Golfer's Elbow vs Tennis Elbow: Causes, Symptoms and How Physiotherapy Can Help

Elbow pain from repetitive activities affects thousands of Malaysians, yet many are confused about the difference between golfer's elbow and tennis elbow. Despite their sporting names, both conditions far more commonly affect non-athletes – office workers, cooks, gardeners, and factory employees across the country. Understanding the distinction between these two conditions is important because the treatment approach, while sharing similarities, has key differences.

The Key Difference: Inner Versus Outer Elbow

Both conditions are forms of tendinopathy – degeneration of tendons at the elbow – but they affect different sides:

Golfer's elbow (medial epicondylitis) affects the tendons on the inner side of the elbow. These tendons belong to the forearm flexor and pronator muscles – the muscles that bend your wrist forward and rotate your forearm palm-down. The pain is felt on the bony bump on the inside of the elbow (medial epicondyle).

Tennis elbow (lateral epicondylitis) affects the tendons on the outer side of the elbow. These tendons belong to the forearm extensor muscles – the muscles that extend your wrist backward and stabilise it during gripping. The pain is felt on the bony bump on the outside of the elbow (lateral epicondyle).

Tennis elbow is approximately 5-10 times more common than golfer's elbow, but golfer's elbow can be more difficult to treat due to the proximity of the ulnar nerve on the inner elbow.

What Causes Each Condition

Golfer's Elbow Triggers

• Repetitive wrist flexion and forearm rotation – Activities requiring forceful gripping with the wrist bent, common in cooking with heavy woks at Malaysian hawker stalls
• Throwing sports – The acceleration phase of throwing in cricket, baseball, or javelin loads the medial elbow structures heavily
• Golf (with poor technique) – Hitting the ground (fat shots), gripping too tightly, or an incorrect swing path can overload the medial tendons
• Carrying heavy loads – Repeatedly carrying grocery bags, children, or heavy equipment with a flexed wrist
• Occupational demands – Plumbing, carpentry, and other trades requiring forceful gripping and twisting tools

Tennis Elbow Triggers

• Extended computer mouse and keyboard use – The most common cause in modern Malaysia, as the wrist extensors stabilise the wrist during typing and mouse work
• Racquet sports – Particularly the backhand stroke in tennis or badminton with poor technique or an overly heavy racquet
• Wringing and twisting motions – Wringing clothes, using screwdrivers, or opening tight jars
• Repetitive lifting with palm down – Pouring from heavy kettles, lifting pans, or carrying plates in the food service industry

Comparing the Symptom Patterns

• Golfer's elbow pain – Located on the inner elbow, worsens with wrist flexion against resistance, gripping, and forearm pronation. May be accompanied by tingling in the ring and little fingers if the nearby ulnar nerve is irritated
• Tennis elbow pain – Located on the outer elbow, worsens with wrist extension against resistance, gripping with the arm straight, and lifting objects palm-down. No nerve symptoms unless the posterior interosseous nerve is involved
• Common to both – Weak grip strength, pain with handshaking, difficulty carrying objects, and morning stiffness that eases with activity

If you recognise these symptoms, it is important to seek professional assessment rather than trying to self-diagnose. Many conditions share similar symptoms, and an accurate diagnosis is crucial for effective treatment.

Struggling with Golfer's Elbow? A physiotherapist can assess your condition and create a personalised recovery plan. Chat with a physiotherapist near you

Physiotherapy Management

Both conditions respond well to physiotherapy, with tendon loading programmes forming the foundation of treatment. However, the specific exercises target different muscle groups.

For Golfer's Elbow

• Eccentric wrist flexion – Slowly lowering a weight from a wrist-flexed position to strengthen the medial tendons
• Pronation strengthening – Progressive loading of the forearm rotation muscles using a hammer or resistance band
• Ulnar nerve mobilisation – If the ulnar nerve is involved, gentle nerve gliding exercises reduce irritation and improve symptoms
• Medial elbow stretches – Extending the wrist and straightening the elbow to gently stretch the flexor-pronator mass

For Tennis Elbow

• Eccentric wrist extension – The Tyler Twist using a resistance bar, or slow lowering of a weight from an extended wrist position
• Isometric wrist extension – Holding the wrist in extension against resistance for pain relief and early tendon loading
• Forearm extensor stretches – Flexing the wrist with the elbow straight to stretch the affected muscles
• Progressive grip strengthening – Building overall forearm strength to distribute load more evenly across the tendons

Shared Treatment Approaches

• Shockwave therapy – Effective for both conditions when they become chronic, stimulating a healing response in the degenerated tendon
• Counterforce bracing – An elbow strap worn below the affected area to redistribute forces away from the damaged tendon during activities
• Manual therapy – Mobilisation with movement techniques (Mulligan approach) and soft tissue work to the forearm muscles
• Ergonomic advice – Workplace modifications to reduce the repetitive loading that caused the condition

Recovery and Return to Activity

Both conditions typically require 3-6 months of consistent rehabilitation for full recovery. Tennis elbow has a slightly better prognosis, with most cases resolving within 12 months.

Golfer's elbow may take longer, particularly if the ulnar nerve is involved. The most important factor in recovery is adherence to the progressive loading programme – doing the exercises consistently and gradually increasing the load as your tendon adapts.

Preventing Elbow Tendon Problems

• Warm up your forearms before activities that involve gripping or repetitive arm movements
• Use proper technique in racquet sports – consider a coaching session to refine your grip and stroke mechanics
• Strengthen your forearm muscles proactively with regular exercises, particularly if your job involves repetitive hand and wrist use
• Use ergonomic tools and equipment that reduce grip force – thicker handles, lighter tools, and appropriate desk setup
• Address early symptoms promptly rather than pushing through pain, which allows the condition to progress

Get Your Elbow Assessed Today

Whether you are dealing with golfer's elbow, tennis elbow, or are unsure which one you have, expert assessment is the essential first step. A qualified physiotherapist can accurately diagnose your condition and create a targeted treatment plan. Find a physiotherapist near you and take the first step toward getting back to the activities you love.