Tennis Elbow & Golfer's Elbow

It tends to begin with something small. A dull ache on the outside of the elbow after a long session at the keyboard. A twinge when you shake hands. Then, gradually, the coffee cup in the morning feels heavier than it should. A screwdriver is suddenly difficult. And the handshake you used to give without thinking now produces a specific, sharp pain at the lateral elbow that you can almost point to with a finger. Tennis elbow and golfer's elbow are among the most common overuse injuries of the upper limb — and despite the sporting names, they affect desk workers, musicians, cooks, and tradespeople far more than they affect athletes.

The clinical picture is well-characterised. According to the 2022 Clinical Practice Guidelines on Lateral Elbow Tendinopathy published in the Journal of Orthopaedic & Sports Physical Therapy (APTA, JOSPT 2022), the annual incidence in the general population is approximately 3 per 1,000 people — rising to 7 to 10 per 1,000 in the 40–60 age group. Tennis players account for only around 5 percent of all clinical cases; yet between 40 and 50 percent of racquet sport players will develop the condition at some point in their career. Without targeted treatment, the typical episode lasts 6 to 24 months. A 2024 comprehensive review in the Journal of Pioneering Medical Sciences found that eccentric strengthening combined with manual therapy produces up to 42 percent pain reduction and 35 percent improvement in grip strength — outcomes that passive treatment and cortisone injections consistently fail to match at 6 and 12 months.

How do I know if I have tennis elbow or golfer's elbow?

The distinction is anatomically clean, though clinically both conditions can coexist and can both present at the same elbow.

Tennis elbow (lateral epicondylitis / lateral elbow tendinopathy)

Pain is located at the lateral epicondyle — the bony prominence on the outer side of the elbow, where the wrist extensor muscles attach. Characteristic triggers: handshaking, lifting with the elbow extended, forearm rotation (turning a key, using a screwdriver), sustained gripping. Pain often radiates down the forearm toward the wrist. The dominant arm is affected in approximately 75 percent of cases.

Golfer's elbow (medial epicondylitis / medial elbow tendinopathy)

Pain is located at the medial epicondyle — the inner bony prominence — where the wrist flexor muscles attach. Characteristic triggers: making a fist, lifting with the elbow flexed, overhead throwing or swinging actions, heavy carrying. Pain may radiate down the inner forearm. Golfer's elbow is significantly less common than tennis elbow — at Munich's Orthopaedic Centre, tennis elbow is diagnosed approximately twenty times more frequently.

Typical features of both conditions:

Point tenderness directly at the epicondyle (outer or inner)
Pain reproduced by resisted wrist extension (tennis elbow) or flexion (golfer's elbow)
Grip weakness — objects feel heavier than expected
Stiffness and pain in the morning that eases with movement
Radiation into the forearm, occasionally toward the wrist or hand

Important differential diagnoses:

Not every elbow pain is tendinopathy. Elbow joint arthritis, radial nerve entrapment (for lateral symptoms), ulnar nerve entrapment at the cubital tunnel (for medial symptoms), and cervical disc herniation at C5–C6 or C6–C7 can all produce symptoms that closely resemble tennis or golfer's elbow. Treating tendinopathy when the actual cause is a compressed nerve produces no improvement — and delays appropriate care. A thorough examination including the cervical spine and shoulder is therefore always part of our assessment.

When to seek urgent care:

Go to A&E for: significant swelling, redness, and warmth at the elbow (possible infection or olecranon bursitis), elbow pain following a fall or direct impact (fracture), or numbness and tingling extending into the hand.

What to do about elbow pain right now

Ice in acute phases, heat in chronic presentations: When tennis elbow has appeared recently and feels warm or inflamed — ice for 15 minutes, several times daily. When symptoms are chronic (present for weeks or months without clear inflammatory signs) — heat improves circulation and prepares the tendon for loading. A grain pillow on the forearm for 20 minutes before activity is a practical measure for many patients.

Start eccentric loading — the most important self-management step: Sit with the forearm resting on the thigh, wrist hanging free over the knee. Hold a light weight (0.5–1 kg). Use the healthy hand to lift the wrist to the start position — then slowly lower it with the affected arm over 3–4 seconds. That slow lowering is the eccentric phase. 3 sets of 15 repetitions daily. For tennis elbow: wrist extension. For golfer's elbow: wrist flexion. Mild pain (2–3 out of 10) during the exercise is acceptable; if symptoms are worse 24 hours later, reduce the weight and continue.

Modify the grip: Tennis players: increase grip size by one overgrip, reduce string tension, and switch to a larger-headed racquet. These three changes reduce the vibration force transmitted to the tendon attachment with each impact. For desk workers: a vertical mouse eliminates the forearm pronation that sustained standard mouse use requires — one of the most common daily drivers of lateral elbow tendinopathy in non-athletes.

What tends to disappoint: Cortisone injections produce reliable short-term pain relief. Multiple high-quality studies, however, show consistently that cortisone-treated patients have worse outcomes at 6 and 12 months than patients treated with exercise and manual therapy. The mechanism is understood: cortisone suppresses the immune response needed for tendon repair and can directly weaken the tendon structure. It is not that cortisone is never appropriate — as a bridge to allow rehabilitation to begin, it can be useful. As a stand-alone treatment or a recurrent intervention, the evidence does not support it.

What's actually happening in the tendon?

The term "epicondylitis" — implying inflammation — is now understood to be a misnomer. Histological studies of chronic tennis elbow consistently find not inflammatory infiltrate but degenerative changes: disordered collagen, failed repair tissue, and micro-vascular in-growth. The more accurate term is tendinopathy — a failed healing response in which repetitive micro-trauma outpaces the tendon's capacity for self-repair.

How it develops:

The extensor carpi radialis brevis (ECRB) is the primary structure involved in tennis elbow — a small but chronically loaded muscle that attaches at the lateral epicondyle and is active in almost every gripping and lifting movement. When the load exceeds the tendon's current capacity — through sustained repetitive use, an unusual activity (hedge-trimming, shovelling snow, a first golf lesson), or a rapid increase in racquet sport volume — micro-tears accumulate. If the load continues without adequate recovery, the tendon produces disorganised replacement tissue rather than healthy collagen. Pain, tenderness, and grip weakness follow.

Who gets it — the non-athlete reality:

Office workers: sustained mouse use, typing with a pronated forearm, poor keyboard position
Tradespeople: sustained screwdriving, hammering, painting
Musicians: string players, pianists, guitarists
Cooks and hairdressers: repetitive cutting, gripping, stirring
Racquet sports athletes: particularly with poor backhand mechanics or undersize grip
Golfers: particularly on the lead arm during the downswing (golfer's elbow) and trail arm (tennis elbow)

The cervical spine connection:

Restrictions in the cervical spine — particularly C5–C6 — sensitise the nerve roots that supply the forearm and elbow. A tennis elbow that fails to respond to correct local treatment frequently has an unaddressed cervical component. Multiple studies show that adding cervical manipulation to local elbow treatment produces significantly better outcomes than local treatment alone. We assess this in every patient.

The shoulder contribution:

Weak shoulder external rotators and scapular stabilisers shift load onto the forearm during gripping and overhead activities. The arm compensates at the elbow and wrist. Addressing shoulder weakness is the upstream intervention that prevents recurrence.

How does a chiropractor treat tennis elbow and golfer's elbow in Munich?

Tennis elbow is a local symptom that rarely has a purely local cause. Our assessment always includes the elbow, wrist, shoulder, and cervical spine. Treatment follows the findings in three progressive phases.

Phase 1: Reduce load, restore tissue quality

In the acute or subacute phase, we focus on reducing tissue irritation and improving blood flow to the tendon attachment. Manual soft tissue techniques targeting the extensor or flexor musculature, trigger point release in the forearm and upper arm, and joint mobilisation of the elbow, wrist, and thoracic spine are the primary tools. Kinesiology taping can offload the tendon attachment and improve sensorimotor feedback. When a cervical component is identified, we treat it simultaneously — and patients consistently notice that addressing the cervical spine accelerates their response to local treatment.

Phase 2: Progressively load the tendon — eccentric training

This is the most evidence-supported component of elbow tendinopathy rehabilitation. Eccentric loading stimulates the production of organised, high-quality collagen and directly addresses the degenerative changes in the tendon. The programme is introduced in the clinic, adapted to the patient's current pain level and daily demands, and progressively advanced. It does not require gym equipment, prior fitness experience, or athletic background. A 60-year-old with a 14-month tennis elbow follows the same fundamental programme as a club tennis player — starting at a lighter load and advancing at the appropriate rate.

Phase 3: Remove the cause — shoulder, cervical spine, technique, ergonomics

This is the phase most often omitted in conventional treatment — and the one that explains why tennis elbows treated symptomatically keep recurring. Once pain has resolved and tendon capacity has been rebuilt, we address why the tendon was overloaded in the first place. This may include: targeted rotator cuff and scapular stabiliser strengthening to redistribute arm loading; workstation ergonomics review (mouse type, keyboard position, screen height); feedback on racquet grip size, string tension, and backhand mechanics for tennis players; and grip and swing technique review for golfers, coordinated with the relevant coach.

A patient who completes all three phases does not typically return with the same elbow problem.

When to see a chiropractor for tennis or golfer's elbow in Munich

As soon as the condition is affecting your work, your sport, or your daily quality of life — and certainly within two weeks if there is no spontaneous improvement. The longer a tendinopathy remains unaddressed, the more disorganised tissue accumulates and the longer rehabilitation takes. The 6–24-month typical unmanaged timeline is not an inevitable biological reality — it is the consequence of inadequate treatment.

You do not need a referral to see us. No GP visit, no orthopaedic waiting list. We offer short-notice appointments because elbow pain affects every task that involves gripping, lifting, or using a keyboard — which is most of modern working life.

Also see a doctor if:

Significant swelling, redness, or warmth accompanies the elbow pain
Symptoms began after a fall or impact
You have progressive numbness or tingling in the hand
After 8–10 weeks of structured conservative treatment without improvement — ultrasound is then indicated to rule out partial tendon tears

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Tennis elbow & golfer's elbow FAQ

Tennis elbow — what should I do immediately? Ice for 15 minutes if acute. Begin light eccentric wrist extension exercises as soon as pain allows. Modify the gripping and lifting activities that most directly provoke symptoms — but don't stop using the arm entirely. If symptoms aren't clearly improving within two weeks, seek professional assessment.

How long does tennis elbow take to heal? With targeted treatment — manual therapy, progressive eccentric loading, and addressing the underlying cause — significant improvement is typically felt within 4–8 weeks. Untreated, the average episode lasts 6 to 24 months. Chronic presentations that have been present for over a year respond more slowly but still consistently improve with correct conservative management.

Is cortisone worth it for tennis elbow? Cortisone provides reliable short-term relief. At 6 and 12 months, however, the evidence consistently shows worse outcomes for cortisone-treated patients compared to those managed with exercise and manual therapy. It is most appropriate as a short-term bridge when pain is too severe to begin rehabilitation — not as a primary or repeated treatment.

Which doctor treats tennis elbow? Orthopaedic surgeons, physiotherapists, and chiropractors all treat elbow tendinopathy. Orthopaedic surgeons are appropriate when imaging is needed or conservative care has failed over 6 months. Chiropractors focus on the mechanical cause: tendon loading, cervical nerve root contribution, shoulder biomechanics, and the progressive rehabilitation programme. Surgery is rarely necessary and should only be considered after 6 to 12 months of consistent conservative treatment.

Can I keep playing tennis with tennis elbow? Usually yes — with modifications. Shorter sessions, fewer backhands, a larger grip, softer strings, and reduced spin generation all reduce the load on the lateral epicondyle. A period of reduced play intensity while rehabilitation is underway is usually better than complete rest. Complete rest delays tendon adaptation and typically means returning to full load with a tendon that hasn't improved its capacity.

What's the difference between tennis elbow and golfer's elbow? Tennis elbow affects the outer elbow (wrist extensors attached at the lateral epicondyle) and is provoked by lifting, gripping, and wrist extension. Golfer's elbow affects the inner elbow (wrist flexors at the medial epicondyle) and is provoked by grasping and wrist flexion movements. Both arise from the same mechanism — overuse tendinopathy — but involve different muscle groups and require different exercise prescriptions.