Tennis Elbow and Golfer's Elbow — What They Are and How Osteopathy Can Help

Tennis elbow and golfer’s elbow are among the most commonly misunderstood conditions in musculoskeletal practice. Despite their names, the majority of people who develop them have never played tennis or golf in their lives. And despite being treated as simple, straightforward conditions, they are frequently mismanaged — with many people spending months or years dealing with pain that responds poorly to rest and anti-inflammatories alone.

Understanding what’s actually happening in the tissue changes everything about how to treat it.

What Are Tennis Elbow and Golfer’s Elbow?

Both conditions are tendinopathies — disorders of tendon tissue resulting from overload and degeneration rather than acute inflammation.

Tennis elbow (lateral epicondylalgia)
Tennis elbow affects the tendons attaching the forearm extensors to the lateral epicondyle — the bony prominence on the outer side of the elbow. It produces pain on the outer elbow that is typically aggravated by gripping, lifting and activities requiring wrist extension or forearm supination.

Golfer’s elbow (medial epicondylalgia)
Golfer’s elbow affects the tendons attaching the forearm flexors to the medial epicondyle – the bony prominence on the inner side of the elbow. It produces pain on the inner elbow aggravated by gripping and activities requiring wrist flexion or forearm pronation.

Both are extremely common — tennis elbow affects approximately 1–3% of the population and is among the most frequent upper limb conditions seen in primary care.

What Causes Them?

Like plantar fasciopathy, elbow tendinopathies are primarily load-related conditions. They develop when the cumulative load placed on the tendon exceeds its current capacity to adapt.

Common precipitating activities include:

Repetitive gripping or lifting — manual work, gardening, carrying
Prolonged computer mouse use — a major cause of lateral epicondylalgia
Sudden increases in activity — returning to sport, new job with different physical demands
Sustained forearm positions — particularly pronation during desk work

Despite its name, tennis elbow is seen most commonly in manual workers, office workers and people who do repeated gripping activities — not racket sports players. The naming reflects historical associations rather than common aetiology.

Why “Epicondylitis” Is Misleading

The traditional term — epicondylitis — implies inflammation. As with plantar fasciitis, histological studies have found that in most established cases, the tissue shows degenerative changes — disorganised collagen, microvascular proliferation, and absence of inflammatory cells — rather than acute inflammation.

This is why anti-inflammatory treatments — NSAIDs, corticosteroid injections, ice — may provide short-term pain relief but rarely resolve the underlying problem. The tissue needs progressive loading to stimulate remodelling — not further suppression of its repair response.

Myths & Misconceptions

“I need to rest it completely” — rest reduces load on the tendon and reduces pain temporarily but doesn’t stimulate the collagen remodelling needed for recovery. Progressive loading is more effective
“A cortisone injection will fix it” — injections can provide meaningful short-term pain relief, but evidence for long-term benefit is limited and repeated injections may weaken the tendon
“I must have been doing something wrong” — tendinopathy develops from accumulated load exceeding tissue capacity, not necessarily from incorrect technique
“It will resolve on its own with rest” — it may eventually, but this often takes 12–18 months or longer without specific treatment. Progressive loading significantly reduces this timeframe
“I need surgery” — Surgery is very rarely indicated and is reserved for severe, long-standing cases that have failed all conservative management. The vast majority of cases respond to rehabilitation

What the Evidence Says Works

Progressive loading — eccentric and heavy slow resistance exercises
Research consistently shows that progressive tendon loading exercises are the most effective treatment for elbow tendinopathy. Specific exercises targeting the wrist extensors (tennis elbow) or flexors (golfer’s elbow) through a full range of motion – starting gently and progressively increasing resistance – stimulate collagen remodelling and restore tendon capacity.

Load management
Identifying and modifying the activities driving the overload — not eliminating them, but managing volume and intensity intelligently — allows the tendon to gradually adapt.

Addressing contributing factors
Weakness or restriction elsewhere – in the shoulder, cervical spine or thoracic spine — can increase load on the elbow. A whole-body assessment often reveals factors that are contributing to the problem from a distance.

How May Osteopathy Help?

Soft tissue treatment
Soft tissue techniques targeting the forearm musculature reduce the muscle tension that contributes to tendon load — providing symptomatic relief and improving the tissue environment for rehabilitation.

Joint mobilisation
Gentle mobilisation of the elbow, wrist and cervical and thoracic spine addresses joint restrictions that may be contributing to abnormal load distribution in the upper limb.

Exercise prescription
A personalised progressive loading programme — with guidance on how much discomfort is acceptable, how to progress and what activities to modify — is the most clinically valuable part of management. Read more about exercise and rehabilitation →

Dry needling
Dry needling targeting trigger points in the forearm musculature can reduce pain and improve tolerance of loading exercises — useful as part of a broader plan rather than as a standalone treatment.

Cervical and thoracic assessment
The cervical spine influences neurological function in the upper limb. Research has found that cervical mobilisation can produce meaningful improvements in lateral elbow pain — reflecting the importance of the whole upper quadrant in elbow tendinopathy.

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Written by John Dods
John Dods holds a Masters of Osteopathy (M.Ost) from the University College of Osteopathy and is registered with the General Osteopathic Council (GOsC) 11168

Last reviewed: July 2026

This information is intended for general educational purposes and should not replace individual medical assessment.