Golfer's Elbow vs Tennis Elbow: Understanding the Difference and Treatment

Two Sides of the Same Joint

Tennis elbow and golfer’s elbow are both forms of tendinopathy affecting the elbow, but they affect opposite sides of the joint. Tennis elbow, or lateral epicondylitis, affects the tendons on the outer side of the elbow where the forearm extensor muscles attach. Golfer’s elbow, or medial epicondylitis, affects the inner side where the flexor muscles attach. Despite their sporting names, most people who develop these conditions are not athletes at all.

In Penang, we see tennis elbow most commonly among factory workers in the Bayan Lepas Free Industrial Zone who perform repetitive gripping and twisting motions, office workers who spend hours using a mouse, and hawker stall operators who repeatedly lift woks and cooking vessels. Golfer’s elbow is common among construction workers, mechanics, and anyone who performs repetitive gripping with the wrist flexed. Understanding which condition you have is essential because the exercises and treatment approach differ significantly.

How to Tell Them Apart

The location of pain is the primary distinguishing feature. Tennis elbow causes pain on the outer bony prominence of the elbow that worsens when you extend your wrist backwards, grip objects, or lift with your palm facing downward. Turning a door handle, shaking hands, and lifting a coffee mug are typically painful. Golfer’s elbow causes pain on the inner bony prominence and worsens with wrist flexion, gripping with the palm facing upward, and activities like turning a screwdriver.

Your home visit physiotherapist will perform specific clinical tests to confirm the diagnosis. For tennis elbow, resisted wrist extension and the Cozen’s test reproduce the outer elbow pain. For golfer’s elbow, resisted wrist flexion and resisted pronation reproduce the inner pain. It is possible, though less common, to have both conditions simultaneously, particularly in people whose work involves heavy and varied manual tasks. Accurate diagnosis directs the treatment programme to the correct muscle group.

Why These Conditions Become Chronic

Both tennis elbow and golfer’s elbow frequently become chronic conditions lasting months or even years. This happens because the underlying problem is not simple inflammation, as the names ending in ‘itis’ might suggest, but rather tendon degeneration – a breakdown of the tendon’s collagen structure called tendinosis. Anti-inflammatory medications and cortisone injections may provide temporary relief but do not address the structural changes in the tendon.

The tendon degenerates because it is subjected to loads that exceed its capacity to repair. Each time the tendon is overloaded, microscopic damage accumulates faster than the body can heal it. The key to treatment is not rest – prolonged rest actually weakens the tendon further – but rather a carefully graded loading programme that stimulates the tendon to rebuild its collagen structure. This is where physiotherapy excels, providing the specific loading protocol that research has shown to be the most effective treatment for tendinopathy.

Evidence-Based Treatment: Eccentric and Isometric Loading

The cornerstone of tendinopathy treatment is therapeutic loading. Isometric exercises – holding a position without movement – are used in the early stages to reduce pain. For tennis elbow, this involves holding your wrist in a slightly extended position against resistance for 30 to 45 seconds. For golfer’s elbow, the wrist is held in a slightly flexed position. Research shows that isometric loading can reduce tendon pain by 50 to 70 percent immediately.

As pain settles, eccentric exercises become the primary treatment. Eccentric loading means slowly lowering a weight through the painful movement, which stresses the tendon in a way that stimulates collagen reorganisation and strengthening. For tennis elbow, this means slowly lowering the wrist from an extended position while holding a light weight. Your home visit physiotherapist in Penang will demonstrate exact technique, prescribe the correct weight and repetitions, and progress the programme over six to twelve weeks as the tendon gradually strengthens and pain resolves.

Manual Therapy and Adjunct Treatments

While loading exercises are the primary treatment, manual therapy accelerates recovery by addressing contributing factors. Your physiotherapist will assess and treat restrictions in the neck, shoulder, and wrist that alter the mechanical chain and overload the elbow. Soft tissue massage of the forearm muscles reduces tension on the affected tendon. Joint mobilisation of the elbow and wrist improves movement quality.

Shockwave therapy has growing evidence for chronic tendinopathy that has not responded to exercise alone. It delivers acoustic waves to the tendon, stimulating blood flow and cellular repair. Dry needling of trigger points in the forearm muscles can provide significant pain relief. Taping techniques can offload the tendon during work activities, allowing you to continue necessary tasks while the tendon heals. Your home visit physiotherapist will combine these treatments based on your specific presentation, adjusting the approach as you progress through recovery.

Preventing Recurrence

Once your tennis elbow or golfer’s elbow has resolved, preventing recurrence requires addressing the factors that caused it. Ergonomic modifications at your workstation are essential – adjusting mouse position, keyboard height, and chair setup to reduce forearm strain. For manual workers, grip technique modification, regular rest breaks, and tool handle padding reduce tendon loading.

Ongoing maintenance exercises are equally important. Performing your eccentric and strengthening exercises two to three times per week after recovery maintains the tendon strength that treatment has built. Your home visit physiotherapist in Penang will create a maintenance programme and advise on workplace modifications specific to your job. If you notice the earliest signs of returning pain – morning stiffness in the forearm, pain with gripping after prolonged use – resuming your exercises immediately usually prevents a full recurrence. Early intervention is always more effective than waiting for the condition to become established again.