Elbow Pain: What Causes It and How Physiotherapy in Calgary Can Help (2026 Update)

Primary Keyword: elbow pain physiotherapy Calgary  ·  Secondary: tennis elbow treatment Calgary, golfer's elbow physio, lateral epicondylalgia treatment, MacLeod Trail elbow pain, South Calgary elbow physiotherapy.

Author: Colin Bouma, PT, FCAMPT  ·  Updated for 2026

Elbow pain is one of those conditions that sneaks up on people. It rarely starts with a dramatic injury. One week your grip feels weaker. The next week shaking hands hurts. A month later you cannot turn a doorknob without wincing, and pouring the kettle has become a full-body decision. By the time most patients walk into our Calgary clinic, they have been ignoring it for six months and Googling "tennis elbow" — even though they have never picked up a racket.

I am Colin Bouma, an FCAMPT-certified physiotherapist (the highest manual therapy designation in Canada) practising on MacLeod Trail SW. This post is the 2026 update to one of our most-read pieces, rebuilt around what current research — including 2021-2024 systematic reviews — actually says works for the elbow. Some of it will surprise you, especially if your doctor has been quick to suggest a cortisone shot.

The Four Most Common Elbow Problems We See

1. Lateral elbow tendinopathy ("tennis elbow")

Pain on the outside of the elbow, often radiating into the forearm, worse with gripping, lifting with the palm down, and shaking hands. The condition affects roughly 1–3% of adults per year. Only a small fraction play tennis — most cases come from desk work, trades, and any activity that loads the wrist extensors repeatedly. The modern term is lateral elbow tendinopathy or lateral epicondylalgia, not "epicondylitis" — there is little active inflammation, and the suffix "-itis" is misleading. It is a load-tolerance problem, not an angry inflamed structure that needs to be quieted.

2. Medial elbow tendinopathy ("golfer's elbow")

The same idea, on the inside of the elbow. Pain with gripping, forearm rotation, and resisted wrist flexion. Less common than the lateral version, equally treatable, and again — most cases have nothing to do with golf.

3. Cubital tunnel syndrome (compression of the ulnar nerve)

Numbness or tingling in the ring and little fingers, often worse at night or with the elbow bent (phone calls, sleeping with arms folded). This is the elbow's equivalent of carpal tunnel syndrome. Catching it early matters — prolonged compression can cause measurable grip weakness that is harder to reverse.

4. Distal biceps tendinopathy or tear

Pain at the front of the elbow at the biceps insertion. Tendinopathy is gradual; a complete tear is usually a sudden, traumatic event (lifting something heavy with a "pop") and warrants prompt orthopedic assessment because surgical repair, when indicated, is time-sensitive.

What the Evidence Actually Says About Tennis Elbow

Cortisone shots: the seductive trap

If your elbow has been hurting for two months, and your family doctor offers an injection, here is what the data actually show. A landmark 2013 JAMA trial randomized 165 patients with tennis elbow to corticosteroid injection, multimodal physiotherapy, both, or placebo, and followed them for a year (Coombes et al., 2013). Patients in the injection groups had lower one-year recovery rates and higher recurrence than placebo. A broader 2010 Lancet systematic review of corticosteroid injections for tendinopathy found the same pattern across multiple tendons: short-term relief, worse long-term outcomes (Coombes, Bisset, & Vicenzino, 2010).

The short-term relief is genuine. It is also a trap. The injection settles the symptoms while you keep loading the tendon the same way that produced the problem in the first place — and the tendon's underlying capacity continues to degrade. There are specific situations where a single, well-timed injection can be useful (severe pain blocking engagement with rehab, for example), but as a default first-line treatment, the evidence has been clear for over a decade: do not start there.

Exercise: the actual heavy hitter

A 2021 systematic review and meta-analysis of 30 trials and 2,123 patients found that exercise outperformed passive interventions (massage, ultrasound, taping alone, etc.) for lateral elbow tendinopathy — with small but consistent effects on pain, function, and grip strength (Karanasios et al., 2021). A 2021 meta-analysis specifically of eccentric loading showed it improves pain and strength compared with concentric exercise or adjunct therapy alone (Cullinane et al., 2014; updated meta-analyses through 2021).

A 2024 network meta-analysis in the Journal of Hand Surgery compared every common intervention head-to-head (exercise, dry needling, shockwave, PRP, corticosteroids, surgery, and more) and concluded that progressive exercise and education remain the most reliable foundation, with select adjuncts useful in specific cases (Lowdon et al., 2024).

Manual therapy plus exercise vs. wait and see

The classic Bisset trial published in the BMJ randomized 198 tennis elbow patients to mobilization-with-movement plus exercise, corticosteroid injection, or "wait and see." At 6 weeks, the injection group looked great. At 52 weeks, the physiotherapy group had the best outcomes and the injection group had the worst (Bisset et al., 2006). Tennis elbow does often improve on its own over 8–12 months — but "wait and see" comes at the cost of a year of frustration, and a good rehab plan can dramatically shorten that timeline.

What an Honest Treatment Plan Looks Like

1.     Identify the actual driver. Is it a true tendinopathy? Is it a neck or radial nerve referral mimicking elbow pain? Is your grip pattern at work the underlying load problem? A careful clinical exam, not a quick "looks like tennis elbow" diagnosis, sets up the rest.

2.     Load it — sensibly. Isometric and slow heavy resistance for the wrist extensors and forearm. Progressed weekly. The tendon does not want to be left alone; it wants to be loaded at a level it can handle, repeatedly, until its capacity goes up.

3.     Address the chain. Wrist, forearm, elbow, shoulder, and scapular control all matter. A weak rotator cuff or sluggish scapular control increases load on the elbow extensors. We test it; we train it.

4.     Manual therapy as an adjunct. Mobilization-with-movement, soft-tissue work, and neural sliders when the radial or ulnar nerve is contributing. Useful to take the edge off so you can keep training — not the main course.

5.     Modify provocation. Counterforce braces (a forearm strap) can reduce symptoms temporarily for some patients. Adjusting grip mechanics at the keyboard, mouse, hammer, or kettlebell is more durable.

6.     Realistic timelines. Most patients see meaningful improvement in 6–12 weeks of consistent rehab. Stubborn cases can take longer. Anyone telling you they will "fix" your tendinopathy in three sessions is selling, not treating.

A Starting Exercise Plan You Can Try

•      Wrist extensor isometric holds: hand over the edge of a table, palm down, gently pushing up against light resistance and holding for 30–45 seconds. 5 holds per session. Pain to 3–4/10 during the hold is acceptable; sharp or escalating pain is not.

•      Eccentric wrist extensions: holding a light dumbbell, palm down, lower the weight slowly (5 seconds) from extended wrist to flexed wrist; use the other hand to return to the start. 3 sets of 10–15, daily as tolerated.

•      Grip work: a hand-gripper or stress ball, 3 sets of 10, holding the squeeze for 3 seconds each rep.

•      Shoulder and scapular work: rows, band external rotations, and scapular squeezes 2–3 times a week.

•      Activity modification: temporarily reduce the loads that flare you the most; use thicker pen grips, mouse grips, or two-handed lifts.

If symptoms keep escalating after two weeks of consistent loading, get assessed. Not all elbow pain is a tendinopathy.

When Elbow Pain Needs a Same-Week Visit

•      Sudden "pop" with immediate weakness or visible deformity — possible distal biceps or triceps tendon rupture, which can be time-sensitive surgically.

•      Numbness and weakness in the hand that is progressing despite avoiding the aggravating positions.

•      Severe night pain unrelated to position, especially in older adults — warrants ruling out other causes.

•      Joint swelling, redness, and fever — possible infection or inflammatory arthritis.

How We Treat Elbow Pain at Our Calgary Clinic

7.     Detailed assessment. Differentiating true elbow tendinopathy from cervical referred pain, radial tunnel, and shoulder-driven loading patterns.

8.     Loading plans built for adults with jobs. Exercises designed to fit a desk worker, a trades professional, or a weekend athlete — not just the patient who has all day for rehab.

9.     Manual therapy and nerve mobilization where indicated. Used to reduce sensitivity so loading can progress.

10.  Honest education about cortisone and other quick fixes. If an injection or surgical opinion is genuinely warranted, we say so. If it is being offered as a shortcut, we say that too.

11.  Outcome tracking. Validated tools (PRTEE, grip dynamometer) so progress is measured, not guessed.

Why Choose Our Clinic on MacLeod Trail?

We are at 8989 MacLeod Trail SW, serving Haysboro, Kingsland, Fairview, Acadia, and the surrounding South Calgary neighbourhoods. We treat a lot of elbows — desk workers, plumbers, electricians, climbers, golfers, parents lifting toddlers — and the plan is always built around your specific loading demands. As an FCAMPT-certified clinician, I bring advanced manual therapy and clinical-reasoning training to every assessment.

Book an Elbow Pain Assessment

If your elbow has been bothering you for more than two or three weeks, is getting worse, or is starting to limit your work or hobbies, get it assessed before it gets entrenched. Tendinopathies are easier to turn around in months three or four than in years one or two.

Bibliography

Bisset, L., Beller, E., Jull, G., Brooks, P., Darnell, R., & Vicenzino, B. (2006). Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: Randomised trial. BMJ, 333(7575), 939. https://doi.org/10.1136/bmj.38961.584653.AE

Coombes, B. K., Bisset, L., Brooks, P., Khan, A., & Vicenzino, B. (2013). Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: A randomized controlled trial. JAMA, 309(5), 461–469. https://doi.org/10.1001/jama.2013.129

Coombes, B. K., Bisset, L., & Vicenzino, B. (2010). Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: A systematic review of randomised controlled trials. The Lancet, 376(9754), 1751–1767. https://doi.org/10.1016/S0140-6736(10)61160-9

Cullinane, F. L., Boocock, M. G., & Trevelyan, F. C. (2014). Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review. Clinical Rehabilitation, 28(1), 3–19. https://doi.org/10.1177/0269215513491974

Karanasios, S., Korakakis, V., Whiteley, R., Vasilogeorgis, I., Woodbridge, S., & Gioftsos, G. (2021). Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: A systematic review and meta-analysis of 2123 subjects in 30 trials. British Journal of Sports Medicine, 55(9), 477–485. https://doi.org/10.1136/bjsports-2020-102525

Lowdon, H., Chong, H. H., Dhingra, M., Gomaa, A.-R., Teece, L., Booth, S., Watts, A. C., & Singh, H. P. (2024). Comparison of interventions for lateral elbow tendinopathy: A systematic review and network meta-analysis for Patient-Rated Tennis Elbow Evaluation pain outcome. Journal of Hand Surgery (American Volume), 49(7), 639–648. https://doi.org/10.1016/j.jhsa.2024.03.007