Tennis Elbow vs Golfer's Elbow: How to Tell Which One You Actually Have

At a Glance

Tennis elbow hurts on the outside, golfer's elbow on the inside. Two simple self-tests, why the difference matters, and what eases each one.

📋 What You'll Learn

1. What Is the Difference and Why Does It Matter?
2. What Does Science Say?
3. How Do You Use It for Best Results?
4. What Mistakes Do Most People Make?
5. Frequently Asked Questions
6. The Bottom Line

Here is something that catches most people out: fewer than one in ten cases of tennis elbow have anything to do with tennis. The condition is a gripping injury, not a racquet injury, and the same goes for golfer's elbow.

So if the sport name is not the clue, what is? The answer is simpler than you think, and it takes about five seconds to check. Your elbow has two bony bumps, one on the outside and one on the inside. Whichever one hurts when you press it tells you which condition you have.

That distinction matters more than it sounds. The two problems involve different tendon groups, get aggravated by different movements, and need different rehab exercises. Treating one as if it were the other is why plenty of people stay sore for months longer than they need to.

This guide walks through the difference in tennis elbow vs golfer's elbow, the self-tests you can do at your kitchen table, what the research actually shows, and how to support recovery day to day.

Research Spotlight

Only 1.3% of people have true tennis elbow, and just 0.4% have golfer's elbow

Shiri et al., American Journal of Epidemiology (population study, n=4,783)

Tennis elbow is pain on the outside of the elbow, golfer's elbow is pain on the inside. That single sentence covers 90% of what you need to know.

In medical terms, tennis elbow is lateral epicondylitis and golfer's elbow is medial epicondylitis. The epicondyles are the two bony knobs you can feel at the bottom of your upper arm bone. Tendons from your forearm muscles anchor into them.

On the outside, the extensor tendons attach. These are the muscles that pull your wrist and fingers backwards, and they fire every time you grip something. On the inside, the flexor and pronator tendons attach. These bend your wrist forward and rotate your palm downwards.

Repetitive load creates microscopic tears at the tendon anchor point. The tissue tries to repair, fails to keep up, and you end up with a degenerative tendon rather than a classically inflamed one. That is why the "itis" suffix is slightly misleading, and why anti-inflammatory tablets alone rarely fix it.

Why does the difference matter? Because the aggravating movements are opposites. Lifting a full kettle with your palm down torments a lateral elbow. Doing a hard grip with wrist flexion, like wringing out a cloth or swinging a golf club, torments a medial one. Get the diagnosis backwards and your rehab makes things worse instead of better.

There are two quick self-tests clinicians use, and you can approximate both at home in under a minute.

For tennis elbow: rest your forearm on a table, palm down, and make a loose fist. Have someone press down on the back of your hand while you resist and lift the wrist. Sharp pain at the outer bump is a positive sign. Clinicians call this Cozen's test. A second version, Mill's test, involves straightening the elbow, turning the palm down, and bending the wrist fully forward. Pain on the outside again points lateral.

For golfer's elbow: same setup, but palm up. Resist while someone gently presses your hand back into extension. Pain at the inner bump is your marker. Squeezing a tennis ball hard often reproduces it too. Neither test replaces a proper examination, but between them and a firm thumb press, most people can work out which side of the elbow is the problem.

Both conditions are far rarer than the internet suggests, and both are strongly linked to occupation rather than sport.

The reference study here is a Finnish population survey of 4,783 adults published in the American Journal of Epidemiology. It found definite lateral epicondylitis in 1.3% of people and definite medial epicondylitis in 0.4%. Prevalence peaked between ages 45 and 54, and there was no meaningful difference between men and women.

A separate nationwide population study confirmed the same ratio, with lateral cases outnumbering medial by roughly three to one. So if you are trying to guess which one you have and cannot decide, the odds favour tennis elbow.

Occupational research from the same group identified the real risk factors: repetitive gripping, forceful wrist movement, and sustained awkward forearm positions. Trades, food prep, hairdressing, assembly work, and long hours at a keyboard all show elevated rates. Racquet sports barely register by comparison.

On the treatment side, the evidence for topical botanicals is more interesting than most people expect. A clinical overview of comfrey root extract published through the NIH library notes that comfrey ointment outperformed placebo in patients with epicondylitis and tendovaginitis, measured by pressure tenderness. Comfrey has one of the better evidence bases among traditional topical herbs, with multiple randomised trials for musculoskeletal pain.

A Cochrane systematic review of topical herbal therapies reached a similar conclusion for comfrey extract gel in joint pain, rating the evidence as probably beneficial. Devil's claw, arnica, and boswellia have supporting data too, though the trial quality varies. None of these replace loading exercises, which remain the backbone of tendon recovery, but they are a reasonable way to make the painful early weeks more tolerable.

One more finding worth knowing: the tissue under a microscope does not look inflamed in chronic cases. Pathology samples show disorganised collagen, immature blood vessels, and very few inflammatory cells. Researchers now prefer the term tendinopathy over epicondylitis for that reason. The practical consequence is that steroid injections often feel excellent for six weeks and then leave people worse off at twelve months than doing nothing, which is one of the more uncomfortable results in the literature.

What consistently works instead is progressive eccentric loading. Slow lowering movements under load appear to stimulate collagen remodelling in a way that rest simply does not. Combine that with load management and topical symptom relief, and you have the approach with the best evidence behind it for both sides of the elbow.

Topical support works best when it is applied to a specific spot on a schedule, not rubbed on vaguely once a day.

1. Find the exact sore point first. Press along both bony bumps and locate the single spot that reproduces your pain. That is your target, not the whole forearm.
2. Warm the area for two minutes. A quick rub or a warm cloth increases local blood flow and helps absorption. Skip this in the first 48 hours after an acute flare.
3. Apply a pea-sized to almond-sized amount of Rapid Hemp Devil's Claw Pain Gel directly over the tender epicondyle and massage in small circles for 60 to 90 seconds until it disappears into the skin.
4. Extend the application two to three centimetres down the forearm, following the muscle belly. Pain sits at the tendon, but tightness usually sits in the muscle above it.
5. Repeat two to three times daily for at least three weeks. Tendon tissue turns over slowly. Judging any topical after four days is judging it too early.
6. Time one application before your loading exercises. Warming formulas make the eccentric wrist work more comfortable, which means you actually complete the sets.
7. Switch to a calmer formula after activity. If a warming gel feels like too much post-exercise, Hemp Arnica Therapy Cream 75ml is the gentler option for evening use, especially if there is visible swelling or bruising around the joint.
8. Wash your hands immediately. Devil's claw and chilli-based warming formulas sting badly if they reach your eyes.

The most common mistake is complete rest. It feels sensible, and it is exactly wrong. Tendons need graded load to remodel. Two weeks in a sling leaves you with a weaker tendon and the same pain.

The second mistake is treating the wrong side. People read one article about tennis elbow, start extensor stretches, and wonder why their medial pain gets worse. Confirm the location before you commit to a programme.

Third, most people stop far too early. Both conditions are notoriously slow. Realistic timelines run six to twelve months for stubborn cases, and the exercises need to continue well past the point where the pain fades. Stopping at week four is the single biggest cause of relapse.

Fourth, ignoring the cause. If your mouse grip, your knife technique, or your tool handle diameter created the problem, no amount of gel or stretching will hold the gains. Change the load or change the tool.

Fifth, chasing an injection early. Corticosteroid shots give fast relief, and that relief is real. But follow-up data at one year repeatedly shows worse outcomes and higher recurrence than conservative management. If you are offered one, ask what the twelve-month plan looks like.

Finally, people expect topical products to do the whole job. They will not. Comfrey, devil's claw, arnica, and boswellia help you tolerate the rehab. The rehab is what fixes the tendon.

⚠️ Important Note

Numbness or tingling in your ring and little fingers is not typical of either condition. That pattern points to the ulnar nerve, which runs behind the inner elbow, and it needs a medical assessment rather than a topical treatment. See a doctor if pain lasts beyond six weeks, wakes you at night, or comes with weakness or loss of grip.

✅ Key Takeaways

• Outside of the elbow means tennis elbow (lateral epicondylitis); inside means golfer's elbow (medial epicondylitis). Tennis elbow is about three times more common.
• Rest is not the treatment. Progressive loading of the correct tendon group is, and it needs months rather than weeks.
• Topical comfrey, devil's claw and arnica have supporting trial evidence for tendon pain and make the rehab phase far more tolerable.

Sorting out tennis elbow vs golfer's elbow takes one press of a thumb. Outside bump means lateral epicondylitis, inside bump means medial. From there the path is the same in principle and opposite in detail: reduce the aggravating grip, load the correct tendon group progressively, and give it far longer than feels reasonable.

Topical support has a real, if modest, role. Comfrey has trial data specifically in epicondylitis, and warming botanicals make the early rehab sessions bearable. If you want that support in one place, Rapid Hemp Devil's Claw Pain Gel combines devil's claw, arnica, comfrey, and frankincense in a warming base, and Hemp Arnica Therapy Cream 75ml covers the gentler end for swelling and bruising.

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📚 Sources & References

1. Shiri R et al., American Journal of Epidemiology (2006) – Population study of 4,783 adults establishing prevalence of lateral (1.3%) and medial (0.4%) epicondylitis
2. Descatha A et al., PubMed (2011) – Occupational risk factors for lateral and medial epicondylitis in repetitive-work populations
3. Staiger C, Comfrey: A Clinical Overview, PMC/NIH – Review of comfrey root extract trials, including superiority over placebo in epicondylitis and tendovaginitis
4. Cameron M & Chrubasik S, Cochrane review, PubMed – Systematic review of topical herbal therapies for musculoskeletal pain and inflammation
5. Epidemiology of lateral and medial epicondylitis, PMC – Nationwide population-based study confirming age and occupational distribution of both conditions