Reviewed by Matt Stanlake — Head Physiotherapist & Director, Upwell Health Collective. APA Member. AHPRA Registration: PHY0000975408. 20 years clinical experience. Last reviewed: May 2026.
The short answer: Tennis elbow (lateral epicondylitis) affects the outside of the elbow and is caused by overuse of the wrist extensor tendons. Golfer's elbow (medial epicondylitis) affects the inside of the elbow and is caused by overuse of the wrist flexor tendons. Tennis elbow is around 5 to 10 times more common than golfer's elbow. Both are tendinopathies caused by repetitive gripping and wrist movement — not just by tennis or golf. The treatment for both is similar but each targets different muscle groups.
Tennis elbow, medically known as lateral epicondylitis, is a tendinopathy of the wrist extensor tendons where they attach to the outside (lateral) bony bump of the elbow. The most commonly affected tendon is the extensor carpi radialis brevis. Despite the name, less than 5% of patients with tennis elbow actually play tennis.
It's caused by repetitive gripping combined with wrist extension, especially under load. Common real-world triggers include: extended computer mouse use, painting and trade work, gardening, weight training (particularly grip-heavy lifts), and repetitive household tasks. Pain is felt on the outside of the elbow, often radiating down into the forearm. Gripping objects, lifting kettles, shaking hands, and turning door handles are typically painful.
Golfer's elbow, medically known as medial epicondylitis, is a tendinopathy of the wrist flexor and pronator tendons where they attach to the inside (medial) bony bump of the elbow. Despite the name, less than 10% of patients with golfer's elbow actually play golf.
It's caused by repetitive gripping combined with wrist flexion and forearm pronation. Common triggers include: throwing sports, weight training (chin-ups, deadlifts, kettlebell work), trades involving repetitive hammering or driving screws, swimming, and certain musical instruments. Pain is felt on the inside of the elbow, often radiating into the forearm and sometimes the ring and little fingers. Gripping, lifting with the palm down, and pulling movements typically aggravate it.
Locate your elbow bony points. The outer (lateral) bump is on the thumb side when your palm faces forward. The inner (medial) bump is on the little-finger side.
Press firmly on each bump. Tennis elbow is sharply tender on the outer bump. Golfer's elbow is sharply tender on the inner bump. Sometimes both are tender, in which case you may have both conditions or another diagnosis like cervical radiculopathy.
Test the provoking movements. With your arm straight and palm down, try to extend your wrist upward against resistance. Pain on the outside of the elbow suggests tennis elbow. With your arm straight and palm up, try to flex your wrist upward against resistance. Pain on the inside of the elbow suggests golfer's elbow.
"The biggest mistake patients make with elbow tendinopathy is resting it completely. Tendons heal through progressive loading, not through avoidance. The first thing I do with a new tennis or golfer's elbow patient is identify the aggravating activities, modify them temporarily, and start an appropriate loading program straight away. Six to twelve months sounds like a long recovery, but most of that timeline is buying time without doing the right things. With proper rehab the meaningful improvement comes much sooner." — Matt Stanlake, Head Physiotherapist, Upwell Health Collective
Both conditions respond to a similar staged approach, with the targeted muscles being the main difference.
Stage 1 is pain reduction. This means activity modification (not rest), targeted soft tissue release, often dry needling, and counterforce bracing where appropriate. This stage typically lasts 2 to 4 weeks.
Stage 2 is isometric loading. Specific isometric holds of the affected tendon group reduce pain and start tendon adaptation. Isometric loading typically begins by week 2 and runs through week 6.
Stage 3 is progressive isotonic and eccentric loading. The patient performs slow, heavy, controlled wrist extension exercises (for tennis elbow) or wrist flexion exercises (for golfer's elbow) under load. This is the bulk of the rehab and typically runs from week 6 to 16.
Stage 4 is return to sport or full function with gradual reintroduction of provoking activities. This typically runs from week 12 to 24.
Both conditions are slow to resolve because tendons heal slowly. Around 80 to 90% of cases resolve within 6 to 12 months with appropriate treatment. Without treatment, the same percentage of cases still resolve, but typically over 18 to 24 months with much higher recurrence rates.
The factors that speed recovery are: early diagnosis, appropriate loading from week 2 onwards, identification and modification of aggravating activities, and consistency with the home program. Cortisone injections may provide short-term pain relief but are increasingly associated with worse long-term outcomes and higher recurrence rates.
Yes, though it's uncommon. Around 5 to 10% of patients with one condition also have the other, usually because the underlying activity loads both tendon groups. Diagnosis and treatment are managed concurrently.
A counterforce brace can provide useful short-term pain relief during aggravating activities. It is not a long-term solution and should be used alongside an appropriate loading program, not instead of one.
Neither is inherently worse. Tennis elbow is more common because daily activities (computer use, gripping) load the extensor tendons more frequently. Both conditions have similar recovery timelines and similar long-term outcomes with appropriate treatment.
Yes, and in fact you should. The right exercise is the primary treatment. Avoid the specific movements that cause sharp pain, but maintain general fitness and start a tendon loading program early. Complete rest typically worsens outcomes.
Generally no. Multiple studies including 2022 to 2024 reviews show cortisone injections provide short-term pain relief but worse long-term outcomes and higher recurrence rates compared to physiotherapy alone. Reserve cortisone for cases where pain is so severe it prevents any meaningful rehabilitation.
Most cases need 8 to 14 physiotherapy sessions across 3 to 6 months. The early sessions establish the loading program. Later sessions monitor progression, adjust load, and address any compensation patterns.
If you have ongoing elbow pain and aren't sure whether it's tennis elbow, golfer's elbow, or something else, a thorough physiotherapy assessment will identify the exact tissue involved and start you on the right loading program straight away. Upwell Health Collective in Camberwell offers 45 to 60 minute initial appointments. 28 free undercover carparks. All health funds accepted via HICAPS. Book online at upwellhealth.com.au or call (03) 8849 9096.
Matt Stanlake is the Head Physiotherapist and Director of Upwell Health Collective in Camberwell. He is a member of the Australian Physiotherapy Association (APAM) and AHPRA-registered (PHY0000975408) with 20 years of clinical experience. Matt has built Upwell into a 7x award-winning multidisciplinary allied health clinic trusted by AFL legends Mick Malthouse and Jonathan Brown. He is the author of Not Broken and the creator of the Whole Person Care framework.