What these actually are
Tennis elbow and golfer’s elbow are the same kind of problem on opposite sides of the elbow:
- Tennis elbow (lateral epicondylopathy) — pain at the outside of the elbow, where the tendons of the wrist and finger extensors attach. Hurts when you grip, lift with the palm down, or shake hands
- Golfer’s elbow (medial epicondylopathy) — pain at the inside of the elbow, where the tendons of the wrist and finger flexors attach. Hurts when you grip, lift with the palm up, or make a fist
Despite the names, most patients are not tennis players or golfers. These are overuse tendon problems, common with repetitive gripping, lifting, typing, tools, and yes — certain sports.
Not actually “itis.” Despite the name, there is little inflammation in a chronic tennis or golfer’s elbow. The problem is degenerative change in the tendon itself, which is why anti-inflammatory strategies (like steroid injections) work short-term but not long-term. The tendon needs to be loaded and rebuilt, not just quieted down.
Management is nearly identical for both, so this handout treats them together. Where something is specific to one side, it’s called out.
The most important fact: this usually gets better
About 80–90% of patients with tennis or golfer’s elbow are significantly better at one year — with or without treatment. That’s the context for every decision below. We’re choosing between treatments that speed recovery, not ones that determine whether you recover.
Step 1: Load modification (not rest)
Complete rest does not heal tendons — load does. But the wrong load keeps them irritated. The goal is to reduce the aggravating activities enough that the tendon settles, while still using the arm normally.
- Identify the aggravator — a specific tool, grip, lifting pattern, or sport move. The pain usually points to it
- Pace it down, don’t stop it — shorter sessions, lighter loads, frequent breaks
- Use both hands, bigger muscles — carry grocery bags on the forearm or shoulder, not by the fingers; lift with the elbow close to the body
- Consider tool changes — larger-diameter grips (built-up handles), lighter tools, vibration-damping gloves for trades
- For tennis/racquet sports: lower string tension, a larger grip size, and stroke technique review can all help
- For golfers: grip pressure is usually the culprit — “hold the club like a small bird”
Step 2: Eccentric loading
Of all the conservative treatments studied, eccentric strengthening has the most consistent evidence. About 70% of patients recover fully with a structured eccentric program.
The simplest, cheapest version is the Tyler Twist (and its reverse), done with a rubber Thera-Band FlexBar ($15–25, widely available online).
For tennis elbow — the Tyler Twist
- Hold the FlexBar vertically with the painful arm gripping it near the top, palm facing away from you
- Grip the bottom of the bar with the other hand, palm facing you, and twist the bar so your wrists are bent in opposite directions (this preloads it)
- Bring both hands in front of you, bar now horizontal
- Slowly let the painful-side wrist straighten back to neutral over 4 seconds, while the other hand holds steady
- Reset and repeat
For golfer’s elbow — the reverse Tyler Twist
Same idea, mirrored: the painful arm grips the bar with palm facing you and twists the opposite way, then you slowly let the wrist return to neutral over 4 seconds.
The protocol (for either)
- 3 sets of 15 repetitions, once daily
- Expect mild soreness during and after — that’s appropriate. Sharp pain is not
- When the current FlexBar color feels easy, progress to the next stiffer color
- Give it 6 to 12 weeks of consistent daily work before judging. Most recovery happens in the second half of that window
If the written instructions don’t quite click, search for “Tyler Twist FlexBar” on YouTube — it’s a common exercise with plenty of good demonstrations.
Step 3: Counterforce brace
A counterforce brace is a simple strap worn on the forearm, about two finger-widths below the painful bump (over the muscle belly, not over the bony point). It works by changing where force transmits through the tendon.
- Does help in the short term — studies show modest pain reduction at 6 weeks
- Doesn’t change long-term outcomes at 6 months
- Cheap and low-risk — $10–15 from any pharmacy
- Not a substitute for the eccentric exercises. Think of it as a comfort measure during aggravating activities
If you buy one, pick a simple strap with a soft pad. Skip the elaborate multi-strap sleeves.
What about a steroid injection?
Steroid injections work in the short term — most patients feel significantly better within a couple of weeks. But the long-term data is consistent and uncomfortable:
- At 6 to 12 months, patients who got a steroid injection have worse outcomes than those who did eccentric exercises alone — or even those who did nothing
- Recurrence rates are high — most short-term responders regress
- Repeated injections can weaken the tendon and increase the risk of rupture
We generally do not recommend steroid injections for tennis or golfer’s elbow as first- or second-line treatment. We reserve them for patients who are severely limited at work or in sleep and need a bridge while the slower treatments take effect — and even then, rarely more than once.
PRP (platelet-rich plasma) injections and shockwave therapy are increasingly used for stubborn cases. Evidence is mixed but promising. It’s an option to discuss if 3–6 months of exercise-based care hasn’t worked.
When surgery enters the picture (rare)
Fewer than 10% of patients need surgery for tennis or golfer’s elbow. It’s considered only after at least 6–12 months of well-executed conservative care has failed. The operation (debridement or release of the diseased tendon) is outpatient, with a 3–6 month return to full activity. Outcomes are generally good but recovery is not fast.
Frequently asked questions
How long until I’m better? Plan on 3 to 6 months for significant improvement with exercises. Most patients are fully back to normal within a year.
Can I keep playing my sport or working? Usually yes, with modifications. Complete rest actually slows recovery. The goal is “hurts a little during, feels okay afterward.”
Do I need an MRI? Rarely. Diagnosis is made on exam. Imaging is reserved for atypical cases, suspected tear, or symptoms that aren’t responding to months of treatment.
Is heat or ice better? Either is fine for comfort. Neither speeds healing. Don’t overthink it — use whichever feels better.
What about topical NSAIDs like diclofenac gel? Reasonable for flares. Better side-effect profile than oral NSAIDs. Won’t fix the tendon on its own.
Does weight training help or hurt? Done thoughtfully, it helps — strong forearms tolerate load better. Done with too much weight, too many reps, or a death-grip on the bar, it keeps the tendon irritated.
When to call us
- Sudden sharp pain or a “pop” at the elbow, especially with bruising or weakness (possible tendon tear)
- Numbness or tingling into the hand — this suggests a nerve problem, not a tendon problem
- Pain that’s clearly worsening after 3 months of consistent eccentric exercises
- Night pain that wakes you up, or pain that limits basic daily activities
- Red, hot, swollen elbow with fever
This handout is provided for educational purposes and does not replace individualized medical advice. Always follow the specific instructions given by your rheumatologist.