Tennis elbow vs golfer’s elbow: which one do you actually have?

If your elbow hurts after padel, the question that determines your next three weeks is which side hurts.

Outside of the elbow → lateral epicondylitis, the condition every English-speaking world calls tennis elbow. Wrist extensors. Most common in padel.

Inside of the elbow → medial epicondylitis, golfer’s elbow. Wrist flexors. Less common in racquet sports than tennis elbow, but rising in padel because of how the bandeja loads the wrist.

Both names are misleading — tennis elbow is more common in non-tennis-players than tennis-players, and golfer’s elbow is mostly seen in non-golfers. They’re just convenient labels for two specific tendon overload patterns. The mechanism is similar; the location, muscle group, and fix are different.

This is the diagnostic guide. Two minutes of self-testing tells you which one you have. Then we cover the specific fix for each and the cases where they overlap.

The anatomy in 30 seconds

Two bony bumps on the lower end of your humerus, just above the elbow. One on the outside (the lateral epicondyle), one on the inside (the medial epicondyle).

• The lateral epicondyle is where your wrist extensors attach — the muscles that pull your hand backwards, away from the palm. Biggest culprit: extensor carpi radialis brevis (ECRB).
• The medial epicondyle is where your wrist flexors attach — the muscles that pull your hand forward, towards the palm. Biggest culprits: pronator teres and flexor carpi radialis.

Both groups attach via the enthesis — the point where tendon meets bone. Both develop the same pattern of overload: the collagen at the enthesis gets disorganised, the tendon loses load tolerance, and pain shows up.

What differs is which muscles you’re working hardest with your specific sport mechanics.

Self-test in two minutes

Sit down. You need a partner or a sturdy table edge.

Test 1 — the coffee cup

Pick up a full mug. Where do you feel a sharp pain?

• Outside of the elbow → tennis elbow.
• Inside of the elbow → golfer’s elbow.
• Both → both.
• Neither → probably not an epicondylitis.

Test 2 — resisted wrist extension

Make a loose fist with the affected hand, palm down, arm extended straight out in front of you. Have a partner push your knuckles down towards the floor while you resist. Or, alone, push up against the underside of a heavy table with your fist.

• Pain on the outside of the elbow → tennis elbow.
• No pain on the outside → not tennis elbow, or very mild.

Test 3 — resisted wrist flexion

Same starting position, palm up this time. Have a partner push your fingers down towards the floor while you resist. Or push down on a heavy table with your palm facing up.

• Pain on the inside of the elbow → golfer’s elbow.
• No pain on the inside → not golfer’s elbow, or very mild.

Test 4 — Mill’s test (tennis elbow specific)

Arm out in front, palm down. With the other hand, flex the wrist fully (push the fingers down and back towards your forearm). Then straighten the elbow while keeping the wrist flexed.

• Sharp pull or pain on the outside of the elbow → confirms tennis elbow.

Test 5 — pronator test (golfer’s elbow specific)

Arm straight out, palm down. Make a fist. Rotate the wrist so the palm faces up while resisting against your own opposite hand.

• Pain on the inside of the elbow → confirms golfer’s elbow.

If tests 1, 2, and 4 are positive → you have lateral epicondylitis. If tests 1, 3, and 5 are positive → you have medial epicondylitis. If both sets are positive → you have both, and they need to be treated together.

If none of them are positive but the elbow hurts, you might be dealing with something else — radial tunnel syndrome, ulnar neuritis, or referred pain from a stiff cervical spine. That’s a sports physio visit.

Why padel players get both

The mechanics of padel load the inside and outside of the elbow at different moments.

The forehand and the smash load the wrist extensors hardest — ECRB on the outside. Every full-power swing requires the wrist extensors to clamp the racquet and decelerate the swing. Repeated cycles → tennis elbow.

The bandeja and the víbora load the wrist flexors and pronators more — pronator teres on the inside. These shots ask you to pronate (palm-down rotate) the forearm at speed while the elbow is at chest height. Repeated cycles → golfer’s elbow.

The backhand loads both depending on how you grip and rotate. Continental grip with strong wrist snap → more wrist extensor load. Eastern grip with forearm pronation → more wrist flexor load.

Most amateur players have asymmetric weakness — usually weaker pronators and wrist flexors than extensors — so when they overplay bandejas they develop golfer’s elbow first, then their compensatory forehand pattern develops tennis elbow on top. That’s how you end up with pain on both sides.

How the fix differs

The structure of the protocol is similar — progressive eccentric loading of the affected tendon — but which exercises you use is different.

Tennis elbow protocol

Three weeks, building load. The headline exercise:

Eccentric wrist extension. Forearm on a table, hand off the edge, palm down. Hold a 1-2 kg weight. Use your other hand to lift it into wrist extension. Lower slowly (4-5 seconds) back to neutral. 3 × 15 daily in week 1, building to 4 × 12 with heavier load in week 3.

Add heavy grip isometrics (squeeze a ball or stress ball for 30 seconds × 5 sets) in week 2, plus shoulder external rotation work to address the upstream weakness that often coexists with tennis elbow.

Full protocol detail in why your elbow hurts after every padel match.

Golfer’s elbow protocol

Same structure, opposite direction.

Eccentric wrist flexion. Forearm on a table, hand off the edge, palm up. Hold a 1-2 kg weight. Use your other hand to lift it into wrist flexion (curling the wrist up towards you). Lower slowly back to neutral. 3 × 15 daily in week 1, building to 4 × 12 with heavier load in week 3.

Plus eccentric forearm pronation. Hold a hammer or a long-handled tool by the end. Forearm on a table, wrist neutral, palm sideways (thumb up). Slowly rotate the hammer down to palm-down position over 4 seconds. Use the other hand to return it. 3 × 12 each arm.

Add scapular retraction work — band rows, prone Y-T-Ws — because medial elbow problems often coexist with rounded posture and weak mid-back muscles.

When you have both

Don’t alternate. Do them all, same session, in this order: shoulder warm-up, then eccentric extension, then eccentric flexion, then forearm rotations. The whole thing takes 10 minutes and treats the elbow as a system instead of two separate problems.

Things that don’t help (much)

A few common moves that have less evidence than people assume:

• Foam rolling the forearm. Feels good. Doesn’t change the underlying tendon problem.
• Stretching the affected wrist extensors / flexors. Can reduce day-to-day pain a little. Doesn’t fix the tendinopathy. Do it before play if it helps, but don’t replace the loading work with it.
• Tennis elbow / golfer’s elbow straps. Reduce pain during play by changing where the tendon is loaded. Useful for a few weeks. Not a fix.
• Ice. Useful in the first 48 hours after a flare-up. Not a treatment.
• Cortisone injections. Short-term pain relief, worse long-term outcomes than just doing the eccentric loading work. The literature on this has been consistent for over a decade. Avoid unless other options have failed.

The padel-specific contributors

Beyond just the swing mechanics, four things in your padel routine quietly drive elbow pain:

1. A worn grip. A slippery overgrip makes you squeeze twice as hard. Replace yours every six weeks if you play three times a week.
2. Grip diameter that’s too small. Most adult amateurs are using a grip diameter at least half a size too small. Wrapping a second overgrip on for a few sessions tells you immediately whether grip size is contributing — if pain drops noticeably, you’ve been gripping too tight to compensate for a too-thin handle.
3. Stringing tension on tennis-influence racquets — although padel racquets aren’t strung, the rigidity of the face matters. Stiff carbon faces transmit more vibration to the elbow. If you have chronic elbow pain, a slightly softer foam-core racquet can be a meaningful help.
4. No wrist warm-up. Most warm-up sequences ignore the wrists entirely. The forearm rotation work in the seven-minute warm-up is there specifically because most amateur warm-ups skip it and the elbow pays.

When to escalate to imaging

Most cases of epicondylitis don’t need an MRI. You can rehab them blind. But escalate to imaging if:

• The pain has been present for more than six months despite proper loading work,
• You have weakness picking up light objects, not just pain,
• There is numbness, tingling, or shooting pain into the hand or fingers,
• You had a specific moment of acute injury (a sharp pop, a clear instant when something gave),
• Night pain at rest, without movement.

Any of those, see a sports physio or hand-and-elbow specialist before you keep grinding the protocol. A partial tear, a nerve entrapment, or a referred neck issue need different treatment.

Frequently asked

Can I have both at the same time?

Yes, and roughly a third of padel players who present with elbow pain have both. The protocol above treats them in parallel.

How long until I can play normally?

Most cases: full pain-free play at four to eight weeks of consistent loading. Longer if the problem has been present for over six months. The pattern is: sharp daily pain gone in 7-10 days, manageable training pain gone in 3-4 weeks, full pain-free play by week 6-8. Don’t mistake the early pain reduction for healed.

Should I stop padel during rehab?

Pull back to half-volume, skip the shots that hurt most (overheads for tennis elbow; bandejas for golfer’s elbow), and respect a pain ceiling of 3 out of 10 during play. Total rest is counterproductive — tendons need progressive load to remodel.

Is one side easier to treat than the other?

Tennis elbow tends to respond a little faster to eccentric loading than golfer’s elbow does, mostly because the wrist extensors are easier to isolate. Both fully resolve with the right work. Plan on eight weeks of consistent loading for either.

Will it come back?

If you stop the loading work entirely once pain is gone — yes, likely. If you keep one to two short sessions of wrist work per week as maintenance — no, in most cases. Padel keeps loading these tendons, so the maintenance work matches the maintenance demand.

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Padel Mobility runs a structured three-week elbow protocol with daily check-ins, video form review, and a single one-on-one assessment to dial it in to your specific case. If you’ve had elbow pain for a while and the public version above hasn’t fixed it, that’s the next step.