Elbow pain

Elbow pain most of the time is either tennis elbow (lateral epicondylitis) or golfers elbow (medial epicondylitis).

Both conditions are related to inflammation and swelling of the large tendons either on the inside (golfers) or outside (tennis) of the elbow.

Where is the damage?

To begin with swelling and inflammation cause pain because of small tears in the tendon at the side of the elbow. Overtime if it does not heal properly, fibrosis and calcification within the tendon cause chronic pain and stiffness.

This also makes it tricky to treat, although not impossible!

What causes it?

Generally, there is no obvious accident or injury. It does not have to be related to Golf or Tennis, the name is misleading! It is similar to an RSI (repetitive strain injury) in that pain gradually appears over time and its hard to pinpoint an exact cause. You may notice the pain is worse after a particular action or activity.

Repetitive microtrauma over time is what does the damage. Specifically repetitive end-range eccentric loading. This means you are using the muscles around your elbow in the wrong way, due to some task or habit you are repetitively completing or due to biomechanical faults from your shoulder, elbow, wrist or hand.

Throwing sports, tennis, golf, weightlifting and even bowling have all been lead contributors to lateral and medial epicondylitis. Our work activities can also lead to elbow pain, especially if we require a repetitive forceful grip, constant vibration through the wrist and arm and/or commonly having to lift 20kgs or more.

What else could be going on?

Stopping at a diagnosis of just Golfers or Tennis elbow can be detrimental. As up to 84% of people will have a second condition in the same arm at the same time. That second condition could be;

  • Carpal tunnel
  • Lateral epicondylitis (tennis elbow) or medial epicondylitis (golfers elbow)
  • Rotator cuff tendinitis
  • Ligamentous instability, particularly in athletes and weekend warriors
  • Ulnar nerve neuritis, due to associated compression or inflammation of the nerve at the elbow
  • C6 and C6 nerve root cervical radiculopathy

How do I get better?

Treatment which just focuses on pain relief at the tendon, may not be enough to get to the root cause. So making sure your practitioner assesses and treats the whole upper limb and neck is important. A treatment which used multiple different modalities is important too.

At Better Health we work to… 

  • Restore full movement of the elbow and whole upper limb chain
  • Relax tight sore muscles and restricted fascia
  • Strengthen weak muscles
  • Provide support with braces or taping if necessary
  • Rehabilitate the upper limb for proper coordination and movement control
  • Educate you about self-management, including rehab and changing any detrimental habits
  • Manage inflammation if necessary with Shockwave or ultrasound

Amin, Nirav H et al. Medial Epicondylitis: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. June 2015. 23;6:348-355
Hoogvliet et al.  Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review. Br J Sports Med. 2013 Nov;47(17):1112-9
Dr Andrew Richards

Dr Andrew Richards


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