Tennis & Golfer's Elbow
Tendinopathy on the outside (tennis) or inside (golfer's) of the elbow from overuse.
Tennis elbow (lateral epicondylalgia) and golfer's elbow (medial epicondylalgia) are tendinopathies of the common extensor or flexor tendons of the forearm at their attachment on the humerus. Historically labeled 'tendinitis', current histological evidence (Maffulli, BJSM) shows the underlying pathology is degenerative tendinosis with disorganized collagen and minimal inflammatory cells. Annual incidence is approximately 1–3% in the general adult population, peaking in the 40s and 50s.
Patients describe pain and tenderness on the bony point of the outer or inner elbow that intensifies with gripping, lifting, twisting (turning a doorknob, wringing a towel), or shaking hands. Grip strength is often noticeably reduced, and pain may radiate down the forearm. Symptoms typically build gradually over weeks rather than appearing suddenly.
Despite the names, fewer than 5% of cases occur in tennis or golf players. The condition is far more common in tradespeople (plumbers, mechanics, carpenters), office workers with sustained mouse and keyboard use, strength athletes, climbers, and stay-at-home parents lifting children repeatedly. Both elbows are affected equally; the dominant arm is involved more often.
A combined, root-cause approach.
Systematic reviews (Cochrane 2013; Cullinane et al., Clin Rehabil 2014) identify eccentric and heavy slow-resistance exercise as the most effective interventions for elbow tendinopathy, outperforming corticosteroid injection at 6–12 months. We combine ART and instrument-assisted soft-tissue work to restore tendon quality, dry needling to reduce pain and improve local circulation, cervical and shoulder assessment to rule out contributing nerve referral, and a structured loading program to actually remodel the tendon.
- ART and Graston for the forearm
- Dry needling
- Eccentric loading rehab
- Cervical assessment
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Strain, tendinopathy, or partial tears of the rotator cuff causing pain and weakness.