Elbow pain that limits your grip strength, makes it difficult to lift your coffee cup, or sidelines you from your favourite activities at Glen Abbey Golf Course or the Oakville Tennis Club is more than just an inconvenience—it’s a condition that affects your quality of life and needs proper treatment. Tennis elbow and golfer’s elbow are the common names for tendinopathies affecting the outer and inner elbow respectively, and despite their sports-related names, they affect far more office workers, tradespeople, and manual laborers than athletes.
At Midas Physiotherapy in Oakville, our registered physiotherapists specialize in treating elbow tendinopathies using evidence-based approaches. We understand the frustration of a condition that can be stubbornly persistent—and we know that the right treatment approach makes all the difference. Our goal is not just to reduce your pain, but to restore your tendon’s capacity to handle the demands of your work, sport, and daily activities.
Research has dramatically changed how we understand and treat these conditions. We now know that tennis elbow and golfer’s elbow are not inflammatory conditions (“tendinitis”) but rather failed healing responses in the tendon—and this understanding has revolutionized treatment. Rest alone doesn’t work. Cortisone injections provide short-term relief but worsen long-term outcomes. The evidence clearly shows that progressive loading through targeted exercise is the most effective treatment, and that’s the cornerstone of our approach.
For Oakville residents dealing with persistent elbow pain—whether you’re a weekend golfer, a desk worker with mouse-related pain, or a tradesperson whose livelihood depends on grip strength—our Cornwall Road clinic offers comprehensive assessment and individualized treatment programs designed to get you back to full function.
| Feature | Tennis Elbow | Golfer’s Elbow |
| Location | Outer (lateral) elbow | Inner (medial) elbow |
| Tendon affected | Common extensor tendon | Common flexor tendon |
| Aggravating movements | Gripping + wrist extension | Gripping + wrist flexion |
| Relative frequency | More common (80–90%) | Less common (10–20%) |
While the location differs, the underlying pathology and treatment principles are similar for both conditions.
Common Symptoms Patients Experience
Tennis elbow and golfer’s elbow present with characteristic symptoms that typically develop gradually:
- Localized pain: Aching at the lateral epicondyle (tennis elbow) or medial epicondyle (golfer’s elbow) that may radiate into the forearm
- Pain with gripping: Discomfort when grasping objects, shaking hands, turning doorknobs, or using tools
- Weakness: Reduced grip strength—difficulty holding objects, dropping things, or performing tasks requiring firm grip
- Morning stiffness: Elbow and forearm feel stiff upon waking, gradually loosening with movement
- Pain with resisted movements: Wrist extension against resistance (tennis elbow) or wrist flexion against resistance (golfer’s elbow)
- Point tenderness: Specific tender spot directly over the affected epicondyle
- Activity-related patterns: Pain typically worsens with use and may ease with rest (though complete rest doesn’t resolve the condition)
- Pain with lifting: Difficulty lifting objects, especially with the palm facing down (tennis elbow) or up (golfer’s elbow)
- Functional limitations: Difficulty with everyday tasks—carrying groceries, opening jars, using computer mouse, playing sports
Symptoms typically develop gradually over weeks to months rather than from a single incident. Pain that appeared suddenly or follows trauma may indicate a different diagnosis.
How We Treat Tennis and Golfer’s Elbow at Midas Physiotherapy with Evidence-Based Techniques
Our approach to elbow tendinopathy is grounded in current evidence, which clearly shows that progressive loading is the most effective treatment. We design individualized programs that gradually rebuild your tendon’s capacity while managing pain and addressing contributing factors.
- Comprehensive assessment: We evaluate the elbow, forearm, cervical spine, and shoulder to identify all contributing factors—including ruling out referred pain from the neck.
- Progressive loading programs: The cornerstone of treatment—carefully structured exercise that progressively challenges the tendon to stimulate adaptation and healing.
- Isometric exercises: Static muscle contractions that can reduce pain while beginning the loading process—often the starting point for irritable tendons.
- Eccentric and heavy slow resistance training: Progressive exercises that build tendon strength and resilience through controlled loading.
- Manual therapy: Soft tissue techniques, joint mobilization, and treatment of the cervical spine when indicated.
- Dry needling: Targeting trigger points in the forearm muscles and addressing local tissue sensitivity.
- Shockwave therapy: Extracorporeal shockwave therapy (ESWT) has good evidence for chronic tendinopathy that hasn’t responded to exercise alone.
- Load management education: Guidance on modifying activities to reduce aggravating loads while maintaining function.
- Bracing and taping: Counterforce braces and taping techniques that can reduce tendon load during activities when beneficial.
Our Assessment and Treatment Process
Comprehensive Assessment
Your first visit includes detailed history-taking—understanding the onset of symptoms, aggravating activities, previous treatments, and your functional goals. Physical examination assesses the elbow (range of motion, strength, specific tests for tendinopathy), the cervical spine (which commonly refers pain to the elbow), and the shoulder and wrist. We identify the stage of your tendinopathy and any contributing factors.
Diagnosis and Education
We explain what’s happening in your tendon—why it hurts, why rest alone doesn’t work, and why progressive loading is essential for recovery. Understanding tendinopathy helps you participate effectively in treatment and sets appropriate expectations for the rehabilitation timeline.
Individualized Loading Program
Based on your assessment, we design a progressive exercise program starting at an appropriate level for your tendon’s current capacity. For irritable tendons, we begin with isometric exercises that reduce pain while initiating the loading process. As your tendon adapts, we progress through isotonic exercises, eccentric loading, and eventually functional and sport-specific exercises. Load is progressed based on your response—pain that settles within 24 hours indicates appropriate loading.
Adjunct Interventions
While loading is primary, we integrate manual therapy, dry needling, and other interventions to manage pain and address contributing factors. If cervical spine dysfunction is contributing, we treat that alongside the elbow. If shockwave therapy is indicated—typically for chronic cases that haven’t responded to exercise—we can add that to your treatment plan.
Return to Activity
As your tendon strengthens, we progress exercises toward the specific demands of your work, sport, or daily activities. For golfers, this includes grip strengthening and simulated swing progressions. For office workers, it includes tolerance for mouse use and typing. We don’t just eliminate pain—we rebuild your tendon’s capacity to handle the loads you need it to handle.
Frequently Asked Questions
- Should I rest my elbow completely?
No. Complete rest is one of the least effective approaches for tendinopathy. While you should avoid activities that significantly aggravate your pain, tendons need loading to heal. The key is finding the right level of load—enough to stimulate adaptation but not so much that symptoms worsen. We’ll guide you on appropriate activity modification while keeping the tendon loading.
- Should I get a cortisone injection?
We generally recommend against cortisone as first-line treatment. While injections may provide short-term pain relief (4–6 weeks), research shows worse outcomes at 6–12 months compared to physiotherapy, with higher recurrence rates. Cortisone may provide temporary relief that allows you to participate in rehabilitation, but it shouldn’t replace loading exercises. We can discuss the pros and cons for your specific situation.
- How long does tennis elbow take to heal?
Most patients see meaningful improvement within 6–8 weeks of appropriate treatment, but full recovery typically takes 3–6 months. Chronic cases or those with significant degenerative changes may take longer. The good news: with proper rehabilitation, 80–90% of patients fully recover without surgery. Patience and consistent loading are key.
- Why does my elbow hurt if I don’t play tennis?
Despite its name, only about 5% of tennis elbow cases occur in tennis players. The condition affects anyone who performs repetitive gripping and wrist movements—computer work, manual trades, housework, gardening, and many other activities can cause tennis elbow. The name reflects the historical association, not the typical patient population.
- Will a brace help?
Counterforce braces (the straps worn around the forearm) can help reduce pain during activities by redistributing load away from the tendon insertion. They’re useful as a temporary measure while rehabilitating—but they’re not a substitute for loading exercises. We can recommend whether a brace would be helpful for your situation and how to use it appropriately.
- Can neck problems cause elbow pain?
Yes. The cervical spine can refer pain to the lateral elbow, mimicking or contributing to tennis elbow symptoms. This is why we assess your neck as part of every elbow evaluation. If cervical dysfunction is contributing, treating the neck alongside the elbow improves outcomes. In some cases, what appears to be tennis elbow is actually primarily referred pain from the neck.
- Do I need imaging?
Usually not initially. Tennis elbow and golfer’s elbow are clinical diagnoses—we can identify them through history and examination without imaging. Imaging (ultrasound or MRI) may be useful if your presentation is atypical, if you don’t respond to treatment as expected, or if surgery is being considered. Importantly, imaging findings don’t always correlate with symptoms.
- What exercises should I do?
The specific exercises depend on your stage of tendinopathy and current tolerance. Typically, we start with isometric wrist exercises (holding positions without movement), progress to eccentric exercises (controlled lowering), and eventually include heavier resistance training. “Wrist curls” alone aren’t enough—the loading needs to be progressive and appropriately dosed. We’ll design a program specific to your needs.
- Is tennis elbow the same as golfer’s elbow?
They’re similar conditions affecting different tendons. Tennis elbow affects the lateral (outer) elbow—the common extensor tendon. Golfer’s elbow affects the medial (inner) elbow—the common flexor tendon. The underlying pathology is the same (tendinopathy), and treatment principles are similar. The main difference is location and which movements aggravate symptoms.
- When can I return to golf or tennis?
Return to sport is gradual, based on your pain levels and tendon capacity. Typically, we begin with modified play (shorter sessions, lower intensity) once daily activities are comfortable and progress based on your response. Full return usually takes 3–6 months. Returning too quickly risks flare-up; we’ll guide you through a structured progression.
- Will I need surgery?
Very unlikely. More than 90% of patients with tennis elbow and golfer’s elbow recover with conservative treatment. Surgery is reserved for the small percentage who don’t improve despite 6–12 months of appropriate non-surgical management. With proper rehabilitation, you have an excellent chance of full recovery without surgery.
- Can tennis elbow come back?
Recurrence is possible, particularly if the factors that caused the condition initially continue—returning to the same repetitive activities without having built tendon capacity, poor technique, or sudden load increases. Maintaining a regular forearm strengthening routine, using good technique, and progressing activities gradually help prevent recurrence.
Book Your Elbow Assessment
If elbow pain is affecting your grip strength, work capacity, or enjoyment of sports and hobbies, comprehensive assessment is the first step toward effective treatment. Our physiotherapists will identify the source of your pain, explain what’s happening in your tendon, and design a progressive loading program to get you back to full function.
Midas Physiotherapy
2061 Cornwall Road, Unit 3
Oakville, Ontario
Website: midasphysiotherapy.ca
Direct billing available for most major insurance providers.
Related Services
- Shoulder Pain Treatment
- Shockwave Therapy
- Dry Needling
- Sports Physiotherapy
- Work Related Injuries (WSIB)
