Elbow Pain and Strength Training After 50 — Golfer's Elbow, Tennis Elbow, and What to Do About Both

The elbow doesn't get the attention the shoulder and hip do. There's no dramatic moment — no single session where something gives way — and so it tends to be dismissed as a minor irritation until it isn't. For the over-50 trainee who does any serious pulling work, the elbow is one of the most common points of failure, and one of the least discussed. Rows, chin-ups, curls, deadlifts — these are the movements that built much of what you have, and they're also the movements that, over time, can start generating a very specific kind of persistent discomfort.

You probably know the feeling. A tenderness on the inside of the elbow after a heavy row session. A burning on the outside that hasn't quite gone away for weeks. A grip that feels fine under light load but unreliable when you push the weight up. The problem with elbow pain is that it tends to arrive gradually and stay stubbornly — and the usual advice isn't particularly helpful. Rest until it improves. Ice it. Stop doing the movement that hurts. None of that addresses what's actually happening, and none of it tells you how to keep training while things heal.

This page is different. I'm going to give you a clear picture of what's actually going on — which condition you're most likely dealing with, why it developed, and what the research and experience actually suggest about fixing it. More importantly, I'm going to show you how to keep a productive programme running while the elbow recovers, because stopping entirely is almost never the right answer and rarely what a lifetime of training has prepared you to accept.

The first useful thing is knowing what you're actually dealing with, because golfer's elbow and tennis elbow are different conditions at different locations with different aggravating movements — and treating one as the other wastes weeks of rehab effort. The good news is that identifying which one you have is straightforward: it comes down almost entirely to where it hurts.

Golfer's elbow — medial epicondylitis — is pain on the inside of the elbow, on the bony prominence you can feel on the inner side of your upper arm just above the joint. It involves the flexor-pronator tendons that attach there — the tendons of the muscles that flex the wrist and forearm. In a strength trainee, it's almost always the result of heavy or high-volume pulling work: rows, deadlifts, chin-ups, curls. The tendons are repeatedly loaded in a way they can't adequately recover from, and over time the tendon tissue degenerates rather than adapts. Despite the name, you don't need to play golf to get it. In my experience, it's considerably more common in strength trainees than the name implies.

Tennis elbow — lateral epicondylitis — is pain on the outside of the elbow, on the bony prominence on the outer side of the upper arm. It involves the extensor tendons — the muscles that extend the wrist and fingers. In a strength trainee it tends to be associated with gripping work, reverse curls, wrist extension movements, and sometimes pressing exercises that load the wrist extensors. It can also develop from repetitive tasks outside the gym: keyboard work, manual jobs, anything that involves sustained or repeated gripping and wrist extension.

Both conditions are technically tendinopathies — the pathology is at the tendon, not the joint itself. That distinction matters, because it changes everything about how you train around them and what actually helps. Joints respond to rest; tendons, somewhat counterintuitively, respond better to the right kind of loading.

One more point worth making: the over-50 tendon is not the over-30 tendon. After 50, tendons lose some collagen density, take longer to remodel after stress, and have a narrower tolerance between productive loading and overloading. This is not a reason to train less — it's a reason to manage total tendon load more intelligently. I've seen this with my own training. Sessions that felt entirely manageable at 40, repeated at the same volume and frequency in my 50s, started producing exactly the kind of medial elbow tenderness I'm describing here. The training wasn't wrong. The load management was.

As with any tendinopathy, the instinct is to compile a never-do list and live by it. That instinct is understandable but mostly unhelpful. Understanding why a movement aggravates the tendon gives you the framework to modify it intelligently — adjusting the grip, the load, the volume, or the implement — rather than eliminating an entire category of training that you may have been doing for decades.

For golfer's elbow, the primary aggravators are movements that repeatedly load the flexor-pronator tendons under significant tension. Heavy pronated-grip rows — particularly barbell rows — place sustained stress on the medial attachment with every rep. Barbell curls, especially under heavier loads, do the same. Chin-ups and pull-ups with a supinated (underhand) grip are a somewhat surprising offender: the supinated position concentrates load at the medial epicondyle as you pull, and high-volume chin-up work is one of the most reliable ways to develop golfer's elbow that I know of. Deadlifts, because of the sustained high-force gripping they require, also contribute to total medial tendon load — particularly in higher-rep sets.

For tennis elbow, the primary aggravators are movements that load the wrist extensors: reverse curls, wrist extension exercises, and any grip-intensive work where the wrist is held in extension. Repetitive gripping tasks outside the gym — sustained keyboard use, manual work, carrying bags — can be significant contributors and are worth factoring into total tendon load. Certain pressing movements, particularly tricep extensions and press-downs, also load the lateral elbow and can flare an existing lateral tendinopathy.

The common thread through both conditions is this: repetitive loading of a tendon that doesn't have adequate recovery time between sessions. After 50, that recovery window is longer than it used to be — not dramatically so, but enough that the volume tolerance you had at 35 may now sit just above your threshold rather than well within it. The solution is not to stop loading. It's to reduce total tendon load temporarily, introduce the right kind of rehabilitative loading, and rebuild progressively from there.

This is where most online advice on elbow tendinopathy fails the reader. It lists what to avoid in reasonable detail and then says almost nothing useful about what to do. The result is a trainee who has removed their pulling work, is doing nothing to rebuild tendon capacity, and is wondering why things are no better six weeks later.

There are two practical approaches that actually work, and you need both running simultaneously.

The first is load modification — adjusting the way you're loading the affected tendon rather than removing the load entirely. For golfer's elbow, this means switching from pronated-grip pulling to neutral-grip pulling wherever possible. A neutral grip (palms facing each other) significantly reduces the stress at the medial epicondyle compared to a pronated grip. This is a straightforward swap: neutral-grip dumbbell rows instead of barbell rows; a neutral-grip cable attachment instead of a pronated lat pull-down bar; hammer curls instead of barbell curls. The pulling volume stays; the medial load drops. For golfer's elbow and deadlifting, the trap bar is genuinely useful: the neutral grip and upright body position reduce both the gripping stress and the medial elbow load compared to a conventional barbell. The deadlift over 50 guide covers the trap bar setup in full.

The second approach is eccentric and isometric loading — and this is where the actual tendon healing happens. Eccentric work (the controlled lowering phase of a movement, with the muscle lengthening under load) has the strongest evidence base of any intervention for tendinopathy. It stimulates tendon remodelling — the replacement of degenerated tendon tissue with healthy collagen — in a way that rest alone doesn't produce. For golfer's elbow, the key eccentric exercise is the wrist flexion eccentric: hold a light dumbbell with the forearm supported, use the other hand to lift the wrist into flexion, then lower it slowly under control — that slow lowering is the eccentric work. For tennis elbow, the Tyler Twist (a reverse wrist curl performed eccentrically with a Theraband FlexBar or equivalent) has strong clinical support and is worth doing consistently.

Isometric holds — a sustained wrist or grip position held against resistance — are a useful complementary tool. They've been shown to reduce tendon pain acutely in the session and can serve as a way to begin loading the tendon when eccentric work is still too uncomfortable. A sustained grip hold against a fixed object, or a wrist extension or flexion hold against resistance, for 30–45 seconds, several times a day, is low-risk and genuinely useful in the early stages.

After decades of lifting, here's what I've come to believe about elbow tendinopathy: the trainees who recover fastest are the ones who resist the urge to test the elbow with a heavy session every time it feels slightly better, and who commit to the eccentric work with the same seriousness they bring to the programme itself. The eccentric work is unglamorous — light dumbbells, slow tempos, daily repetition — but it's the mechanism through which the tendon actually heals. If I were starting again at 50 with a fresh case of golfer's elbow, the eccentric wrist flexion work would be the first thing I'd add and the last thing I'd drop.

Principles matter, but a concrete template is more useful. The goal here is to keep the upper body programme productive — real training, not a rehabilitation circuit — while the affected tendon gets the modified load and the eccentric work it needs to recover.

The lower body programme is entirely unaffected by elbow pain and should continue without modification. The abbreviated approach that runs through this site adapts naturally — total session time stays within 30–40 minutes, and the pull slot is simply substituted rather than removed.

Beyond what you do in the session, there are two areas that contribute significantly to elbow tendinopathy in the over-50 trainee and are almost never discussed: equipment choices, and a specific technique habit that quietly loads the medial elbow on every pulling rep.

On equipment: the straight barbell forces the wrist and elbow into a fixed position that is not always mechanically kind to the medial tendon. An EZ bar for curls significantly reduces the stress at the medial epicondyle compared to a straight bar — the angled grip allows the forearm to sit in a more neutral position rather than full supination. If you've been doing barbell curls and wondering why the inside of your elbow keeps complaining, switching to an EZ bar is worth trying before anything else. Similarly, a neutral-grip cable attachment for rows and pull-downs removes most of the pronation load from the pulling movement and distributes it more comfortably across the forearm.

Fat Gripz — thick rubber sleeves that slide over a bar or dumbbell handle to increase the grip diameter — are worth knowing about. Thicker handles recruit more of the forearm muscles and distribute gripping stress more widely, which reduces the focal load on the medial tendon attachment. They're inexpensive and genuinely useful for a trainee with chronic medial elbow pain who wants to keep loading the pull pattern.

On technique: there is one habit I see repeatedly in trainees with chronic golfer's elbow, and it's almost never identified as a contributor. Watch a heavy dumbbell row and look at the wrist at the top of the movement — in many trainees the wrist curls upward (into flexion) as the elbow drives back, concentrating load on the medial epicondyle with every rep. The fix is simple: keep the wrist neutral throughout the row and think about driving the elbow back rather than curling the hand up. That single cue removes a significant and repeated stress from the tendon on every rep of every pulling set.

Daily forearm flexibility work is the other underappreciated factor. Tight forearm flexors and extensors increase the load transmitted to the tendon attachments at the elbow. Two stretches, done daily, cost almost nothing and consistently make things more comfortable: a wrist extension stretch (arm extended, palm down, gently pull the fingers back with the other hand until a stretch is felt in the forearm) for the flexors, and a wrist flexion stretch (arm extended, palm up, gently pull the fingers down) for the extensors. Sixty seconds each side, morning and evening. It sounds minor. Over weeks, it isn't.