Your grip used to be the last thing you thought about. Now it is the first. The deadlift lockout, the top of a pull-up, a heavy carry, a curl, even the setup on a bench press, and there it is: a sharp, nagging ache on the inside or the outside of your elbow. By the end of the day a coffee mug or a door handle can set it off too. If you train hard, you probably tried the obvious fix first, backing off and resting it, and it felt better until you grabbed the bar again. That loop is elbow tendonitis, and it is one of the most common complaints I hear from lifters here in Waukee. In this guide I will break down what elbow tendonitis actually is, how to tell tennis elbow from golfer's elbow, and the loading plan I use to get your grip and your lifts back.
Short answer: elbow tendonitis is an overuse injury of the forearm tendons where they anchor at the elbow, irritated and worn down by more load than they were ready for. It shows up in two main spots. On the outside of the elbow it is tennis elbow, or lateral epicondylitis. On the inside it is golfer's elbow, or medial epicondylitis. You do not need a racket or a 9-iron to get either one. A barbell does the job just fine.
Here is the part most people miss. The "-itis" suffix implies inflammation, but when researchers look at the tissue in these long-running cases, they mostly find degeneration, the same wear-and-rebuild pattern you see in a cranky Achilles tendon, which is why you will also see it called tendinopathy. The American Academy of Orthopaedic Surgeons describes tennis elbow as degeneration and microtearing of the tendon, not simple swelling. That distinction matters: inflamed tissue wants you to calm it down, while degenerated tissue wants a smart, progressive load to rebuild. Keep that in your back pocket, because it is exactly why rest alone keeps letting you down.
The quickest tell is where it hurts and which movements light it up. Tennis elbow sits on the outside of the elbow and runs through the wrist-extensor tendons. Golfer's elbow sits on the inside and runs through the flexor-pronator tendons, the ones that close your grip and rotate your forearm (StatPearls, Medial Epicondylitis). Here is the side by side:
| Tennis elbow (lateral) | Golfer's elbow (medial) | |
|---|---|---|
| Where it hurts | Outside of the elbow | Inside of the elbow |
| Tissue involved | Wrist-extensor tendons (mainly the ECRB) | Flexor-pronator tendons |
| Lifts that flare it | Reverse curls, pull-ups, heavy carries, lockouts, hard gripping | Heavy pulls, deadlift grip, curls, rows, wrist flexion and forearm rotation |
| Quick self-check | Pain with resisted wrist extension or a hard squeeze | Pain with resisted wrist flexion or twisting the forearm |
Both are the same type of load-related tendinopathy, and here is the good news: they respond to the same playbook. The reason to tell them apart is so you load the right tissue, then you treat them the same way.
Every heavy grip sends force up through your forearm tendons and into your elbow. When the demand on those tendons climbs faster than they can adapt, the tissue gets cranky and starts to complain. A few common drivers I see in the gym:
Notice the theme. None of these mean your elbow is fragile. They mean the load went up faster than the tissue adapted. Fix the load, train the tissue, and the elbow follows.
Rest takes the edge off, and that is why it is tempting. When you stop gripping and pulling, the tendon settles and the ache fades. The problem is what happens next. Rest calms the symptoms without building any capacity, so the tendon stays exactly as unprepared as the day you stopped. The first heavy pull or hard grip loads it again, and you are right back where you started.
That is the trap. Elbow tendonitis is a capacity problem, not a fragility problem. The fix is not to avoid load forever. It is to give the tendon the right load, in the right dose, so it actually rebuilds.
You fix it by loading it on purpose, in a planned progression. The evidence for both tennis and golfer's elbow points to exercise as the foundation, supported by hands-on care. The 2022 clinical practice guideline in the Journal of Orthopaedic and Sports Physical Therapy recommends resistance exercise and manual therapy for lateral elbow pain. Here is what that looks like in my clinic:
The theme is simple. We do not chase zero pain by hiding from the bar. We rebuild the tendon's tolerance step by step so it can handle what your training asks of it.
Usually yes, with adjustments. You rarely have to shut everything down. We dial the load to a level your elbow can handle, keep the parts of training that do not flare it, and build the rest back on a plan. In practice that might mean using straps or a hook grip to cut grip demand on heavy pulls, trimming volume on the worst offenders for a few weeks, swapping a straight bar for a neutral grip where it helps, and keeping pain-tolerable pressing and pulling while we load the forearm hard on the side.
Keeping you training is the whole point of how I work, the same approach I take to physical therapy for lifters. The goal is to keep you moving toward your goal, not to park you on the couch for a month.
Be honest with yourself on the timeline: elbow tendonitis is usually a matter of weeks to a few months, not days. Isometrics often take the edge off symptoms early, and the progressive strength work rebuilds the capacity that keeps it gone. The encouraging part is that the large majority of cases get better without surgery. The AAOS notes that roughly 80 to 95 percent of people with tennis elbow recover with nonsurgical care. The earlier you start loading instead of only resting, the sooner you tend to turn the corner. Stick with the plan, ramp gradually, and do not bail the moment it feels better, because that is how it sneaks back.
It is worth getting evaluated when the pain is not budging after a few weeks of sensible self-management, when it is limiting your training or your work, or when it keeps coming back every time you push your grip. Those are signs the load and capacity are not matched yet, and a plan beats guessing.
When you come in, the first thing I do in the eval is confirm whether it is tennis or golfer's elbow, find where your capacity is falling short, and check the whole chain from your grip up to your shoulder. From there you get a specific loading plan built around the lifts you actually care about.
If your elbow has been calling the shots, that is what I do here at Fortitude and Freedom Performance Therapy in Waukee. Care is one-on-one and gym-based, so you are practicing the exact loads you need to get back to, whether that is deadlifts, pull-ups, pressing, or a grip-heavy event. We start with a full movement evaluation, then build a progressive plan around your sport and your schedule. If dry needling fits your case, I will use it for the forearm as part of the plan, not as a stand-alone fix.
Is it elbow tendonitis or tendinopathy, and does it matter?
They describe the same problem at different stages. Early irritation can involve some inflammation, but stubborn, long-running cases are mostly tendon degeneration, which is why they are often called tendinopathy. It matters because degenerated tendon responds to progressive loading, not to rest and anti-inflammatories alone.
Can I still deadlift with tennis or golfer's elbow?
Most lifters can, with adjustments. Using straps or a hook grip to reduce grip demand, trimming volume for a few weeks, and keeping the load tolerable usually lets you keep pulling while the tendon rebuilds. Full rest tends to feel good briefly, then disappoint.
Do elbow straps or counterforce braces help?
A counterforce brace can offload the sore tendon and ease symptoms in the short term, which can buy you room to train. It is a helpful tool, not a cure. The loading work is what actually changes the tendon.
Which heals faster, tennis elbow or golfer's elbow?
They follow similar timelines and respond to the same loading principles. What moves the needle most is starting progressive strength work early and managing the load on the lifts that flare it, rather than which side of the elbow is involved.
Elbow tendonitis is not a sign your arm is broken, and it is not something you have to wait out by avoiding the bar. It is a load-tolerance problem in the forearm tendons, and the fix is to rebuild that tolerance with isometrics, progressive strength work, and a smart ramp back to your training. Tell tennis elbow from golfer's elbow so you load the right tissue, modify the lifts that flare it, and keep training while you get stronger. Rest alone keeps you stuck in the loop. Loading gets you out of it. If your grip has been running your training, let's build a plan to take that back. Reach out through our contact page and let's get you back to the lifts you love.
This article is for education and is not medical advice. Elbow pain can have more than one cause, so please get evaluated by a qualified healthcare provider before starting a new treatment or training plan. Individual results vary.
Stop working around the pain. Start fixing the problem with a provider who gets it.
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