Tennis and Golfer’s Elbow: Causes, Symptoms and How Chiropractic Care Can Help

The first thing to know about tennis elbow is that most people who have it have never played tennis. It shows up in a cross wide section of people including professions such as decorators, gardeners and office workers. Then it is prevalent in new parents lifting a growing baby and anyone who has gripped, twisted or lifted more than their tendons can cope with. The pain of tennis elbow sits on the bony knob on the outside of the elbow and is felt sharply when you shake hands, pour the kettle or turn a stiff door handle.

Its mirror image is golfer’s elbow which produces the same pain but on the inside of the elbow and most people with this presentation don’t necessarily play golf either.

Both are common, both are stubborn if mishandled and both come with a body of evidence. The quick fixes disappoint but a patient based approach led by you and knowing the things you can do yourself do work and being aware of this from the start of your recovery could save you months of prolonged pain. As one of the most searched forms of arm pain, here is a detailed explanation of both arm conditions.

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What are tennis and golfer’s elbow?

Both tennis and golfer’s elbow are tendinopathies that means that they are overload problems in the tendons. Tendons that anchor your forearm muscles to the bony points of the elbow.

In tennis elbow (lateral epicondylalgia), the affected tendons are the ones that lift the wrist and fingers which are anchored to the outer bump of the elbow.

In golfer’s elbow (medial epicondylalgia), it is the tendons that flex the wrist and grip and these are anchored to the inner bump of the elbow.

Despite the word “itis” in their older names, this is not really an inflammation but a change in the tendon’s structure after it has been asked to do more than it could adapt to. Tennis elbow is much the more common of the two, typically arriving between the ages of 35 and 55. Both conditions share the same essential character: pain at a precise bony spot that flares with gripping and lifting, a tendon that has lost tolerance to load and tennis elbow has a strong tendency to recover and the majority of tennis elbow settles within a year even without treatment.[1]

what causes these two elbow conditions?

The pattern I see in my chiropractic clinic is nearly always a change in load rather than a single injury. A weekend spent repointing a patio, a new pull-up routine at the gym, a fortnight of hedge cutting, a laptop centred summer or simply gripping a tennis racquet or golf club with a technique that has changed: the tendon is loaded harder or differently than usual and it tends to object a few days or weeks later.

Age matters because tendon tissue adapts more slowly from the late thirties onward. Occupations with repetitive gripping and twisting ranging from plumbing to hairdressing, carry more risk than sport does.

For golfer’s elbow, throwing, heavy lifting with flexed wrists and tennis racquet or golf club grips that overwork the forearm flexors are the usual suspects. Neither means you must give up the activity, only that the load and the tendon need realigning and be more in step with each other.

Explore our shoulder and arm guides

Shoulder and arm pain: the main guide

Shoulder

Elbow, wrist and hand

Tennis elbow and golfer’s elbow (you are here)
Carpal tunnel, cubital tunnel and guyon’s syndrome
De Quervain’s tenosynovitis
Thumb arthritis
RSI and repetitive strain injury

When arm pain starts in the neck or shoulder girdle

Related guides

Other areas of the body

Bones and joints

Symptoms of tennis elbow and golfer’s elbow

Tennis elbow gives a sharp, well localised pain at the outer elbow bump often spreading a little down the forearm. It is provoked by gripping, lifting with the palm down, wringing a cloth or shaking hands. A weakening grip is common and the morning after a heavy day of activity is often the worst. Tennis elbow is a common complaint I see often from local patients who play tennis just up the road at the West Hants Club in Talbot Woods.

Golfer’s elbow is the same story relocated to the inner bump and provoked by gripping, lifting palm-up and wrist curling. Telling them apart from each other matters. Pain with pins and needles into the ring and little fingers alongside inner elbow pain suggests the ulnar nerve rather than the tendon. We have so many golf courses to blame locally where we live here in Bournemouth, Merrick Park, Parkstone Golf Club and Broadstone being amongst them.

If arm pain presents with neck stiffness or symptoms running below the elbow into the hand this points toward the neck rather than the elbow, which is one reason I examine the neck in every elbow case. The source of the condition is important. True tennis and golfer’s elbow are precise: one spot, one bump, reproduced by one movement.

an infographic explaining the common causes and professions who often suffer with tennis elbow and golfers elbow pain

How chiropractic care may help

The evidence on elbow tendinopathy is unusually clear about what not to do. Corticosteroid injections relieve pain impressively for about six weeks, then the advantage reverses: at one year, injected elbows do worse than elbows treated with physical therapy or even left untouched, with high recurrence rates.[1][2] A large review across tendinopathies confirmed the same pattern of short-term gain and longer-term cost.[3] Meanwhile, a trial comparing hands-on treatment plus exercise against injections and against waiting found the active approach best over the middle and long term.[1] Exercise-based care outperforms passive treatments overall, though the measured effects are modest and the evidence certainty is low, which is precisely why sensible expectations beat miracle promises.[4]

My approach follows that evidence. Hands-on treatment for the elbow, forearm and the neck and upper back are areas that influence arm function and treating them helps settle pain and restore movement in the early weeks. The central focus in the treatment plan, though, is progressive loading: a graded programme that rebuilds the tendon’s tolerance, starting where your tendon actually is and adding load as it adapts. I also research the cause, whether that is grip size of the club, technique, tool choice or workload spikes because a tendon reloaded into the same trap simply objects again. Expect meaningful change over six to twelve weeks with full tolerance sometimes taking longer in a long-standing case. The plan is adjusted visit by visit to how your elbow responds.

If tennis or golfer's elbow pain is affecting your game or getting in the way of things you would rather be doing, come and talk it through. I offer a free 15-minute consultation, you can come in for a short no-obligation chat with no examination or treatment.

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red flags

Elbow tendinopathy is benign and red flags here are rare but a few rare situations warrant a doctor first.

See your GP promptly if the elbow is hot, red and swollen, especially with fever, which can suggest infection or gout rather than tendinopathy; if pain follows a fall or a sudden pop with immediate weakness, which needs assessment for a tear or fracture; if you have unexplained weight loss, night sweats or a history of cancer alongside new arm pain; or if both hands are becoming clumsy or numb, which is a nerve question rather than a tendon one. Elbow pain arriving with chest tightness, breathlessness or sweating phone 999.

Everything else, including months of stubborn, grip-provoked soreness in your elbow, is safe to start with an chiropractic examination.

your first visit to Bournemouth Chiropractic

Your first appointment covers how your painful elbow condition started, what provokes it and what your arm needs to cope with. Then an examination: finding the precise tender point, testing resisted wrist and grip movements that reproduce the pain, checking the ulnar nerve in golfer’s elbow cases and screening your neck so referred pain is not mistaken for a tendon problem. I explain what I find and we agree a plan, including what to modify now and what to keep doing. There is more on the your chiropractic first visit and also lots of helpful answers to common questions ahead of meeting me on my FAQ page.

Frequently Asked Questions

Can a chiropractor help with tennis elbow?

Yes, chiropractic treatment could be a good treatment choice for tennis and golfer’s elbow pain. Hands-on treatment combined with a graded exercise programme outperformed both steroid injection and wait-and-see over the medium to long term in a landmark trial.[1] I pair that with finding with fixing whatever movement overloaded the tendon in the first place. If your case needs a different route, I will say so early on.

Should I get a steroid injection in my elbow?

The evidence says be cautious. Injections for elbow pain work well for about six weeks, then outcomes at one year are worse than with active treatment or even no treatment and recurrence is high.[1][2][3] There are occasional cases where short-term relief has a genuine purpose, but as a default first move, the research does not support it.

How long does tennis or golfer’s elbow take to get better?

With a sensible loading programme, most people notice real change in the discomfort of tennis or golfer’s elbow in six to twelve weeks, as a rough guide. Left entirely alone, the majority of tennis elbow resolves within a year.[1] Long-standing cases take longer to rebuild. The common mistake is resting completely until pain vanishes then returning to full load and starting the injury and pain cycle again.

Should I wear one of those elbow straps?

A counterforce brace for your elbow can take the edge off during unavoidable gripping work and for some people that makes the working day manageable. It is a symptom tool, not a treatment: the tendon still needs progressive loading to recover its capacity. By all means use one, just not instead of the treatment programme.

Does tennis or golfer’s elbow show up on a scan or X-ray?

Elbow conditions such as these rarely show up on a scan or X-ray. Both conditions are diagnosed by examination: the precise tender spot plus pain on resisted movement is the test. Imaging earns its place when the story does not fit, when a tear is suspected after sudden trauma or when a stubborn case fails to progress as it should.

Whatever is behind your tennis elbow or your golfer's elbow, come and find out

Tennis elbow and golfer's elbow are usually linked to overuse, but elbow pain can also be part of a wider picture involving the neck and upper back. Working out which it actually is is important, so a proper assessment is a good starting point. I'd happily see you to find out what's going on. During your consultation I'll be able to answer your questions honestly.

Elbow pain like this is a common reason people book in to see me here in Bournemouth and nearby Talbot Woods and its sports clubs.

If I find your elbow pain is connected to your neck or upper back, chiropractic care is a very well-tolerated option worth considering as treatment and I'll explain to you whether that link applies to you. If it turns out to be an isolated overuse injury without that connection, I'll be upfront about that too and point you toward the right kind of help that might benefit you further, whether that's your GP, a physiotherapist or another specialist.

Call, message or email, whatever's easiest and we'll take it from there.

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References

[1] 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. https://doi.org/10.1136/bmj.38961.584653.AE

[2] 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. https://doi.org/10.1001/jama.2013.129

[3] Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376(9754):1751-1767. https://doi.org/10.1016/S0140-6736(10)61160-9

[4] Karanasios S, Korakakis V, Whiteley R, Vasilogeorgis I, Woodbridge S, Gioftsos G. Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials. Br J Sports Med. 2021;55(9):477-485. https://doi.org/10.1136/bjsports-2020-102525

Medical Disclaimer: The information on this website is for general informational purposes only and does not constitute medical advice, nor is it a substitute for diagnosis, treatment, or guidance from a qualified healthcare practitioner. If you have any health concern, please consult your GP or another appropriately qualified clinician. Chiropractic treatment isn’t suitable for everyone. Suitability is assessed at your initial consultation, with referral to another healthcare professional made where appropriate. Treatment outcomes vary between individuals, and no guarantee of results is made or implied.

Practitioner: Leslie Budzynski D.C. | Doctor of Chiropractic | GCC registration: 00043 | BCA membership number: 0072