Tennis and golfer's elbow

We start with what you do: your sport, your job, and any recent change in load. That might be a big week of riding, a new climbing project, or a new tool or task at work. Then we find where the pain is and what brings it on. We test your grip strength and how your wrist and fingers handle pushing against resistance, and press on the tendons where they attach to the elbow.

We also check your neck and the nerves of the arm. They can cause elbow pain that looks like tennis or golfer's elbow but needs different treatment. If the pain does not fit a tendon pattern, or does not settle, we ask you to see a doctor or nurse practitioner.

Loading exercise is the main treatment. Tendons respond to load, so we set exercises that work the forearm muscles at a level the tendon can handle. The load then builds step by step as the tendon gets stronger. We also look at what loads the tendon in daily life and change it where we can, such as grip size, tool handles or technique.

Other treatments can help alongside the exercise plan:

• Forearm strap (counterforce strap): a brace that can make gripping more comfortable. See splints and bracing.
• Shockwave therapy: a treatment that directs focused sound waves (acoustic waves) through the skin at the painful tendon. Physiotherapists use it for tendon pain that has not settled with exercise, including tennis elbow. See shockwave therapy.
• Needling: IMS or dry needling uses a fine needle to target tight, sensitive bands in the forearm muscles. See IMS and dry needling.
• Hands-on treatment: massage and gentle joint movements (mobilization) to ease pain and stiffness around the elbow.
• Hand therapy: this covers the elbow as well as the hand and wrist. For slow-to-settle elbow pain, we can include a Certified Hand Therapist, certified by the Hand Therapy Certification Commission, in your care. See hand therapy.

You do not always have to stop your sport. Often we lower the load rather than remove it, with shorter rides, easier climbs or fewer racquet sessions while the tendon builds strength. As the pain settles, we raise the load back toward full training.

For riders, we look at brake lever reach and position, grip size, and how much you drag the brakes on long descents. Climbers build back through easier grades and larger holds before small crimps. For trades work, we look at tool grip and ways to share the load between both arms. Racquet players may also want a coach to check technique and grip size.

Book an assessment if elbow pain is affecting your grip, your sport or your work. Come in too if it keeps coming back each time you return to riding, climbing or the job.

See a doctor or nurse practitioner first if you felt a sudden pop in the elbow while lifting, and the arm now feels weak. A torn tendon there may need a surgeon's opinion soon.

Go to the emergency department right away, or call 911, if any of these happen:

• the elbow looks out of shape, or you cannot move it at all, after a fall
• your hand or fingers are numb, cold or pale after an injury
• a hot, red, swollen elbow with a fever