Patient information · Orthopaedics and physiotherapy
Tennis and golfer's elbow
loading the tendon, not resting it
Pain on the outside of the elbow is tennis elbow; on the inside it is golfer's elbow. Most people who get either have never played the sport. Both are tendon problems, and the treatment that works is graded loading — which is close to the opposite of what most people instinctively do.
Arrange assessment rather than self-treating if you have
- elbow pain after a fall or direct injury, with swelling or deformity
- pins and needles or numbness in the hand or fingers
- weakness of grip that is worsening, or difficulty straightening the elbow
- a hot, red, swollen elbow with fever
- pain that is constant and present at rest or at night, rather than related to use
- no improvement after three months of appropriate treatment
Constant night pain, neurological symptoms or systemic upset all point away from a simple tendon problem and need examining. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
It is not inflammation, despite the name
The suffix 'itis' is a historical misnomer. What is actually happening is disorganised, degenerative change in the tendon where it attaches to the bone, with very little inflammation present. This matters practically: anti-inflammatories give only short-term pain relief, rest alone does not heal the tendon, and the treatment that genuinely works is progressive loading to stimulate the tendon to remodel.
Recognising it
- Tennis elbow — pain on the outer bony point of the elbow, worse gripping, lifting with the palm down, shaking hands, turning a doorknob or holding a kettle.
- Golfer's elbow — pain on the inner bony point, worse gripping and with the palm turned up.
- Both are tender to press directly over the bony point, and both frequently ache after activity rather than during it.
- Common causes are DIY, decorating, gardening, plumbing, keyboard and mouse use, carrying, and any sudden increase in gripping activity.
The treatment that works
- Modify, do not stop. Reduce the aggravating activity enough to bring pain to a tolerable level, but keep using the arm. Complete rest weakens the tendon further.
- Start isometric holds. Hold a light weight with the wrist steady for 30 to 45 seconds, five repetitions, several times a day. These reduce pain and are the entry point when things are very sore.
- Progress to slow, heavy loading. With a light dumbbell or resistance band, lower the wrist slowly over three to four seconds, then use the other hand to return it. Three sets of ten to fifteen, every other day.
- Increase the weight gradually as it becomes comfortable. Discomfort during exercise up to about 4 out of 10 is acceptable and expected; it should settle within 24 hours.
- Keep going for months, not weeks. Stopping when it feels better is the commonest reason it returns.
Other measures
- A counterforce brace worn on the forearm just below the elbow reduces the load on the attachment and helps many people during activity.
- Anti-inflammatory gel rubbed in locally for symptom relief.
- Reviewing technique and equipment — grip size, mouse and keyboard position, tool weight.
- Shockwave therapy has reasonable evidence for tendon problems that have not responded to loading exercises.
- Surgery is rarely needed and reserved for the small number still limited after a year or more of proper treatment.
Steroid injections: short-term gain, long-term cost
A corticosteroid injection typically gives good relief for six to twelve weeks. However, several good-quality trials show that at six and twelve months, people who had an injection do worse than those who did exercise alone, with higher recurrence rates. Injections are not banned — they have a role where pain is preventing any rehabilitation at all — but they should not be the first move, and they should always be followed by a loading programme.
Book an appointment if pain has lasted more than six weeks, is affecting your work, or you want a structured loading programme rather than guesswork. Our physiotherapy team can assess the tendon, check for nerve involvement, arrange ultrasound, and set the programme up properly — and we offer shockwave therapy on site.
Physiotherapy, ultrasound and shockwave on site
Same-day appointments most days, seven days a week, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.