.svg)
Meta Description: Learn the differences between tennis elbow and golfer’s elbow, how they’re diagnosed, and evidence-based treatments. See how Ke'Ale Chiropractic in Honolulu, led by Dr. Wyland Luke, helps patients return to pain-free work and sport.
Repetitive hand and wrist tasks load small forearm tendons where they anchor to the elbow. When those loads outpace recovery, the tendon fibers fray, thicken, and become sensitive. Tennis elbow affects the outside of the elbow. Golfer’s elbow affects the inside. Both show up in tradespeople, desk workers, parents of toddlers, musicians, and weekend athletes across Honolulu, not just on courts and courses.
The elbow is a hinge where the humerus meets the radius and ulna. Tendons from the forearm muscles attach to bony bumps called epicondyles. On the outer side, the extensor group lifts the wrist and fingers and stabilizes the wrist during gripping. On the inner side, the flexor-pronator group bends the wrist and turns the forearm palm-down. When those attachment points become irritated from repetitive work, sport, or sudden spikes in activity, pain starts right where tendon meets bone.
Tennis elbow, or lateral epicondylitis, centers on the extensor carpi radialis brevis (ECRB) tendon at the lateral epicondyle. It often follows repetitive wrist extension and forearm supination, frequent mousing, heavy gripping, or backhand strokes. Golfer’s elbow, or medial epicondylitis, involves the flexor-pronator origin at the medial epicondyle. It tends to follow repetitive wrist flexion and pronation, forceful gripping, topspin forehand strokes, or pulling and carrying tasks done with a bent wrist.
Location is your first clue. Outer elbow pain that flares with gripping, lifting a kettle with the palm down, or resisting wrist extension points to tennis elbow. Inner elbow pain that flares with squeezing, carrying a grocery bag, hammering, or resisting wrist flexion points to golfer’s elbow. Weak grip is common in both. Numbness into the ring and little fingers suggests ulnar nerve irritation, which is more often seen with golfer’s elbow because the nerve runs nearby. Morning stiffness, a tender spot on the epicondyle, and an ache that lingers after use are shared patterns.
A focused exam reproduces pain in predictable ways. For tennis elbow, tenderness sits over the lateral epicondyle, pain appears with resisted wrist extension or middle finger extension, and tests like Cozen’s or Mill’s provoke the outer elbow. For golfer’s elbow, tenderness sits over the medial epicondyle, pain appears with resisted wrist flexion or forearm pronation, and a valgus stress may be considered if ligament pain is suspected. Screening the neck and shoulder is smart because nerve irritation or shoulder mechanics can feed elbow pain. Imaging is reserved for atypical cases or slow progress; X-rays help rule out arthritis or calcifications, while ultrasound or MRI can visualize tendon thickening or partial tears.
Most cases begin after a spike in volume or intensity: a big home project, longer keyboard sessions, a racquet change, or a return to sport after a break. Poor wrist position while lifting or typing, a small or worn racquet grip, or tools that force awkward angles keep symptoms going. Correcting those drivers is as important as treating the tendon.
Both conditions respond to a blend of activity changes, hands-on care, and progressive loading. The early goal is to reduce angry inputs, then rebuild tendon capacity and grip strength.
Shorten or modify the tasks that provoke pain. Switch heavy lifts to a palm-up position to reduce extensor load for tennis elbow. Keep the wrist straighter during carries to unload the flexor-pronator group for golfer’s elbow. Use brief ice after activity if it eases soreness. Counterforce straps can reduce peak load at the tendon during tasks, while a night wrist splint may help if you wake with pain. At Ke'Ale Chiropractic in Honolulu, Dr. Wyland Luke also addresses neck and shoulder tension that keeps forearm muscles overactive during desk work.
Gentle joint mobilization for the elbow, wrist, and upper thoracic spine can improve mechanics, while soft tissue work to the forearm flexors or extensors, supinator, pronator teres, and triceps reduces protective tone. Nerve glide drills are added if neural tension contributes to symptoms, especially along the ulnar nerve for inner elbow pain or the radial nerve for outer elbow pain.
Tendons recover by being loaded the right way. Eccentric and slow heavy resistance exercises increase tendon strength and improve pain tolerance. For tennis elbow, a common start is wrist extension with a dumbbell: lift with both hands, lower slowly with the affected side, keeping the elbow slightly bent and the forearm supported. For golfer’s elbow, begin with wrist flexion in a similar controlled pattern. Progress to isometric holds and then to heavier, slower reps as pain allows. Grip endurance work using putty, rice bucket drills, or a towel wring helps restore daily function without flaring symptoms.
For desk work, keep the wrist in neutral, lower mouse sensitivity if you tend to overgrip, and bring input devices close to the body. For racquet sports, match grip size, string tension, and racquet weight to your hand and stroke. Emphasize using the shoulder and trunk to generate power, not the wrist alone. For tools, choose padded handles and keep wrists straight during pulls and pushes. Dr. Luke often reviews workstation photos or short stroke videos from patients to give targeted cues that stick.
Low-level laser may reduce pain and make loading work more tolerable. Shockwave therapy can be considered in stubborn, chronic cases to stimulate healing, followed by a structured loading program. Corticosteroid injections provide short-term pain relief but do not improve long-term outcomes and may weaken tendon with repetition; they are best reserved for select cases with a clear plan to reintroduce strength. Platelet-rich plasma is an option some patients pursue; evidence is mixed, and results hinge on proper rehab afterward.
Dr. Wyland Luke starts with a precise diagnosis, load audit, and movement assessment of the neck, shoulder, and wrist. Care blends manual therapy, a phased loading plan, and real-world adjustments at work or on the court. Most patients follow a two-part home plan: a short daily routine to calm symptoms and a strength routine three days per week that progresses in small, clear steps. Follow-ups track pain during tasks, morning stiffness, grip strength, and work or sport tolerance. The clinic coordinates with primary care or orthopedics if imaging or co-management is needed.
With consistent care, many patients feel steadier grip and reduced task pain within four to six weeks. Chronic, high-load cases may need three to six months to rebuild full tolerance. Signs of progress include less pain during the same workload, improved grip dynamometer readings, and the ability to tolerate heavier or slower reps without a next-day flare. If progress stalls, the plan is adjusted—often by changing exercise tempo, volume, or the angle of load.
A Honolulu carpenter with outer elbow pain after a tight deadline improved by switching to neutral-grip lifting, adding slow wrist extension loading, and soft tissue work to the extensor-supinator complex. Within eight weeks he returned to full duty without daily bracing. A graphic designer with inner elbow pain and ulnar tingling improved after wrist-neutral workstation changes, gentle nerve glides, and progressive wrist flexion loading, then maintained gains with twice-weekly strength and monthly tune-ups.
How do I know if it’s tennis elbow or golfer’s elbow? Outer elbow pain that worsens with gripping and resisted wrist extension points to tennis elbow. Inner elbow pain that worsens with gripping and resisted wrist flexion points to golfer’s elbow. Nerve tingling into the ring and little fingers leans toward golfer’s elbow.
Do I have to stop all activity? Usually no. Replace or modify the motions that spike pain, then reintroduce load with structured strength. Relative rest plus progressive loading beats complete rest.
Will a brace fix it? A counterforce strap can lower peak tendon load during tasks and help short term. It works best alongside a strength plan and technique changes.
What about injections? Steroid injections may ease pain briefly but are not a long-term fix and can weaken tendon with repeats. PRP and shockwave are options for stubborn cases, but rehab remains the foundation.
How long will recovery take? Many improve within six to twelve weeks. Longstanding cases may need several months. Tendons respond to steady, patient loading.
Can this be prevented from coming back? Keep wrist-neutral habits, maintain forearm and grip strength, and avoid sudden spikes in workload. Quick tune-ups at the first sign of returning pain help.
Ke'Ale Chiropractic in Honolulu helps patients sort out tennis elbow from golfer’s elbow and build a clear plan to recover strength and comfort. If gripping, lifting, or typing stirs up your elbow, book an appointment with Dr. Wyland Luke and start a step-by-step plan that fits your work and sport.
