobilization approaches provide direction for the treatment of lateral and medial epicondylitis? Hoogvliet P, et al. A thorough examination. 0:1-9 in Br J Sports Med.

Epicondylar injury in sports. Hume PA, et al. Epidemiology, kind, mechanisms, assessment, management, and prevention are all covered in this article. Sports Medicine 36:151-170 (2006).

CM Kaczmarek, CM Kaczmarek, CM Kaczmarek, CM Kaczmarek, CM Kaczmarek, CM Kaczmarek, CM Kaczmare Strength and Conditioning Journal, vol. 30, no. 3, pp. 35-40, 2008.

Eccentric exercise therapies for tendinopathies, Lorenz D. Strength and Conditioning Journal, vol. 32, no. 1, pp. 90-98, 2010.

NASM Essentials of Corrective Exercise Training. Eds: Michael A. Clark & Scott C. Lucett. 2011. Lipincott Williams & Wilkins.

Widespread pain in chronic epicondylitits, Pienimaki T, et al. European Journal of Pain, vol. 15, no. 9, pp. 921-927, 2011.

Tennis elbow treatment with platelet-rich plasma. 10th of August, 2011. Sweat Science.

Shiri R & Viikari-Juntura E. Lateral and medial epicondylitis: Role of occupational factors. Best Practice & Research Clinical Rheumatology 2011;25:43-57.

Prevalence and factors of lateral and medial epicondylitis: A population research, Shiri R, et al. 164:1065-1074 in American Journal of Epidemiology, 2006.

B. Rothschild. Tennis elbow: a mechanical solution to a mechanical problem. World Journal of Orthopaedics, vol. 4, no. 1, pp. 103-106, 2013.

Taylor SA & Hannafin JA. Evaluation and management of elbow tendinopathy. Sports Health 2012;4:384-393.

C Van Hofwegen et al., Van Hofwegen C, et al., Van Hofwegen C, Epicondylitis is a condition that affects athletes’ elbows. 577-597 in Clin Sports Med, 2010.

Occupation and epidondylitis: A population-based study, Walker-Bone K, et al. Rheumatology (Oxford) 51:305-310 in 2012.

Wise SL, et al. Rehabilitating athletes with medial epicondylagia. Strength & Conditioning Journal 2011;33:84-91.

As many tennis and golfers know, a tennis and a golfer’s elbow are very similar conditions. They both involve the elbow, and there are similarities in pain, rehab, and prognosis. Most of these similarities are because of tendons of the elbow that are located in the joint. There are however differences. One is that a golfer’s elbow does not have a capsule, but a golfer’s elbow does have a bursa (a small fluid filled sack that is like the inside of an egg). Also, a golfer’s elbow does not require cortisone injections, but a golfer’s elbow does require injections of an anti-inflammatory drug called Restasis.. Read more about lateral epicondylitis and let us know what you think.

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Tennis elbow is a condition in which the tendons, or bands of tissue that connect your forearm muscles to your elbow joint, become inflamed and painful. The treatment for this condition is usually rest, ice, and anti-inflammatory medications like ibuprofen. Golfers elbow is a similar condition that affects the tendons at the back of your forearm. This condition can be treated with rest, ice, and anti-inflammatory medications like ibuprofen.”}},{“@type”:”Question”,”name”:”What is the difference between golfers elbow and tennis elbow?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”
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Frequently Asked Questions

How do you treat tennis elbow and golfers elbow?

Tennis elbow is a condition in which the tendons, or bands of tissue that connect your forearm muscles to your elbow joint, become inflamed and painful. The treatment for this condition is usually rest, ice, and anti-inflammatory medications like ibuprofen. Golfers elbow is a similar condition that affects the tendons at the back of your forearm. This condition can be treated with rest, ice, and anti-inflammatory medications like ibuprofen.

What is the difference between golfers elbow and tennis elbow?

Golfers elbow is a condition that occurs when the tendons in the forearm become inflamed and irritated. Tennis elbow is a condition that occurs when the tendons in the forearm become inflamed and irritated, but also due to overuse of the arm muscles during tennis play.

How do you treat epicondylitis?

Epicondylitis is a condition that causes pain in the elbow. It can be treated with physical therapy, but sometimes it may require surgery.

Related Tags

This article broadly covered the following related topics:

  • golfers elbow treatment
  • lateral epicondylitis
  • golfers elbow
  • golfer’s elbow
  • inner elbow pain