Medial vs. lateral epicondylitis explained by a North Georgia chiropractor: causes, why golfers get both, conservative treatment, and when to seek care.
If you have nagging pain on the inside or outside of your elbow, you are not alone, and you are probably wondering which one you have and what to do about it. I see this constantly in my offices in Canton, Cartersville, and Rome — and not just in golfers. Plumbers, painters, rock climbers, pickleball players, and people who spent a weekend ripping out drywall all come through my door with the same complaint: "My elbow is killing me and I don't remember hurting it." That last part is the tell. These problems almost never come from a single injury. They build quietly from repeated load until the tendon finally complains.
"Golfer's elbow" and "tennis elbow" are the everyday names for two distinct tendon problems, and the names are honestly a little misleading — most people who get them have never swung a club or a racquet. In this article I want to do something simple and useful: tell you clearly how the two differ, explain why golfers in particular can end up with both, walk through the conservative care I actually use, and be honest about the symptoms that mean you should get checked sooner rather than later. No scare tactics, no sales — just the same straight talk I give patients across North Georgia.
The short answer: it is the same kind of problem on opposite sides of the elbow. Golfer's elbow, or medial epicondylitis, is irritation of the tendons that attach to the bony bump on the inside of your elbow — the medial epicondyle. Those tendons belong to the muscles that flex your wrist and curl your fingers toward your palm. Tennis elbow, or lateral epicondylitis, affects the tendons on the outside bump — the lateral epicondyle — where the muscles that extend your wrist and pull your hand back attach. So the simplest field test is location: inside elbow points toward golfer's; outside points toward tennis.
According to the American Academy of Orthopaedic Surgeons, medial epicondylitis produces pain and tenderness at that inner bump that often worsens with gripping and wrist flexion, and it can radiate down the inner forearm. Tennis elbow does the mirror image — pain that flares when you grip, lift, or extend the wrist, like turning a doorknob or shaking hands. The Mayo Clinic describes golfer's elbow as pain that can spread from the inner elbow into the forearm and wrist, sometimes with stiffness, weakness in the hand, or even tingling in the ring and little fingers.
One thing I want to clear up, because it changes how we treat it: despite the "-itis" in the medical names, the chronic version of both conditions usually is not raging inflammation. When researchers look at these tendons under a microscope after weeks or months of symptoms, they typically find disorganized, degenerated tendon fibers rather than a swarm of inflammatory cells. That is why the more accurate word is tendinopathy. It matters for you because it explains why pure rest, ice, and anti-inflammatories so often disappoint — they may calm a flare, but they do nothing to rebuild a tendon that has gotten weak and disorganized. Tendons get better when you load them correctly, not when you hide from load forever.
Here is the rough self-check I teach patients. Press on the bony bump on the inside of your elbow, then make a fist and bend your wrist down against light resistance from your other hand — if the inside lights up, that points toward golfer's elbow. Now press the outer bump and try to lift the back of your hand up against resistance with your arm straight — if the outside complains, that points toward tennis elbow. Plenty of people are tender in both spots, and that is genuinely common. This is a clue, not a diagnosis; a hands-on exam sorts out the in-between cases and rules out the things that masquerade as elbow tendinopathy.
What can masquerade as one of these? A few things I always keep on my list. Irritation of the ulnar nerve as it passes behind the inner elbow can mimic golfer's elbow but tends to bring numbness or tingling into the ring and little fingers. A pinched nerve in the neck can refer pain down the arm and fool you into chasing the elbow when the real driver is higher up. Less commonly, a partial tendon tear, a joint problem inside the elbow, or even referred pain from the shoulder shows up wearing the same costume. None of this is meant to alarm you — the overwhelming majority of inside-or-outside elbow aches really are straightforward tendinopathy — but it is exactly why I do not diagnose anyone off a text message. A careful history and a physical exam settle it quickly.
Both conditions come from the same root: repeated load that outpaces the tendon's ability to recover. Mayo Clinic notes that golfer's elbow develops from repeated or forceful wrist and finger motion, and crucially that it is not limited to golf — racquet sports, throwing, and any forceful, repetitive gripping work can produce it. The common thread across every case I see is grip. Every time you clamp down hard on a club, a hammer, a dumbbell, or a steering wheel on a long drive to Atlanta, the wrist flexors and extensors fire to stabilize, and they pull on those elbow attachments. Do that thousands of times with a death grip and the math eventually catches up with the tissue.
Now, why both in a golfer? Think about what each arm is doing. The trail arm (the right arm for a right-handed player) does a lot of wrist flexion and forearm pronation through impact, loading the medial tendons — the golfer's-elbow side. Meanwhile the lead arm absorbs the shock of impact and the deceleration that follows, and a chronically extended, tense lead wrist loads the lateral tendons — the tennis-elbow side. Add in hitting "fat" shots that catch the ground, mats at the range, an oversized or over-tight grip, and high swing volume, and it is entirely possible to irritate the inside of one elbow and the outside of the other. That is not bad luck. It is two different mechanical demands meeting two tendons that were already near their limit.
The deeper issue, and the one I care about most, is that the elbow is usually the place the body sends the bill — it is rarely where the debt was run up. If your hips don't rotate well, if your thoracic spine is stiff, or if your shoulder lacks mobility, your arms and wrists end up overworking to make up the difference. That is the kinetic chain at work, and it is exactly why I look well beyond the sore elbow. As a Titleist Performance Institute (TPI) Certified provider at Medical Level 3 and Golf Level 2, I assess how a body moves through a golf swing and where the chain breaks down; my SFMA Level 2 (Selective Functional Movement Assessment) training adds a systematic way to trace a painful joint back to the movement restriction actually causing the overload. You can read more about how I approach the whole athlete on my golf performance and sports injuries pages, and locally I see plenty of this through my Canton golf performance work.
When someone comes in with elbow pain, I rarely spend the whole visit on the elbow. Yes, I confirm which tendon is irritated, how irritable it is, and how much it tolerates being loaded — that tells me where to start the rehab. But then I work up the chain. Using the SFMA Level 2 framework, I screen how the wrist, elbow, shoulder, thoracic spine, and hips move, and I look for the spot where motion is missing and another region is compensating. If your mid-back won't rotate, your arms swing harder to make up the difference. If a hip is stiff, your upper body torques to compensate, and the wrist and elbow pay for it. Finding that primary restriction is what separates a fix that lasts from one that fades the moment you go back to your normal volume. The elbow is the symptom; the assessment is about finding the cause.
The reassuring news is that the large majority of these cases improve with conservative, non-surgical care — it just takes patience and the right kind of work, not just time off. I want to be clear that no honest clinician can promise a cure or a timeline that fits everyone; tendons are individual, and how long you have had it matters. Here is the framework I use, and it is essentially the same for both the medial and lateral versions, with the loading direction flipped.
I rarely tell anyone to stop everything. "Relative rest" means backing off the specific aggravating load — the death grip, the high-volume range sessions, the repetitive work task — while keeping the arm moving in pain-free ranges. Complete shutdown lets the tendon get even weaker and deconditioned, so when you return, you are right back where you started. AAOS lists activity modification and addressing the offending movement as first-line steps for medial epicondylitis, and that matches what works in practice. We dial the load down, not off.
Tight, ropey forearm muscles and restricted tissue around the elbow keep tension on the tendon attachment. Manual soft-tissue techniques — including Active Release Technique — help restore glide between the muscle and surrounding tissue and reduce that constant pull. I also check the joints up the chain, because a stiff wrist, elbow, or shoulder forces the irritated tissue to do more than its share. Spinal and joint manipulation has a reasonable evidence base for musculoskeletal pain; the NCCIH notes it is generally considered safe when performed by a trained professional, and the American College of Physicians guideline supports manual and active, non-drug approaches as part of conservative musculoskeletal care. Hands-on work feels good and buys you a window — but it is not the whole fix on its own.
This is the heart of it. Tendons respond to gradual, controlled load by reorganizing and strengthening. For these conditions, slow eccentric loading — emphasizing the lowering phase of a wrist movement — is the workhorse. For golfer's elbow, that means slow wrist-flexion lowering with a light weight; for tennis elbow, slow wrist-extension lowering. We start light, keep it to a mild, tolerable ache rather than sharp pain, and add load over weeks. This is the opposite of resting and waiting, and it is what turns a tendon that has been sore for months into one that holds up again. It is unglamorous and it is slow, and it works.
A realistic word on the timeline, because patients always ask: tendon remodeling is measured in weeks to months, not days. It is normal to feel a low-grade ache during and after the exercises early on — that is different from sharp, worsening, or lingering pain, which means we have pushed too hard and need to scale back. The most common reason these programs fail is not that they do not work; it is that people quit at three weeks because they felt better and assumed they were done, then re-load a tendon that was only halfway rebuilt. Consistency and gradual progression beat intensity every time here.
If we rebuild the tendon but never change why it got overloaded, you will likely be back. So we address the inputs: grip size and grip pressure, range-session volume, and the mobility and strength gaps up the chain that made the arm overwork. For golfers, this is where I coordinate with your coach. I treat the body, not the swing — I am not going to rebuild your golf swing, and I will tell you honestly when something is a coaching question. But when stiff hips, a locked-up mid-back, or a cranky shoulder are driving the elbow problem, that is squarely my job, and it connects to the shoulder and related joint work I do. The best outcomes happen when your golf pro and I are rowing in the same direction.
People ask about counterforce straps — the bands that wrap around the forearm just below the elbow. They can take some edge off the pull on the tendon during activity for certain people, and I have no problem with a patient trying one as a short-term comfort tool. Just understand what it is: a way to tolerate load while the real work happens, not a treatment that rebuilds anything. The same goes for ice or an over-the-counter anti-inflammatory during a flare — fine for short-term symptom relief, not a substitute for loading the tendon. Decisions about injections or any medication belong with your physician; my lane is conservative, hands-on care and rehab, and I will refer you out when something falls outside it.
Most elbow tendinopathy is safe to manage conservatively, but I want you to know the situations where you should not just wait it out. See a clinician promptly — and head to urgent care or the ER for the acute red flags — if you notice any of the following.
Mayo Clinic specifically flags that you should contact a doctor if elbow pain doesn't respond to rest and basic care, or if it is associated with the more alarming signs above. For the ordinary, slow-building ache without those red flags, an evaluation still pays off — getting the diagnosis right and starting the correct loading program early tends to shorten the whole episode. Tendons that have been ignored for a year are simply harder to turn around than ones we catch at six weeks.
You can stack the odds in your favor, even if nothing is a guarantee. The biggest lever is managing load: increase volume gradually, whether that is range sessions or a home-improvement project, and give tissue time to adapt rather than going from zero to a marathon weekend. Watch your grip — both the size of the handle and how hard you squeeze. A relaxed, appropriately sized grip is one of the most underrated injury-prevention tools there is, and it costs nothing.
Beyond that, keep the forearms, wrists, shoulders, and mid-back mobile and strong, so the load gets shared instead of dumped on the elbow. A few minutes of forearm and grip strengthening, plus general upper-body conditioning, goes a long way. If you play golf, build your fitness for the demands of the swing, and let your pro handle technique while you keep the body capable of executing it. This is exactly the kind of whole-body screening my TPI and SFMA training is built for: spotting the mobility or stability gap that is quietly loading your elbow before it becomes a problem. I work with athletes and weekend warriors all over North Georgia — from Cherokee County out to Bartow and the LakePoint crowd, and up around Floyd County and the Berry and Shorter communities in Rome — and the pattern is the same everywhere: the people who manage their load and keep the whole chain strong are the ones who stay on the course and off my table.
If your elbow has been talking to you for more than a couple of weeks, don't tough it out indefinitely. Conservative care is effective for most people, but it works best when it is the right care, started early, and aimed at the real cause. I am available at all three offices — Canton, Cartersville, and Rome — and I am always happy to take a look and tell you honestly what I think is going on. No sales. Only exceptional care.
Location is the fastest clue. Golfer's elbow (medial epicondylitis) causes pain on the inside of the elbow that worsens with gripping and bending the wrist down. Tennis elbow (lateral epicondylitis) causes pain on the outside that flares when you extend the wrist, lift, or turn a doorknob. Many people are tender in both spots, so a hands-on exam confirms it and rules out look-alike problems.
Usually not. I favor relative rest — backing off the specific aggravating load and death grip while keeping the arm moving in pain-free ranges. Total shutdown tends to leave the tendon weaker, so symptoms return on the way back. We reduce load, then gradually rebuild the tendon with progressive eccentric exercise.
Because chronic golfer's and tennis elbow are usually tendinopathy — disorganized, weakened tendon tissue — rather than active inflammation. Rest and ice can calm a flare but do not rebuild the tendon. Controlled, progressive loading is what reorganizes and strengthens the tissue, which is why a structured loading program tends to outperform rest alone.
I treat the body, not the swing. I address grip, soft tissue, joint mechanics, tendon loading, and mobility or strength gaps up the kinetic chain — hips, mid-back, and shoulder — that overload the elbow, drawing on my TPI Medical Level 3 and Golf Level 2 and SFMA Level 2 training. Swing technique is your golf pro's job, and the best results come when your coach and I coordinate.
Get evaluated promptly for numbness, tingling, or weakness into the hand, a sudden pop with weakness or swelling, an elbow that locks or won't fully move, night pain, or pain that hasn't improved after several weeks. Seek urgent or ER care for fever, redness, warmth, or a hot swollen joint, which can signal infection.
This article is for general education and is not a substitute for an individual evaluation. External links are provided for reference and do not imply endorsement.
