Golfer's Elbow and Tennis Elbow in Lifters: Why It Happens and How to Train Through It

If you get golfers elbow lifting weights, the culprit is usually the tendon that attaches your wrist flexors to the inside of the elbow, overloaded by heavy gripping, rowing, curling and chin-ups. Tennis elbow is the mirror image on the outside, from the wrist extensors. For both, the best-supported fix is gradually loaded exercise plus smart grip and exercise swaps, not complete rest.

This page is the clinical-style companion to our joint-friendly lifting guide, which covers the general rules. I will stick to the inner and outer elbow tendons here. One honest note first: the research is thinner than you would hope, and I will flag where.

Inner vs outer elbow pain: which one do you have?

Both conditions are now usually called tendinopathy or epicondylalgia, because the problem is a tendon that has become sensitive and less tolerant to load, not just “inflammation.”

Golfer’s elbow (medial epicondylitis) is linked to repeated forced wrist extension and forearm supination during activities that involve wrist flexion and pronation (Amin et al., 2015). In the gym, that is a heavy barbell row where your grip is fighting the bar, hard curls, and chin-ups on a thick or awkward grip.

Tennis elbow (lateral epicondylitis) often shows up in lifters who press with the wrists bent backward, do heavy reverse curls, or hold deadlift-style loads with an overhand grip for long sets.

Pain at the front of the elbow, near the biceps tendon, is a different problem. Our distal biceps tendonitis guide covers that one.

Why do heavy pulling and pressing set it off?

Think of it as a load mismatch. Your back may be ready for 100 kg on a row, but your forearm tendons are the weak link holding the bar. When grip becomes the limiter, the flexor tendon at the inside of the elbow does extra work every rep, set after set, week after week.

Common triggers lifters report (coaching observations, not tested causes):

• A sudden jump in pulling volume (new program, extra back day).
• Thick-handled or fixed overhand grips on pull-ups and rows.
• Heavy barbell curls with a straight bar, which fix the wrist and forearm in one position.
• Presses where the wrist bends back under the bar.
• Poor recovery: short sleep and high stress may make any irritated tissue less tolerant of load.

None of this proves a single cause. Tendon pain is multifactorial, and I cannot tell from an article which of these applies to you.

Does rest, cortisone or exercise work best?

Here is what the better studies show.

Exercise beats passive treatment, but modestly. A 2021 systematic review and meta-analysis of 30 trials (2123 participants) in lateral elbow tendinopathy found exercise outperformed corticosteroid injections on all outcomes at all time points except short-term pain, with low certainty. Compared with wait-and-see, it helped on some outcomes only, with very low certainty. The authors concluded the effects are small, and noted that exercise programmes varied a lot in load, duration and frequency (Karanasios et al., 2021).

Cortisone is a short-term trade. A Lancet meta-analysis found corticosteroid injections had a large effect on pain for lateral epicondylalgia versus no intervention in the short term (SMD 1.44), but no intervention was favoured at intermediate term (SMD -0.40) and long term (SMD -0.31) (Coombes et al., 2010). Serious adverse events were rare in that review (one tendon rupture among 991 injected people).

The single trial behind that picture is easy to read too. In 198 adults with tennis elbow, injection looked best at 6 weeks, but 47 of 65 early successes later regressed, and long-term outcomes were worse than physiotherapy (elbow manipulation plus exercise). Physiotherapy beat wait-and-see early, but at 52 weeks most people in both groups reported success (Bisset et al., 2006).

The cautious takeaway: tennis elbow often settles on its own, injection can buy short-term relief at a possible long-term cost, and exercise is a reasonable middle path. Whether to inject is a conversation for your doctor.

Eccentric wrist exercises: do they work?

Eccentric means lowering a load slowly. For the elbow, that is the lowering phase of a wrist curl or wrist extension.

In a randomized trial of 120 people with tennis elbow lasting over three months, daily eccentric exercise (lowering a weight) for three months with gradually increasing load reduced pain faster than concentric exercise (lifting it), with about a 10% higher responder rate, and strength also rose more. Function and quality of life did not differ between groups (Peterson et al., 2014).

So eccentrics look useful, but not magical. Honest summary: a modest edge, in one trial population.

What about the Tyler twist for golfer’s elbow?

Golfer’s elbow has far less research than tennis elbow, and I want to be upfront about that.

The Tyler twist uses a rubber bar. You twist it with your good hand, then slowly untwist it using the sore arm’s wrist flexors. In a 2014 study, 20 patients with chronic medial epicondylosis who had failed earlier treatments added this eccentric exercise (3 x 15, twice daily) to standard physical therapy. DASH disability scores improved from 34.7 to 7.9 on average, over about 6 weeks (Tyler et al., 2014).

Sounds impressive, but there was no control group, and patients also received stretching, ultrasound, massage and heat or ice. A 2026 systematic review of 5 studies (143 patients) concluded eccentric exercise may reduce pain and improve function in golfer’s elbow, but certainty is low and larger trials are needed (See et al., 2026).

Is heavy slow resistance right for the elbow?

Heavy slow resistance (HSR) uses slow, heavy reps, usually 3 seconds up and 3 down. It is well known for knee and Achilles tendons, but the elbow evidence is much thinner.

A 2024 Norwegian feasibility trial randomised 60 people with tennis elbow to HSR, shockwave therapy, or information and advice. Only 6 of 19 people (32%) complied with HSR, mainly due to pain aggravation, and outcomes improved in all three groups. The authors suggested HSR may not be suitable for tennis elbow (Sveinall et al., 2024). It was a feasibility study, not a test of which treatment works best.

My read: slow, controlled loading makes sense, but starting “heavy” on a cranky elbow tendon is a recipe for flaring it. Build up.

A sensible structure, to confirm with a physio (illustrative, not a prescribed protocol):

1. Calm it. Light isometric holds of the wrist in the pain-free range.
2. Go slow. Eccentric wrist curls (inner elbow) or wrist extensions (outer elbow) with a light dumbbell, 3 seconds lowering.
3. Add load gradually. Slightly heavier, still slow, only if pain stays low and settles by the next day.
4. Return to lifts. Bring rows, curls and presses back with the swaps below.

For a general rule on how much pain is acceptable, see our guide to good vs bad pain and the traffic light model for returning after injury.

Gym fixes: straps, neutral grips and EZ-bars

This is where you keep training without feeding the problem.

Problem lift	Swap or fix	Why it may help
Barbell row, pull-up	Lifting straps on the heaviest sets	Takes load off gripping forearm muscles
Straight-bar curl	EZ-bar or neutral-grip hammer curl	Less forced wrist angle
Overhand pull-ups	Neutral-grip handles or lat pulldown	Eases wrist and forearm position
Heavy bench press	Dumbbell or neutral-grip press, bar over forearm	Keeps wrist from bending back
Heavy deadlift hold	Straps or mixed grip on top sets only	Grip stops being the limiter

I want to be clear: these are coaching adjustments based on how the tendons are loaded, not treatments proven in trials. I did not find a controlled study of lifting straps for elbow tendinopathy. If you want the full back-day case for straps, see lifting straps for back hypertrophy.

Straps are unlikely to cost you much back development. When grip gives out before your lats do, straps let the back keep working while the forearm tendon gets a break. Save grip-specific work for separate light, controlled days, and see our arm and forearm guide and grip strength protocols for that.

What to do this week

1. Find which side is tender (inner or outer) and note which lifts spike it.
2. Swap those lifts using the table above. Keep training everything else.
3. Start light eccentric wrist work on the correct side and progress slowly.
4. Keep pain low and settled by the next morning. If it is worse after two sessions, pull back a step.
5. Put the exercises into a balanced split, for example our free push day and pull day plans, and edit the exercises that irritate you.

When to see a doctor

Get it checked if you have numbness or tingling in your fingers, visible swelling, a sudden pop followed by weakness, pain after a fall or hit, pain at night that does not ease, or no improvement after several weeks of sensible changes. These can mean a nerve, joint or partial tendon tear needs a proper exam. This article is general information, not a diagnosis.

The bottom line

Elbow tendinopathy in lifters is usually a load problem: pulling and pressing volume grew faster than the forearm tendons could handle. Exercise is better supported than rest or injections over the long run, though effects are small and evidence is low certainty. Eccentric work is a sensible tool, slow heavy loading needs a gradual build, and straps, neutral grips and EZ-bars let you keep training. Stay patient, and bring in a clinician early if it does not budge.