Tennis and Golfer’s Elbow

These conditions are not the same, however the processes involved are remarkably similar:

Tennis elbow, otherwise known as lateral epicondylitis, is inflammation of a muscle attachment point on the outside of the elbow. Golfer’s elbow, or medial epicondylitis, is inflammation of the corresponding muscle attachments on the inside of the elbow.

Tennis elbow is caused by overuse of the extensor muscles of the forearm, an injury particularly associated with racquet sports, while golfer’s elbow is caused by overuse of the flexor muscles of the forearm

Both conditions can cause intense elbow pain. This pain will probably be worse on movement and gripping. Pain may also radiate towards the hand, in some cases covering almost the whole forearm and hand. This may be sharp, dull, or tingling in nature. Strength loss is also relatively common.

The process leading to tennis/golfer’s elbow is accrual of damage to the tendon area of certain muscles. This may occur in response to small repetitive or strenuous loads. Strictly speaking, it is not this loading or damage that causes symptoms, but the subsequent inflammatory response as the tendon begins to heal.

Inflammation is like bruising, but if the responsible area is not rested/treated it can become a self-perpetuating process. By not letting damage properly repair, your inflammatory response goes into overdrive and can actually lead to new tissue damage all by its self.

One of the first phases of tissue healing is the deposition of scar tissue. This is strong material, but it is not adapted to take specific demands in the same way the previously healthy tendon was. This means there is a predisposition to recurrence of the initial injury.

Resolution of either tennis or golfer’s elbow depends on the stage of the injury:

If the injury is relatively new (less than 2 weeks) and not severe, use of anti-inflammatory pharmaceuticals and ice, and rest should be sufficient.

If the injury has been present for some time (anything over 2 weeks) treatment may be required. This is a very simple injury to treat, usually requiring only soft tissue release techniques. Response time varies significantly according to chronicity and patient compliance, but most injuries should heal in less than 6 weeks, potentially requiring another 6 weeks to regain full strength in severe cases.

A complication of tennis elbow is radio-ulnar joint dysfunction. The loads and stresses that caused the tennis elbow can impact on one of the elbow joints. This is a significant cause of chronicity for tennis elbow sufferers. In this case manipulation or mobilisation is the only route to complete resolution of symptoms. Manipulation should provide resolution in less than 3-4 treatments.

If left, radio-ulnar joint dysfunction will predispose to recurrence of tennis elbow, can produce pain in the absence of soft tissue injury, and may cause early degenerative changes.