What it is
Tennis elbow (lateral epicondylalgia) and golfer’s elbow (medial epicondylalgia) are tendinopathies of the muscles that attach at the elbow:
- Tennis elbow affects the wrist extensors on the outside of the elbow. The muscles you use to lift your wrist or fingers up.
- Golfer’s elbow affects the wrist flexors on the inside of the elbow. The muscles you use to grip, curl your fingers, or rotate your forearm down.
Despite the names, you don’t need to play either sport. The most common patients we see are people who type a lot, mouse a lot, lift a lot, climb, garden, or recently picked up a new repetitive activity. Anyone whose wrist or forearm is doing more work than the system was conditioned for.
These are tendon problems, and tendons get better with the right kind of loading. Not with rest, not with cortisone shots, and not just with stretching.
What causes it
Common contributors:
- A change in volume. A new instrument, a renovation project, a new sport, a return to climbing or lifting after a layoff. Tendons respond to load, and they don’t love rapid changes.
- Forearm and wrist weakness. Most cases involve a wrist or forearm that hasn’t been deliberately strengthened in years.
- Grip mechanics. Gripping too tight, mousing for hours, or holding tools in ways that compress the structures around the elbow.
- Shoulder and scapular control. A tired shoulder pushes more work down the chain to the forearm. The elbow is often the symptom; the shoulder is sometimes the cause.
- Cervical (neck) referral. Some elbow pain is actually referred from the neck, particularly when there’s tingling or numbness alongside it.
What it feels like
- Pain on the outside (tennis) or inside (golfer’s) of the elbow
- Tenderness right over the bony point of the elbow
- Pain with gripping, lifting, shaking hands, or twisting (e.g., turning a doorknob, opening a jar)
- A weak, “give-out” feeling in the grip
- Sometimes a deep ache that lingers after activity stops
How we treat it
The cornerstone of modern treatment is progressive isometric and eccentric loading. Slowly, deliberately asking the tendon to do more work. Done correctly, this resolves cases that have lingered for months.
A typical plan:
- Differential assessment. Confirm we’re dealing with tendinopathy vs. neck referral vs. nerve entrapment vs. joint involvement.
- Manual therapy to the elbow joint, forearm muscles, and cervical or thoracic spine to restore upstream mobility and downregulate the tissue around the painful tendon.
- Dry needling of the forearm extensor or flexor mass. Often produces rapid, dramatic relief and makes the loading work much more tolerable.
- Progressive isometric and eccentric loading, usually with a light dumbbell, hammer, or band. Calibrated to a level you can do without flaring, then progressed every week.
- Modify, don’t avoid. Keeping you doing as much of the activity that caused it as we can (adjusted technique, adjusted volume) beats complete rest.
- Address the chain. Shoulder and scapular work, neck mobility, and grip ergonomics, so the next flare doesn’t happen.
When dry needling helps
Dry needling is particularly effective for:
- Forearm extensor mass trigger points (tennis elbow) and flexor mass trigger points (golfer’s elbow)
- Triceps and biceps trigger points referring into the elbow region
- Upper trap and scalene trigger points contributing to the chain
When to seek help
Elbow tendinopathy that’s been around longer than two or three weeks is worth treating early. The tendon-loading work has the best outcomes when started before the issue becomes truly chronic. We also see plenty of patients who’ve had it for a year or more and respond very well.
Seek immediate medical care for any of the red-flag symptoms above.