Pain guide
Most elbow pain is a sore tendon, an irritated nerve or a swollen bursa, and it gets better. Where it hurts is the best first clue: the outside of the elbow points to tennis elbow, the inside to golfer's elbow, tingling in the ring and little fingers to the ulnar nerve, and a sudden pop at the front to the biceps tendon.
Start with the warning signs below. Then find your pain on the map: if it fits a clear pattern, go to that guide; if you're not sure, follow the plan on this page from stage 1.
Exercise is for pain that has been checked or is clearly mild and settling.
Location narrows the likely causes; it does not diagnose.
Worse gripping, lifting, turning a door handle, shaking hands or using a mouse, and tender on or just below the bony bump on the outside. Usually tennis elbow, most common between 35 and 54. Most people who get it don't play tennis.
Read: Tennis elbow →Inside of the elbowWorse gripping, lifting heavier things and bending the wrist, and tender over the bony bump on the inside. Usually golfer's elbow; most cases are not from golf.
Read: Golfer's elbow →Inside of the elbow, with tingling in the ring and little fingersWorse leaning on the elbow or keeping it bent, such as holding a phone or sleeping with the arm tucked up. Points to the ulnar nerve, the "funny bone" nerve (cubital tunnel syndrome). Constant numbness, a weak or clumsy hand, or wasting between the thumb and index finger needs a GP.
Read: Ulnar nerve entrapment →Front of the elbow, after a sudden popLifting something heavy, then bruising, a bulge in the upper arm and weakness turning the palm up: a possible torn biceps tendon, usually in men over 30. Get help from NHS 111 the same day; the guide explains why timing matters.
Read: Front of the elbow (biceps tendon) →Front of the elbow, an ache with curls, chin-ups or carrying, and no popCame on gradually: possibly distal biceps tendinopathy, an overloaded tendon, which is rare.
Read: Front of the elbow (biceps tendon) →Like a soft egg, often after leaning on it or a knock: olecranon bursitis. If it is hot and red and you feel feverish, it may be infected and needs a same-day check. See "Swelling on the point of the elbow" below.
Dips, push-ups and triceps extensions: possibly the triceps tendon, which is rarely the problem. A sudden pop with weakness straightening the arm could be a tear: get help from NHS 111. See "Back of the elbow" below.
Aching with use, often in older people, after an old injury or after years of manual work: elbow arthritis or stiffness after an injury. Catching or locking can mean a loose fragment.
Read: Elbow arthritis and stiffness →Possibly a fracture, especially with swelling, bruising or a change of shape. Get help from NHS 111, or go to A&E if it has changed shape or is numb.
Changes when you move your neck, often with neck pain or stiffness too: a pinched nerve in the neck can be felt at the elbow. See "Is it my neck?" below.
Read: Pinched nerve in the neck →Shoulder and upper arm, stopping above the elbowUsually the shoulder, often the rotator cuff. The shoulder guide's map helps tell them apart.
Read: Shoulder pain →Possibly a pulled elbow, usually under school age. It needs a doctor or nurse, usually in the emergency department, where it is usually put back.
Thrower's elbow ("Little League elbow"). Pain often comes before a more serious injury: stop throwing and get it checked.
An infection in the joint or the bursa, or gout, usually developing over a few days. Get an urgent GP appointment or call NHS 111 the same day.
Possibly a heart attack, especially with shortness of breath, sweating or feeling sick. Call 999.
Often waking you at night and eased by shaking the hand. This is usually the median nerve at the wrist (carpal tunnel syndrome), not the elbow.
Read: Carpal tunnel syndrome →The NHS says elbow and arm pain is not usually a sign of anything serious, and asks readers not to diagnose themselves. The map tells you what is likely, not what you have. If your pain doesn't fit, or isn't easing after a few weeks, get it checked.
Source 1
Tennis elbow, the most common cause, usually gets better on its own, but over months rather than weeks. In the no-treatment and placebo groups of 24 trials (1,085 people), 89% were much better or recovered at a year. Every 2.5 to 3 months, about half of those still sore recovered, and how long it had already lasted made no difference to the chances. In two trials, 83% and 90% of people told to wait and see had a successful outcome at a year.
Golfer's elbow has been studied far less, but it is managed the same way.
Searches for elbow tendonitis usually mean one of two common problems: tennis elbow on the outside or golfer's elbow on the inside. Clinicians now prefer "tendinopathy" to "tendonitis", because by the time people seek care the inflammation has often settled, and guidelines recommend loading the tendon rather than resting it completely. Tendon problems at the front (biceps) and the back (triceps) of the elbow are rare.
The JOSPT tennis elbow guideline lists a pinched nerve in the neck (cervical radiculopathy) first among the conditions that can mimic tennis elbow, alongside nerve problems near the elbow. People who reported nerve symptoms had worse pain and disability at 8 weeks.
Clues that point to the neck (editorial): pins and needles or numbness in the hand, pain that changes when you turn or tilt your head or look up, and neck pain or stiffness alongside the elbow pain. The pinched nerve in the neck guide has its own staged plan. The NHS advises seeing a GP for pins and needles that keep coming back or don't go away.
The bursa is a small fluid-filled sac between the bony point of the elbow and the skin. Pressure or friction, such as leaning on your elbows, can make it swell; occasionally it gets infected. It can ache, feel tender or warm, and hurt more when you press on it or move it.
The NHS advice: rest it from pressure, use ice for about 10 minutes every few hours, take painkillers, and pad or cushion it. See a GP if it isn't better after 1 to 2 weeks, and get a same-day check (urgent GP appointment or NHS 111) if you have a high temperature or feel hot, cold or shivery, can't move the joint, or have very severe or shooting pain.
In a trial of 90 people with non-infected bursitis, a compression bandage plus anti-inflammatories cleared it in 83% by 4 weeks, draining it in 65%, and draining plus a steroid injection in 85%. The steroid worked fastest, but the authors favoured compression and anti-inflammatories as the safest balance: reviews link steroid injections for bursitis with more complications, including infection and thinning of the skin, and found non-surgical care safer than surgery.
Exercise isn't a treatment for bursitis, and no study has tested it. Keep the elbow moving within comfort with the stage 1 moves below, avoid leaning on it, and do forearm planks on padding, or swap them for straight-arm planks, while it settles (editorial).
Triceps tendinopathy is very rare, and little has been published about it. Pain at the back of the elbow when straightening against resistance (dips, skull crushers, close-grip pressing) is the usual story, compared with tennis elbow on the outside (editorial). Use mid-range triceps work such as pushdowns and the elbow pain rule. A sudden pop with weakness straightening the elbow could be a torn tendon: get help from NHS 111.
Pulled elbow: when a young child's arm is pulled or the child is swung by the arms, a forearm bone can slip out of the ligament that holds it at the elbow. The child holds the arm still at their side. A doctor or nurse moves it back, usually in the emergency department. It can happen again, but rarely once children reach school age; avoid pulling or swinging children by the arms.
Young throwers: in 50 young throwers with a fracture of the growth plate on the inner elbow, 84% of those asked had elbow pain before the injury. In US high school baseball, specific pitching rules (rest between consecutive days, a daily limit of 105 pitches or fewer) were linked with fewer shoulder and elbow injuries, though the national rule change as a whole made no measurable difference. Elbow pain in a young thrower is a reason to stop throwing and get checked, not to play through. A UK care pathway also lists elbow pain in a child or teenager as a reason for referral.
Several popular beliefs about elbow pain are weaker than they sound.
Sources 2, 12, 31, 32, 11, 24, 25, 34, 35, 21, 38, 30, 28, 41, 45, 40, 46
A UK care pathway strongly recommends offering physiotherapy for tennis elbow, and the JOSPT guideline recommends strengthening the muscles that lift the wrist (grade B). In a review of 30 trials, exercise beat a steroid injection on every outcome and at every time point except short-term pain. In many areas you can refer yourself to NHS physiotherapy.
In a trial of 198 people, physiotherapy (manual therapy plus exercise) beat wait-and-see at 6 weeks (65% vs 27% success), but not at a year (94% vs 90%). A 2024 Cochrane review found small benefits at the end of treatment that were not sustained, on low-certainty evidence. Expect exercise to help you recover a bit faster and keep your arm strong, not to work overnight.
The JOSPT guideline recommends still holds (isometric), lifting (concentric) and slow lowering (eccentric) exercise for the wrist, at about 3 sets of 15 for 6 to 12 weeks. Slow lowering may ease pain slightly more than other exercise in meta-analyses of small trials; across tendon problems, still holds were no better than lifting and lowering. Pick what you can do regularly within the pain rule.
In a placebo-controlled trial of 165 people with tennis elbow, fewer had recovered at a year after a steroid injection (83% vs 96%), and more had the pain come back (54% vs 12%). A review of 41 trials found a large short-term effect that reversed by the medium and long term. A UK care pathway recommends strongly against steroid injections for tennis elbow.
Cochrane reviews found little or no benefit over a placebo from platelet-rich plasma (PRP) or blood injections (pain 0.16 points better out of 10 at 3 months) and from shockwave therapy (9 trials, 1,006 people). A UK care pathway recommends strongly against shockwave, and NICE allows both shockwave and blood injections only with special arrangements because the benefit is uncertain.
Forearm straps and wrist splints give an immediate drop in pain and a better grip while you wear them, but no long-term benefit has been shown. In one placebo-controlled trial of 31 people, a counterforce brace eased pain at rest from 2 to 12 weeks. A UK care pathway allows a strap as an option rather than recommending it outright.
There is no evidence that surgery for tennis elbow does better than a placebo operation. The NHS says surgery may be an option after 6 to 12 months, but the chance of recovering stays about the same through the first year, so how long it has lasted is not, on its own, a reason for surgery.
Tennis elbow is diagnosed from the story and an examination. Imaging is for when the diagnosis is uncertain.
Use heat or ice, whichever feels better, wrapped in a towel: the NHS suggests up to 20 minutes every 2 to 3 hours for tennis elbow, or 10 to 15 minutes every few hours for elbow and arm pain in general. The evidence for ice is weak (JOSPT grade E, theory only). For pain relief the NHS suggests paracetamol or an anti-inflammatory gel; a UK care pathway allows anti-inflammatories for up to 4 weeks, gels preferred, on low-quality evidence.
Some discomfort during forearm exercises is fine. Keep it mild: no more than about 3 to 4 out of 10. It should settle within an hour or so, and your elbow should be no worse the next morning. If it is worse, go lighter next time (a lighter weight, a bendier bar, fewer reps or a shorter hold), not nothing. When a set no longer causes any discomfort, it's time to progress.
Tingling is the exception: stop any exercise or position that brings on pins and needles or numbness in your hand, especially in the ring and little fingers, and avoid holding the elbow fully bent while it settles.
This is lower than the 5 out of 10 used on this site's back and shoulder pages, because most elbow trials used pain-free or nearly pain-free exercise. A UK consensus paper that reviewed the tennis elbow trials reports that all but one asked for pain-free exercise; the exception, as that paper describes it, allowed mild pain below 4 out of 10. The JOSPT guideline says the load should not make symptoms worse, and elbow specialists suggest doing the flexible-bar exercises with discomfort of about 3 to 4 out of 10.
Pushing harder backfires at the elbow. Still holds done above people's own pain threshold left more pain 30 minutes later, while holds below it did not, and in one trial most people gave up heavy loading, mainly because it aggravated their pain. In long-lasting muscle and joint pain generally, allowing some pain did no harm. The exact 3 to 4 out of 10 figure and the settling times are editorial. If pain climbs from week to week, or you notice a warning sign, stop and get it checked.
Start at the first stage. Each move opens a full guide with a 3D demo.
Days 0 to 14, little and often. Find what eases it, and use heat or ice if it helps. If a move clearly makes the outside or inside of the elbow worse, the tennis or golfer's elbow guide is the better plan. Doses are editorial starting points unless a source is named.
3D demoWrist & forearm flowBeginner · No equipment10 slow reps each direction, 2 to 3 times a day
Harder: Wrist flexor stretch
3D demoElbow bend and straighten (elbow range of motion)Beginner · No equipment10 slow reps, 2 to 4 times a day · The NHS suggests bending and straightening your arm; 10 reps is an NHS Borders leaflet dose
Harder: Dumbbell biceps curl
3D demoBall squeezeBeginner · Other / check instructions30 s of squeezing and releasing, 5 to 10 times a day · As firmly as you can without increasing your pain: an NHS Borders leaflet's dose
Harder: Band finger extension
3D demoBand finger extensionBeginner · A band2 sets of 15
Easier: Ball squeeze · Harder: Band overhead triceps extension
Move on when: Everyday tasks feel a little easier, and your elbow is no worse the next morning.
About weeks 2 to 6. The forearm moves once a day or most days; the rows, rotations and push-ups 2 to 3 times a week.
3D demoReverse wrist curlBeginner · A dumbbell + A bench or box5 holds of 30 to 45 s, then 3 sets of 10 to 15 · Start as a still hold with the wrist level, then lift and lower; within a UK consensus protocol's doses
Easier: Wrist-extensor eccentrics · Harder: Seated One-Arm Dumbbell Palms-Down Wrist Curl
3D demoWrist curlsBeginner · A dumbbell3 sets of 10 to 15 · The UK consensus protocol's dose for lifting and lowering
Easier: Wrist-extensor eccentrics · Harder: Seated One-Arm Dumbbell Palms-Down Wrist Curl
3D demoDumbbell forearm rotationBeginner · A dumbbell + A bench or box3 sets of 10 · Hold the handle nearer the weighted end to make it easier
Easier: Wrist-extensor eccentrics · Harder: Dumbbell reverse curl
3D demoBand rowBeginner · A band + An anchor point2 to 3 sets of 12 to 15
3D demoStanding band external rotationBeginner · A band + An anchor point2 to 3 sets of 12 to 15
Harder: Side-lying external rotation
Move on when: Every set stays within the elbow pain rule, and a set no longer causes any discomfort.
From about week 6, and ongoing. Doses are editorial starting points.
3D demoHammer curlBeginner · A dumbbell3 sets of 8 to 12
Easier: Seated dumbbell curl · Harder: Alternating hammer curl
3D demoDumbbell biceps curlBeginner · A dumbbell3 sets of 8 to 12, lowering slowly
Easier: Seated dumbbell curl · Harder: Standing Inner-Biceps Curl
3D demoTriceps pushdownBeginner · A cable machine3 sets of 10 to 12 · At the gym
3D demoDumbbell triceps kickbackBeginner · A dumbbell3 sets of 10 to 12 · The home option
3D demoFarmer's carryBeginner · A dumbbell + A kettlebell3 walks of 20 to 30 m
Harder: Suitcase carry
Move on when: Add load one change at a time. Then keep a twice-weekly habit: the wrist and forearm routine below fits.
Lifting with the palm facing down loads the muscles on the back of the forearm most. Lift with the palm up or thumb up and keep the object close to your body; use the least grip force that works, thicker handles, lighter tools and frequent breaks. This is standard advice, but direct trial evidence is thin (JOSPT grade E).
No trial has tested gym swaps for elbow pain. These come from where it hurts and from the known risk factors, forceful and repeated gripping, twisting and heavy handling (editorial):
Hold 2 to 3 times for 20 to 30 seconds, a mild stretch, never sharp.
| Stretch | Reasonable for | Take care or skip | Why |
|---|---|---|---|
| Wrist extensor stretch (tennis elbow stretch) | Tennis elbow; a tight forearm after typing, gripping or tool work | Tingling in the hand: ease off | The standard stretch in NHS and UK consensus tennis elbow programmes. Stretching alone matched stretching plus strengthening at 6 weeks in one trial, but has no long-term advantage. |
| Wrist flexor stretch | Golfer's elbow; a tight forearm from desk work | Tingling in the fingers: ease off | The NHS inform golfer's elbow stretch. |
| Wrist & forearm flow | Everyone; the first moves of the day | None within comfort | Moves the wrist and forearm through their whole range with no load. |
| Kneeling Forearm Stretch | Healthy wrists; later stages | Irritable golfer's elbow or wrist pain | Body weight goes through stretched wrist flexors, the muscles on the inside of the forearm, not the extensors. |
| Quadruped wrist rocks | Getting back to push-ups, yoga or handstands | Irritable golfer's elbow; wrist pain | Weight through a bent-back wrist loads the inner-elbow tendons (editorial). |
| Overhead Triceps Stretch | A tight back of the arm; a stiff elbow that lacks bend | Tingling in the ring and little fingers | It holds the elbow fully bent, which squeezes the ulnar nerve. |
| Standing biceps stretch | A tight chest and front of the shoulder | An irritable tendon at the front of the elbow (editorial) | Mostly a shoulder stretch, with little effect at the elbow. |
| Median nerve slider (neck-to-arm nerve glide) | Arm pain and tingling coming from the neck | Not for little-finger tingling (the ulnar nerve); not in the first painful days | The neck guide's nerve glide, for a different nerve. |
Tennis elbow usually settles within a year. A staged exercise plan with 3D demos, the pain rule the trials used, and honest answers on straps and injections.
Pain guideGolfer's elbow hurts on the inner elbow when you grip or lift. A staged exercise plan with 3D demos, the reverse Tyler twist, and when tingling means a nerve.
Pain guideTingling in the ring and little fingers? Why the ulnar nerve gets irritated at the elbow, which positions to change, whether nerve glides help, and when to act.
Pain guideA pop, bruising and a bulge in the upper arm need a same-day check. A front-of-elbow ache without a tear: what helps, how to load it and what to avoid.
Pain guideAn elbow that won't fully bend or straighten, from arthritis or an old injury. Range-of-motion and strength exercises with 3D demos, and when to get it checked.
Where it hurts says the most. Pain on the outside with gripping and lifting is usually tennis elbow; on the inside, golfer's elbow; at the front with curls or carrying, the biceps tendon; at the back when straightening against resistance, the triceps. Lifting with the palm down loads the outer-elbow tendons most, so lifting with the palm up or thumb up often hurts less.
Leaning presses on two things: the ulnar nerve on the inside of the elbow, which causes tingling in the ring and little fingers, and the bursa on the point of the elbow, which can swell into a soft lump. Pad the elbow, rest on your forearm instead, and see the ulnar nerve guide or the bursitis section above.
Tennis elbow can range from mild discomfort to constant pain that disturbs sleep. No trial has tested sleeping positions for elbow tendon pain; not lying on the sore arm is a sensible start (editorial). If the ring and little fingers tingle at night, sleeping with the elbow bent is a known trigger, and a towel wrapped around the elbow stops it bending fully. A hot, swollen elbow with a fever needs a same-day check.
Either, wrapped in a towel: the NHS suggests up to 20 minutes every 2 to 3 hours for tennis elbow, or 10 to 15 minutes every few hours for general elbow and arm pain. The evidence for ice is weak, so use whichever feels better.
Elbow and arm pain is not usually a sign of anything serious. But call 999 if arm pain comes on suddenly with pressure, heaviness, tightness or squeezing across your chest, especially with shortness of breath, sweating or feeling sick. Sudden weakness or numbness in one arm with a drooping face or slurred speech is also a 999 call.
Tingling in the ring and little fingers, worse leaning on the elbow or keeping it bent, points to the ulnar nerve at the elbow. Tingling with neck pain, or that changes when you move your head, points to the neck. Tennis elbow on its own shouldn't cause numbness. Constant numbness, a weak or clumsy hand, or wasting between the thumb and index finger needs a GP, and numbness after an injury needs A&E.
Usually one of two common problems: tennis elbow on the outside or golfer's elbow on the inside. Clinicians now call them tendinopathies, because the inflammation has often settled by the time people seek care, and the treatment is gradual loading rather than complete rest. Tendon problems at the front and back of the elbow are rare.
Go by where it hurts: tennis elbow on the outside, golfer's elbow on the inside, and the triceps tendon at the back of the elbow, worse straightening against resistance. Triceps tendon problems are rare. The plans for tennis and golfer's elbow mirror each other.
After a fall or knock, yes: get help from NHS 111, because about half of people who can't fully straighten the elbow after an injury have a fracture. After a pop with bruising and a bulge, think of a biceps tear and get a same-day check. A stiffness that came on gradually points to arthritis or an old injury, and an elbow that locks or catches should be checked for a loose fragment.
Usually not. Tennis elbow is diagnosed from the story and an examination, and imaging is for when the diagnosis is uncertain. After a fall, an X-ray checks for a fracture; a suspected biceps tear may need a scan.
A forearm strap can ease pain during the jobs that hurt and improve your grip while you wear it, but no long-term benefit has been shown. Use it for a few weeks if it helps, alongside the exercises, not instead of them.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
