Golfer's elbow vs tennis elbow: which one do you have?

The names are the first source of confusion, and they mislead almost everyone. Most people with golfer’s elbow have never swung a club, most people with tennis elbow have never held a racket, and golfers themselves develop tennis elbow at least as often as the condition named after their sport. What the two conditions share is a mechanism: an overloaded tendon where the forearm muscles anchor to the elbow. What separates them is which side of the elbow is involved, which movements provoke the pain, and a few important differences in how they are examined and managed.

This article walks through how to tell the two apart, what the research says about how common they are and who gets them, why the standard advice about rest and cortisone deserves more caution than it usually receives, and how golfers in particular can approach recovery without giving up the season.

The 60 second self check

Both conditions produce pain at a bony point on the elbow that you can cover with one fingertip. The side tells you most of what you need to know.

Tennis elbow (lateral epicondylitis) is pain at the outer elbow, on the thumb side when your palm faces forward. The wrist and finger extensor muscles attach here through a common tendon. Pain is typically provoked by gripping, lifting with the palm facing down, shaking hands, turning a stubborn jar lid, or lifting a coffee cup. Pressing on the bony knob at the outside of the elbow reproduces the pain, and so does straightening the wrist upward against resistance with the elbow extended.

Golfer’s elbow (medial epicondylitis) is pain at the inner elbow, the side that brushes your ribs at address. The wrist flexor and forearm pronator muscles attach here. Pain is provoked by flexing the wrist downward against resistance, rotating the forearm palm down against resistance, gripping hard, or carrying loads with the palm facing up. Tenderness sits directly on or just in front of the bony point at the inner elbow.

A useful kitchen table test: hold your arm straight out, palm down, and have someone press down on the back of your hand while you resist. Sharp outer elbow pain suggests tennis elbow. Now flip the palm up and resist someone pressing down on your fingers. Inner elbow pain suggests golfer’s elbow.

Side by side comparison

	Golfer’s elbow	Tennis elbow
Medical name	Medial epicondylitis	Lateral epicondylitis
Pain location	Inner (medial) elbow	Outer (lateral) elbow
Tendons involved	Wrist flexors and pronators	Wrist and finger extensors
Provoked by	Resisted wrist flexion, forearm pronation, hard gripping	Resisted wrist extension, gripping with palm down
Everyday triggers	Carrying with palm up, hammering, lifting weights	Handshakes, jar lids, lifting a kettle or coffee cup
Share of cases	Roughly 1 in 4	Roughly 3 in 4
Nerve to watch	Ulnar nerve (ring and little finger tingling)	Radial nerve branches (less common)
Typical age	40s to 50s	40s to 50s

The proportions come from the best population study available. In a Finnish study of 4,783 working age adults, the prevalence of definite lateral epicondylitis was 1.3 percent and medial epicondylitis was 0.4 percent, with the highest rates in people aged 45 to 54 (Shiri et al., American Journal of Epidemiology, 2006). Tennis elbow is roughly three times as common as golfer’s elbow in the general population, and neither condition showed a difference between men and women.

The name ends in “itis,” but it is usually not inflammation

Both conditions were named in an era when persistent tendon pain was assumed to be inflammatory. Tissue studies have since shown that the primary finding in chronic cases is tendinosis: degenerative change in the tendon with disorganized collagen and an absence of the inflammatory cells that “itis” implies (StatPearls, Lateral Epicondylitis; Amin et al., Journal of the American Academy of Orthopaedic Surgeons, 2015). The distinction is practical, not academic. Treatments aimed purely at suppressing inflammation address a process that is largely absent in the chronic phase, which is part of why anti-inflammatory approaches alone tend to disappoint, and why progressive tendon loading, which stimulates the tendon to remodel, has become the core of modern management.

Who actually gets these conditions

The strongest risk factors are not sports at all. In the Finnish population study, the combination of repetitive arm movements and forceful work carried an odds ratio of 5.6 for lateral epicondylitis, and smoking carried an odds ratio of 3.4. Smoking, obesity, repetitive movement, and forceful gripping were each independently associated with medial epicondylitis (Shiri et al., 2006). A follow up review by the same group identified forceful work above 5 kilograms of handled load and vibration exposure as consistent occupational risk factors (Shiri and Viikari-Juntura, Best Practice and Research Clinical Rheumatology, 2011). Carpenters, mechanics, assembly workers, and people who spend hours gripping tools develop these conditions far more often than athletes do.

That said, golf earns its association honestly. In a prospective one year study of 588 Australian amateur golfers, the overall injury incidence was 15.8 injuries per 100 golfers per year, and the elbow and forearm accounted for 17.2 percent of all injuries, second only to the lower back at 18.3 percent. Almost half of all injuries occurred during the golf swing, with ball impact the single most common moment of injury at 23.7 percent (McHardy et al., American Journal of Sports Medicine, 2007). In golfers, repeated impact loading through the grip, turf contact, and high swing volumes without conditioning are the usual contributors, and reviews of upper limb golf injuries report that amateur golfers develop lateral elbow pain at least as often as medial (McHardy and Pollard, Chiropractic and Osteopathy, 2005). The lead arm, the left arm for a right handed golfer, is the more commonly affected side.

Red flags and conditions that masquerade as elbow tendinopathy

Most inner or outer elbow pain is exactly what it appears to be, but a careful examination rules out a short list of mimics.

Ulnar nerve involvement. The ulnar nerve runs immediately behind the inner elbow, and irritation of it can accompany golfer’s elbow in a meaningful minority of cases (Amin et al., 2015). Tingling or numbness in the ring and little fingers, night symptoms, or hand weakness point toward the nerve rather than, or in addition to, the tendon. This distinction changes management, because aggressive stretching and certain braces can aggravate an irritated ulnar nerve.

Neck referral. Cervical radiculopathy, particularly involving the C6 and C7 nerve roots, can refer pain to the outer forearm and elbow. Elbow pain accompanied by neck pain, pain radiating below the elbow into specific fingers, or symptoms provoked by neck positions deserves a cervical examination before the elbow takes all the blame.

Other local causes. Pain at the back of the elbow suggests triceps tendinopathy or olecranon bursitis rather than either epicondylitis. Deep aching with clicking or locking can indicate joint surface or ligament problems. A history of a single sharp injury, rather than gradual onset, changes the differential entirely.

Imaging is rarely needed to make either diagnosis. Both are clinical diagnoses made by history and examination, and X-rays or MRI are reserved for atypical presentations, suspected alternative diagnoses, or symptoms that fail to respond to a proper course of loading treatment (StatPearls, Medial Epicondylitis).

What the evidence says about treatment

The research here is unusually clear, and it contradicts two pieces of extremely common advice.

Complete rest does not fix a tendinopathy. Tendons adapt to load, and a degenerative tendon that is fully rested becomes a deconditioned degenerative tendon. The modern approach reduces the specific loads that provoke sharp pain while keeping the tendon working at a tolerable level, then progressively rebuilds capacity.

Cortisone provides a fast start and a worse finish. This is one of the best documented paradoxes in musculoskeletal medicine. In a randomized trial of 198 people with tennis elbow, corticosteroid injection produced clearly better results than physiotherapy or wait and see at six weeks, but 47 of the 65 initial injection successes had regressed by follow up, and at 52 weeks the injection group had significantly poorer outcomes than the physiotherapy group (Bisset et al., BMJ, 2006). A systematic review of 41 randomized trials covering 2,672 participants confirmed the pattern across studies: a large short term benefit for lateral elbow pain, with the effect reversed at intermediate and long term follow up, where no intervention outperformed the injection groups (Coombes et al., The Lancet, 2010). A cortisone injection is not automatically wrong, but it should be an informed choice about trading short term relief for a worse expected course at one year, not a default first step.

Progressive loading is the treatment with the best long term record. A reasonable evidence based ladder looks like this:

1. Isometric holds for pain control in the irritable phase. Push or pull against an immovable resistance in the provocative direction, without movement, at a moderate effort. A common prescription is 5 holds of 30 to 45 seconds, once or twice daily. Reviews of isometric protocols in tendinopathy support them as a way to load the tendon while keeping symptoms manageable, though effects vary by tendon and person (Clinical Therapeutics systematic review, 2026).
2. Eccentric and heavy slow resistance loading as symptoms allow. For golfer’s elbow specifically, a study of 20 patients with chronic medial epicondylosis who had already failed previous treatment, including cortisone in seven and physical therapy in seven, added a single eccentric wrist flexor exercise using an inexpensive rubber bar, performed as 3 sets of 15 twice daily. Disability scores improved from 34.7 to 7.9 over an average of six weeks of care, and 14 of the 20 patients were golfers (Tyler et al., International Journal of Sports Physical Therapy, 2014). The equivalent eccentric wrist extensor version is well studied for tennis elbow.
3. Grip, forearm rotation, and shoulder capacity work. The elbow sits in the middle of a chain. Weakness at the shoulder and trunk pushes more work to the forearm, so a complete program does not stop at the wrist.

A counterforce brace can help you stay active. The familiar strap worn a few centimeters below the elbow changes where the tendon load is applied. A meta analysis of randomized trials found counterforce bracing reduced pain in lateral elbow tendinopathy, with the clearest benefit as a short term adjunct during provocative activity rather than a cure on its own (Shahabi et al., Prosthetics and Orthotics International, 2020). For golfer’s elbow the same style of strap is worn on the flexor side. If ulnar nerve symptoms are present, brace placement needs care.

Expect months, not days. In the Bisset trial, roughly 9 in 10 participants reported a successful outcome at one year regardless of starting treatment, which is genuinely reassuring: the natural course of these conditions is favorable. But chronic cases commonly take 3 to 6 months of consistent loading to resolve, and rushing the process with repeated injections is the most reliable way to still have the problem next season.

Returning to golf without starting over

For golfers, the practical questions are what to modify and when to come back. The research and clinical experience point to a few specifics.

You usually do not need to stop playing entirely. Reduce volume first: fewer range balls, more putting and short game, and avoid repeated shots off mats or hard turf during the irritable phase, because impact loading was the single most common injury moment in the amateur study (McHardy et al., 2007). Sharp pain during the swing is the signal to scale back further; mild ache that settles within a day is generally acceptable during a loading program.

Check the grip before blaming the swing. A grip that is too small or worn encourages excessive squeezing, and grip pressure is a direct line to both flexor and extensor tendon load. Interestingly, in the amateur injury study, golfers who had changed their clubs more recently had significantly lower injury odds, with an odds ratio of 0.32, which is consistent with worn equipment quietly increasing load (McHardy et al., 2007).

Progress in stages. A sensible return sequence is putting, then chipping, then half swings with short irons, then full swings, then driver, then course play, advancing every few days as symptoms allow rather than on a fixed calendar.

Look above and below the elbow. Limited shoulder or thoracic rotation, or a swing that relies heavily on hand action, concentrates load in the forearms. This is where a clinical evaluation earns its keep: the elbow is examined directly, the ulnar nerve and neck are screened, and the movement pattern that overloaded the tendon in the first place gets addressed rather than just the sore spot.

Frequently asked questions

Can I keep playing golf with golfer’s elbow or tennis elbow?

Usually yes, with modifications. Reduce practice volume, prioritize short game, avoid mats and heavy turf contact while symptoms are irritable, and use pain as a guide: sharp pain during play or pain that worsens through the next day means the current load is too high. Complete rest is rarely required and does not by itself resolve tendinopathy.

How long does recovery take?

Recent onset cases often settle in 6 to 12 weeks with load management and exercise. Chronic cases, meaning symptoms present for months, commonly take 3 to 6 months of consistent loading work. The long term outlook is good: in randomized trial data, about 9 in 10 people reported successful outcomes at one year across treatment groups.

Do I need an MRI or X-ray?

Usually not. Both conditions are diagnosed by history and physical examination. Imaging is reserved for atypical features, suspected nerve involvement, a traumatic onset, or pain that fails to respond to a properly performed course of loading treatment.

Should I get a cortisone injection?

Understand the trade first. Trial data show cortisone produces the best six week results and the worst one year results, with high recurrence after early improvement. For most people, a loading program is the better first choice, with injections reserved for specific situations after that discussion.

Which brace should I use?

A counterforce strap worn a few centimeters below the elbow, positioned over the extensor muscles for tennis elbow or the flexor muscles for golfer’s elbow, reduces pain during activity for many people. It is an adjunct that helps you tolerate play and daily tasks while the loading program does the real work. If you have tingling in the ring and little fingers, get evaluated before strapping the inner elbow.

References

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2. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939. PubMed 17012266
3. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. The Lancet. 2010;376(9754):1751-1767. PubMed 20970844
4. Tyler TF, Nicholas SJ, Schmitt BM, Mullaney M, Hogan DE. Clinical outcomes of the addition of eccentrics for rehabilitation of previously failed treatments of golfers elbow. International Journal of Sports Physical Therapy. 2014;9(3):365-370. PubMed 24944855
5. Amin NH, Kumar NS, Schickendantz MS. Medial epicondylitis: evaluation and management. Journal of the American Academy of Orthopaedic Surgeons. 2015;23(6):348-355. PubMed 26001427
6. McHardy A, Pollard H, Luo K. One-year follow-up study on golf injuries in Australian amateur golfers. American Journal of Sports Medicine. 2007;35(8):1354-1360. PubMed 17387218
7. McHardy A, Pollard H. Golf and upper limb injuries: a summary and review of the literature. Chiropractic and Osteopathy. 2005;13:7. PubMed 15967021
8. Shahabi S, Bagheri Lankarani K, Heydari ST, et al. The effects of counterforce brace on pain in subjects with lateral elbow tendinopathy: a systematic review and meta-analysis of randomized controlled trials. Prosthetics and Orthotics International. 2020;44(5):341-354. PubMed 32635812
9. Shiri R, Viikari-Juntura E. Lateral and medial epicondylitis: role of occupational factors. Best Practice and Research Clinical Rheumatology. 2011;25(1):43-57. PubMed 21663849
10. Soliman EFF, Nagra D, Goh SL, et al. Isometric exercises for tendinopathies: a systematic literature review. Clinical Therapeutics. 2026. PubMed 42203537
11. Li D, Hammad A, Kaiser K. Medial Epicondylitis (Golfer’s Elbow). StatPearls. PubMed 30085542
12. Buchanan BK, Varacallo MA. Lateral Epicondylitis (Tennis Elbow). StatPearls. PubMed 28613744

This article is educational and is not a diagnosis. If elbow pain is limiting your golf or daily activities, a clinical evaluation can identify which structure is involved and what loading plan fits your situation.