# Tennis and golfer's elbow Pain on the outside of the elbow (tennis elbow, lateral epicondylalgia) or the inside (golfer's elbow, medial epicondylalgia) usually comes from overloading the forearm tendons used for gripping. In Whistler, common causes are braking on a mountain bike, climbing, trades work and racquet sports. We assess the elbow, settle the pain, and strengthen the tendons with a step-by-step loading exercise plan. ## Symptoms - Pain on the outside or inside of the elbow, sometimes spreading down the forearm - Pain when you grip, lift or twist, such as opening a jar or turning a door handle - Tenderness when you press on the bony bump on the outside or inside of the elbow - A weak grip, or dropping things - Pain braking on a bike, pulling on climbing holds or using tools - Stiffness in the elbow or forearm first thing in the morning ## Assessment 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. ## Treatment 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](https://backinactionphysiotherapy.com/services/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](https://backinactionphysiotherapy.com/services/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](https://backinactionphysiotherapy.com/services/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](https://backinactionphysiotherapy.com/services/hand-therapy). ## Getting back to sport 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. ## When to come in 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 ## Who treats it - [Therese Leigh, Physiotherapist, BSc Physiotherapy, MHA, Dip Sport Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/therese-leigh) - [Mike Conway, Physiotherapist, M. PT Sports, M. PT Manips, M. PT Studies, BSc Kin, CHT, GunnIMS, FCAMPT, CSCS](https://backinactionphysiotherapy.com/team/mike-conway) - [Bianca Matheson, Physiotherapist, BSc PT, Grad Dip PT Manips, Dip Sports Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/bianca-matheson) - [Jian Soares, Physiotherapist, M ClinPhys, BSc PT, FCAMPT](https://backinactionphysiotherapy.com/team/jian-soares) - [Dana Elliott, Physiotherapist, MScPT, BSc](https://backinactionphysiotherapy.com/team/dana-elliot) - [Julie Charette, Physiotherapist, BSc PT, Cert. MDT](https://backinactionphysiotherapy.com/team/julie-charette) - [Emilie Noble, Physiotherapist, MSc PT, BSc Kines, AN-IMS](https://backinactionphysiotherapy.com/team/emilie-noble) - [Cameron Gant, Physiotherapist, BSc Physiotherapy, PG Cert Sports Physio](https://backinactionphysiotherapy.com/team/cameron-gant) - [Nicole Klopfer, Physiotherapist, B Physiotherapy (Hons) (UMelb), M Physiotherapy (Manips) (UWA), PGrad Cert Cont & PF Rehab (UMelb), GunnIMS](https://backinactionphysiotherapy.com/team/nicole-klopfer) - [Michael Pearce, Physiotherapist, BSc PT](https://backinactionphysiotherapy.com/team/michael-pearce) - [Kelsey Rey, Physiotherapist, MPT, BHK](https://backinactionphysiotherapy.com/team/kelsey-rey) - [Keeley Wentzel, Physiotherapist, BSc Physiotherapy (Hons)](https://backinactionphysiotherapy.com/team/keeley-wentzel) ## Services - [Physiotherapy](https://backinactionphysiotherapy.com/services/physiotherapy) - [Hand Therapy](https://backinactionphysiotherapy.com/services/hand-therapy) - [Shockwave Therapy](https://backinactionphysiotherapy.com/services/shockwave-therapy) - [IMS and Dry Needling](https://backinactionphysiotherapy.com/services/dry-needling) - [Splints and Bracing](https://backinactionphysiotherapy.com/services/splints-and-bracing) - [Registered Massage Therapy (RMT)](https://backinactionphysiotherapy.com/services/massage-therapy) ## Frequently asked questions ### Do I have to play tennis to get tennis elbow? No. The name comes from tennis, but most people who get it do not play. Any repeated gripping, lifting or twisting can overload the tendon on the outside of the elbow. That includes long descents on a mountain bike, a day of climbing, or using a screwdriver or a mouse for hours. Golfer's elbow is the same problem on the inside of the elbow. ### Should I rest my elbow completely? Usually not. Easing off whatever flares it up helps, but complete rest can leave the tendon weaker when you go back. Tendons get stronger with the right amount of load. As a guide, activity is fine if it makes your pain no more than a little worse, and the pain settles by the next morning. ### Does a tennis elbow strap help? It can. A counterforce strap sits just below the elbow and takes some of the pull off the sore tendon when you grip. Some people find it makes riding, work or play more comfortable. It supports the elbow but does not treat the tendon, so use it alongside your exercises. We supply tennis elbow braces and can show you where to wear one. ### How long does tennis elbow take to get better? It varies. Tendon pain often settles slowly, and it can take longer if the gripping that set it off continues. It depends on how long you have had it, how much your job or sport loads the arm, and how steadily you keep up the exercises. We track your grip strength and pain during daily tasks, and adjust the plan as you go. ## Massage for recovery Massage therapists do not diagnose, so start with a physiotherapist. Once you have a diagnosis and a plan, our registered massage therapists can help with the recovery. [About massage therapy](https://backinactionphysiotherapy.com/services/massage-therapy) *This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.*