Condition Guide · Brighton & Hove
Elbow tendinopathy is one of the most common and most mismanaged overuse conditions. Rest and anti-inflammatories rarely resolve it. Progressive loading does.
Two Distinct Conditions
Both are tendinopathies of the elbow, but they affect different sides, different muscle groups, and require different treatment approaches. Getting the diagnosis right is the essential first step.
Lateral epicondylalgia
Pain on the outer (lateral) side of the elbow, where the forearm extensor tendons attach to the lateral epicondyle. The most common elbow tendinopathy. Despite the name, most cases occur in people who have never played tennis, typically from sustained gripping, keyboard work or repetitive forearm activity.
Medial epicondylalgia
Pain on the inner (medial) side of the elbow, where the forearm flexor and pronator tendons attach to the medial epicondyle. Less common than tennis elbow. Can be associated with ulnar nerve symptoms including tingling in the ring and little fingers. Often aggravated by throwing, gripping and wrist flexion activities.
Understanding the Condition
Both tennis elbow and golfer's elbow are tendinopathies, degenerative conditions of the tendon rather than inflammatory ones. The tendons at the elbow have been subjected to cumulative overload, producing micro-tears and a failed healing response that results in disorganised, poorly vascularised tendon tissue that is painful under load.
This degenerative nature explains why the standard management approach, rest, ice and anti-inflammatories, produces limited long-term results. Anti-inflammatory medication targets inflammation, but the primary pathology here is degeneration. Rest reduces pain temporarily but removes the loading stimulus the tendon needs to remodel and strengthen.
Tendon tissue has a relatively poor blood supply compared to muscle, which slows its healing response. Significant structural improvement in tendinopathy typically takes 3-6 months of consistent management. This is not a reason for pessimism, the majority of elbow tendinopathies resolve fully with the right approach, but it does set realistic expectations about the timeline.
Sustained gripping activities, keyboard and mouse use, lifting with the palm down, and repetitive forearm rotation are the primary aggravating factors for tennis elbow. For golfer's elbow, gripping, throwing and wrist flexion are the key drivers. Identifying and managing these activities, not stopping them entirely but reducing cumulative load, is an important part of management alongside the rehabilitation programme.
Corticosteroid injections produce rapid short-term pain reduction in elbow tendinopathy, which makes them appealing. However, multiple high-quality studies show that injection produces worse outcomes at 6 and 12 months compared to a wait-and-see approach or physiotherapy. They may also weaken tendon tissue. They are generally not recommended as a first-line treatment and should be considered carefully if offered.
Treatment Approach
Effective management combines hands-on treatment with a progressive loading programme and correction of the contributing factors.
Accurate identification of lateral vs medial presentation, assessment of grip strength, cervical screen (neck problems frequently refer to the elbow), and review of aggravating activities.
Targeted work to the forearm extensor or flexor musculature to reduce tension, improve tissue quality and reduce the load being transmitted to the affected tendon.
Highly effective for elbow tendinopathy. Needling directly to the tendon and surrounding musculature produces significant pain reduction and improved tissue response.
A structured tendon loading programme, starting with isometric exercises and progressing to isotonic and functional loading over weeks, is the evidence-based foundation of management.
Neck and upper thoracic problems frequently contribute to or mimic elbow pain. Ruling out cervical involvement before treating the elbow in isolation avoids a common management error.
A counterforce brace or specific taping technique can provide meaningful symptom relief during activity while the rehabilitation programme progresses.
Self-Management
Sustained isometric wrist extension (tennis elbow) or flexion (golfer's elbow) against resistance for 30-45 seconds provides pain relief and a gentle loading stimulus. Start here before progressing to dynamic loading.
Avoid sustained gripping with the wrist in flexion. Use a wider grip on tools and equipment where possible. Mouse grip and keyboard position are worth reviewing for desk-based presentations.
For sport-related presentations, technique is frequently a contributing factor. A racquet strung too tightly, a grip too small, or a throwing mechanics fault all increase tendon load significantly.
For chronic tendinopathy, warmth before activity improves tissue extensibility and blood flow. Ice may help after activity to manage discomfort, but is not a primary treatment for degenerative tendinopathy.
A tennis elbow brace worn just below the elbow reduces the load through the affected tendon during activity. Available from pharmacies. Useful for symptom management during rehabilitation.
Elbow tendinopathy resolves fully in the majority of cases but takes time. Consistent application of the right management over 3-6 months produces significantly better outcomes than sporadic treatment.
Tennis elbow and golfer's elbow respond well to the right management. Early accurate assessment and a structured loading programme changes outcomes significantly.