Elbow Pain: It's Rarely About the Elbow

Your elbow is the critical link between your shoulder's power and your hand's precision. Every time you grip a barbell, swing a golf club, or type an email, your elbow absorbs and transfers force through a complex system of tendons, ligaments, and nerves. When pain shows up here, it's usually not because the elbow failed. It's because something upstream (shoulder, neck) or downstream (wrist, grip mechanics) forced the elbow to compensate beyond its capacity.

The names "Tennis Elbow" and "Golfer's Elbow" describe where the pain lives, not who gets it. We treat competitive tennis players from Cooper Tennis Complex and pickleball regulars from Meador Park alongside lifters, desk workers, and tradespeople. The mechanism matters more than the sport. Understanding what's actually driving your elbow pain is the first step toward getting back to full function.

What brings active people through our doors:

  • Racquet sports tennis serves, pickleball dinks and drives at Dropshots in Ozark or Pickleball Warehouse in Marionville
  • High-volume gripping from pull-ups, deadlifts, kettlebell work, or barbell cycling in CrossFit and HIIT classes
  • Rotational sports golf swings, throwing mechanics, and overhead athletes
  • Repetitive desk work hours of typing and mouse use requiring constant low-level muscle activation

The grip-extension connection: Every time you grip something, your wrist extensors (the "Tennis Elbow" muscles) fire to stabilize your wrist. Without this stabilization, your grip would collapse. This is why typing, driving, and carrying grocery bags can cause lateral elbow pain just as easily as swinging a racquet. (AAOS, 2024)

Identifying the Source of Your Elbow Pain

Lateral Epicondylalgia (Tennis Elbow)

The most common elbow complaint in active adults. Despite the name, this is a tendinopathy of the common extensor tendon on the outside of your elbow, not an inflammation. Think of the tendon as a rope: repetitive use causes individual strands to fray. In adults over 30, the body struggles to repair these micro-tears fast enough, leaving you with disorganized, weakened tissue that hurts with every grip. (PMC, 2014)

Feels like Aching or sharp pain on the bony outside of the elbow; weak grip; pain when lifting objects palm-down
Worse with Gripping, turning doorknobs, shaking hands, lifting with palm down, typing/mouse use
Better with Resting the forearm, lifting with palm up (supinated), using a counterforce brace
Key insight This is a degenerative process ("tendinosis"), not an acute inflammation ("tendinitis"). Treatment requires progressive loading to rebuild the tendon, not just rest. (Cleveland Clinic, 2024)
Common in: Tennis and pickleball players, adults 30-50, desk workers, lifters, and tradespeople. The condition affects anyone doing repetitive gripping, whether holding a racquet, barbell, or computer mouse.

Medial Epicondylalgia (Golfer's Elbow)

The mirror image of Tennis Elbow, affecting the inside of your elbow. This tendinopathy involves the common flexor tendon, which controls wrist flexion and grip strength. It's common in golfers (especially those who "hit fat" or have technical faults), weightlifters doing heavy curls or front rack work, and anyone using hand tools with repetitive torque.

Feels like Pain on the bony inside of the elbow; may radiate into the forearm; weak grip
Worse with Wrist flexion, gripping with palm up (curls), shaking hands firmly, turning screwdrivers
Better with Resting the forearm, lifting with palm down (pronated), avoiding torque-heavy activities
Key insight In golf, it often results from "casting" the club or striking the ground before the ball. In lifting, poor front rack position or curling with wrist flexion are common culprits.
Common in: Golfers at Millwood or Horton Smith, weightlifters, tradespeople using power tools, and athletes in throwing sports. (HSS, 2024)

Cubital Tunnel Syndrome (Ulnar Nerve Compression)

Your "funny bone" isn't a bone at all. It's the ulnar nerve running through a narrow tunnel at the inside of your elbow. When this nerve gets compressed or stretched, it creates numbness and tingling in your ring and pinky fingers. Unlike tendinopathy, which aches and throbs, nerve compression feels electric, buzzy, or like your hand is "asleep."

Feels like Numbness/tingling in the ring and pinky fingers; "electric" sensation; hand weakness in severe cases
Worse with Sleeping with elbow bent, leaning on elbows, holding phone to ear, prolonged driving
Better with Keeping elbow straight, avoiding direct pressure on inner elbow, night splinting
Key insight Sleep position is often the dominant factor. Sleeping with elbows fully bent stretches the nerve taut and decreases blood flow, which is why symptoms are frequently worst in the morning. (Cooper Health, 2024)
The towel trick: Wrapping a bath towel around your elbow at night prevents bending past 90 degrees, often resolving symptoms without expensive splints. (AAOS, 2024)

Radial Tunnel Syndrome

Often misdiagnosed as Tennis Elbow, Radial Tunnel Syndrome involves compression of the radial nerve as it passes through the forearm muscles. The critical difference: pain is located about 2 inches below the elbow (in the muscle belly), not directly on the bone. Treatment protocols for tendinopathy can actually make nerve compression worse, which is why accurate diagnosis matters.

Feels like Deep, gnawing ache or burning fatigue in the forearm muscles; may radiate to the back of the hand
Worse with Twisting motions (screwdriver, wringing towel), turning doorknobs, repetitive pronation/supination
Better with Forearm in neutral ("handshake") position, avoiding repetitive rotation, vertical mouse use
Key insight Pain 4-5 cm below the lateral epicondyle, not on it, suggests nerve involvement rather than tendon. (Cleveland Clinic, 2024)
Differentiation matters: Aggressive soft tissue work that helps tendinopathy can aggravate nerve compression. We test specifically for this before choosing treatment approach.

Little League Elbow (Youth Athletes)

In skeletally immature athletes (ages 9-14), the growth plate on the inside of the elbow is structurally weaker than the ligament. When young throwing athletes create valgus stress (the force that wants to open the elbow inward), the growth plate fails before the ligament does. This ranges from inflammation (apophysitis) to complete separation (avulsion fracture). (Boston Children's, 2024)

Feels like Deep bone pain on the inside of the elbow; hurts to throw; decreased throwing velocity
Worse with Throwing (especially acceleration phase), any valgus stress on the elbow
Better with Complete rest from throwing; ice after activity
Key insight Inner elbow pain in a throwing athlete under 15 is never "just soreness." It must be evaluated as a potential growth plate injury.
For parents: Pitching through this pain can cause the growth plate to tear off or deform permanently, requiring surgery. X-rays are essential to rule out structural damage. We see this frequently in youth baseball and softball players across Springfield, Nixa, and Republic. (Nemours KidsHealth, 2024)

Triceps Tendinopathy (Lifter's Elbow)

Pain at the back of the elbow, just above the point, where the triceps tendon attaches. Common in lifters doing high-volume pressing: bench press lockouts, overhead press, dips, and skull crushers. The forceful extension under load strains the tendon insertion over time.

Feels like Pain at the back of the elbow during or after pressing movements; tender to touch above the elbow tip
Worse with Push-ups, bench press (especially lockout), overhead press, triceps extensions
Better with Avoiding full lockout, reducing pressing volume, eccentric loading protocol
Key insight Often develops gradually with high training volume. Partial range movements can maintain strength while the tendon recovers.

Find Your Pattern: Elbow Pain Comparison

Feature Tennis Elbow Golfer's Elbow Cubital Tunnel Radial Tunnel Little League
Pain location Outside of elbow (bone) Inside of elbow (bone) Inside elbow + 4th/5th fingers Forearm (below elbow) Inside elbow (deep)
Pain quality Aching, sharp with grip Aching, sharp with flexion Electric, buzzy, numb Deep ache, burning Deep bone pain
Worst trigger Gripping, doorknobs Palm-up curls, torque Sleeping with bent arm Twisting motions Throwing
Numbness/tingling No Occasionally Yes (ring/pinky) Sometimes (dorsal hand) No
Typical population Adults 30-50 Golfers, lifters Desk workers, sleepers Tradespeople Youth throwers 9-14

How We Evaluate Elbow Pain at 417 Performance

The Kinetic Chain Approach

Elbow pain is frequently the victim, not the culprit. A stiff thoracic spine forces the shoulder to compensate. A weak rotator cuff transfers load to the elbow. Limited wrist mobility makes the forearm work overtime. We evaluate the entire upper extremity to find the true driver, whether you're a desk worker from Springfield, a pitcher from Ozark, or a golfer from Nixa:

  • Provocative testing to differentiate tendinopathy from nerve entrapment (critical for treatment selection)
  • Shoulder and scapular screening to identify proximal contributors to elbow overload
  • Wrist and grip assessment because restricted wrist mobility increases forearm strain
  • Workstation and sport mechanics review addressing the repetitive patterns driving your symptoms

Treatment Philosophy

We combine soft tissue work with joint mobilization and progressive loading specific to your diagnosis. Tendon problems require eccentric loading to rebuild collagen. Nerve problems require mobility work and position modification. Treating one like the other makes things worse. Learn more about our three-phase treatment approach.

Targeted Treatments for Elbow Recovery

Your progressive loading program drives the long-term result. At our Springfield clinic, we use these targeted treatments to accelerate your return to activity:

Dry Needling

Dry needling releases tension in the forearm extensors, flexors, and supinator muscles that contribute to both tendinopathy and nerve compression. Particularly effective for stubborn trigger points that don't respond to stretching alone.

Graston Technique

Instrument-assisted soft tissue work breaks down scar tissue and adhesions in the muscle bellies that may be tethering nerves or creating abnormal tension on the tendon insertions.

Nerve Flossing

For cubital and radial tunnel syndromes, specific nerve gliding techniques mobilize the neural tissue through its tunnels, reducing compression and restoring normal sliding mechanics without aggressive stretching.

Common Questions About Elbow Pain

"Tennis Elbow" and "Golfer's Elbow" describe pain location, not cause. Tennis and pickleball players absolutely get these conditions from the repetitive gripping and wrist stabilization their sports demand. But so do lifters, desk workers, tradespeople, and anyone doing repetitive hand work.

The mechanism is the same regardless of the activity: repetitive gripping overloads the forearm tendons faster than they can recover. Whether you're hitting backhands at Cooper Tennis Complex or typing reports all day, the tissue response is identical.

Usually yes, with modifications. The goal is avoiding movements that reproduce sharp pain while maintaining strength.

For Tennis Elbow: Avoid palm-down pulling (overhand pull-ups, rows). Use lifting straps for deadlifts. Switch to neutral or supinated grip.

For Golfer's Elbow: Avoid palm-up curling and heavy front rack positions. Use a thumbless grip on pressing movements.

Rule of thumb: If pain exceeds 3/10 during activity or lingers the next day, you're causing further damage.

If the numbness is in your pinky and ring finger, it's likely Cubital Tunnel Syndrome (at the elbow), not Carpal Tunnel (at the wrist). Carpal tunnel affects the thumb, index, and middle fingers.

The fix is often simple: sleep with your arm straighter. A towel wrapped around the elbow prevents bending past 90 degrees and can resolve symptoms within weeks. If you're a side sleeper who tucks your arm under your pillow, that position is likely the culprit.

For tendinopathy: A counterforce brace (strap worn just below the elbow) can help by compressing the muscle belly and dispersing force before it reaches the irritated tendon. It's a useful tool during activity but doesn't replace treatment.

For nerve compression: Night splints that prevent elbow flexion are often the highest-yield intervention. Keeping the elbow straighter while you sleep allows the nerve to recover overnight.

Yes. Elbow pain in a youth thrower is not normal soreness. It's a warning sign of stress on the growth plate that requires evaluation. They should stop throwing immediately until cleared.

The standard protocol for Little League Elbow is 6-12 weeks of no throwing, followed by a gradual return-to-throw program. Playing through it can cause permanent bone damage. X-rays are often needed to rule out growth plate separation.

Prevention matters: enforce pitch counts, mandate 3-4 months of no overhead throwing per year, and watch for fatigue, which is the number one predictor of injury.

When to Seek Immediate Care

Most elbow pain is mechanical and responds to conservative treatment. However, some presentations require urgent evaluation:

  • Sudden "pop" followed by visible deformity in the upper arm (possible biceps rupture)
  • Elbow locked and unable to straighten after trauma
  • Red, hot, swollen elbow tip with fever (possible septic bursitis)
  • Progressive weakness in grip or finger extension
  • Youth athlete with bone pain after throwing, unable to fully extend elbow

You Don't Have to "Just Live With It."

Ignoring that nagging ache won't make it go away, but the right guidance will.

Tell us your story, and let’s see if we are the right fit to help you finally find relief. 

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