Tennis Elbow and Golfer’s Elbow: Heat or Ice?

Tennis elbow and golfer’s elbow are the same problem on opposite sides of the same elbow (yeah).

Tennis elbow is pain on the outside of the elbow, golfer’s elbow on the inside. Most people with either have never played the sport. If you do play, see racquet sports shoulder and elbow pain.

The question of heat or ice depends almost entirely on how long you’ve had it. The general framework is in heat or ice: a physio’s decision guide.

The name is misleading

Both are called “-itis”, which suggests inflammation.

In cases lasting more than a few weeks, the tissue changes seen are degenerative rather than inflammatory: the tendon has been overloaded and hasn’t repaired properly.

That matters, because anti-inflammatory thinking, rest and ice, treats a problem that has largely moved on.

What a struggling tendon needs is structured graded load. The same story plays out in the Achilles and the outside of the knee.

So, Heat or Ice?

Stage	Use
First few days after a sudden flare-up	Cold, for pain relief
Weeks to months in, stiff and achy	Heat before your exercises
Sore the evening after a heavy day	Either; most prefer cold
Stiff first thing in the morning	Heat

If the flare came with visible swelling, the 48–72 hour rule applies before you reach for heat at all.

For a long-standing case, the practical use of heat is as a warm-up: 10–15 minutes on the forearm and elbow, lowest setting, then straight into your loading exercises. The elbow has thin skin over bone, so keep it low and check afterwards. More on the sequence: “my physio said use heat”.

What actually works

Loading the tendon. Slow, progressive strengthening of the wrist extensors (tennis elbow) or flexors (golfer’s elbow) has the best evidence. Typically a light weight, slow movements, several sets, most days, progressed over months.

Mild discomfort during the exercise is acceptable; pain that lingers into the next day means the dose was too high. A physiotherapist or hand therapist can set that dose, which is the part people get wrong alone.

Managing what aggravates it. Gripping, twisting and carrying with the palm down are the usual culprits. Adapting how you do those tasks matters more than any treatment. The same grip-saving ideas are set out in hand arthritis.

Time. Tendons are slow. Several months is normal, and that’s not a sign it’s going badly.

What to be cautious about: complete rest, which weakens the tendon further; and repeated steroid injections, which often give quick relief but have worse outcomes at a year than exercise in several studies.

Everyday adjustments

• Carry bags with the palm up, or over the forearm
• Build up thin handles with foam tubing to reduce grip force
• Two hands for kettles, pans and heavy objects
• Check mouse and keyboard position if you’re at a desk. See upper back pain from desk work and thumb and wrist pain from phone use.
• A brace or strap helps some people during aggravating tasks, but it’s a supplement to loading, not a substitute

See a therapist if…

• It’s been more than six weeks and isn’t improving
• You have pins and needles or numbness in the hand, which points to a nerve rather than the tendon. See carpal tunnel and heat.
• You’re losing grip strength or dropping things
• The elbow is swollen, hot or red, or you have a fever
• The pain started with a fall or a sudden snap
• It keeps returning every few months

Hand therapists and physiotherapists treat this often. The value is in setting the right loading programme and the right progression, which is hard to judge for yourself.

Clinically reviewed by: Nigel Chua (Hand Occupational Therapist) & Louise Yow (Physiotherapist). This article is general information, not a diagnosis. electricheatpad.com sells electric heat pads.