The Modern Elbow Problem: Why Tennis Elbow and Golfer’s Elbow Are Really Scapula Problems in Disguise

My dear reader,

Two conditions walk into my Marylebone clinic almost every week:

Tennis Elbow (lateral epicondylitis)

and

Golfer’s Elbow (medial epicondylitis).

The funny part?

Half the people who suffer from them don’t play tennis.

The other half don’t play golf.

Some do neither and still arrive clutching their elbow like a Victorian poet in emotional distress.

The common question is always:

“Paulius, why does my elbow hurt when I’m not really doing anything extreme?”

My answer — delivered as gently as possible — is this:

Your elbow is innocent.

Your scapula is the troublemaker.

Let me explain.

Why the Elbow Suffers in Modern Life

The elbow is a simple hinge joint living between two far more complex characters:

• The hand, which we overuse

• The shoulder–scapula complex, which we underuse

When the shoulder and scapula lose their natural control — as they often do in modern life — the forearm muscles take on too much work.

This is how Tennis Elbow and Golfer’s Elbow quietly start.

Tennis Elbow (Lateral Epicondylitis)

Overload of the common extensor tendon, especially ECRB.

Golfer’s Elbow (Medial Epicondylitis)

Overload of the common flexor tendon, mainly the wrist/finger flexors.

Both tendons become inflamed, irritated, thickened or simply fed up with modern living.

But here’s the key:

These conditions are NOT forearm problems.

They are scapular stability problems.

The Scapula: The Forgotten Architect of the Arm

Your scapula (shoulder blade) is not a passive bony plate.

It is the central control hub for upper-limb biomechanics.

Muscles that stabilise the scapula include:

• Lower trapezius

• Middle trapezius

• Rhomboids

• Serratus anterior

• Upper traps (in moderation…)

When these muscles work well, the arm moves smoothly and load travels down the chain efficiently — shoulder → elbow → wrist → hand.

When they don’t?

The elbow becomes the unwilling shock absorber.

Why Scapular Control Is Disappearing in Modern Humans

We lose scapular control because we no longer live the life our shoulders evolved for.

Our ancestors:

• Climbed trees

• Threw spears

• Hung from branches

• Carried heavy objects

• Reached in all planes of motion

Us, modern people:

• Forward shoulders at a desk

• Arms in front of the body

• Little overhead movement

• No climbing

• No hanging

• Repetitive gripping (mouse, phone, gym bar)

As the scapular stabilisers weaken:

• The shoulder becomes forward and unstable

• The rotator cuff overworks

• The forearm takes up the slack

• The elbow tendons become overloaded

• Pain arrives slowly and stays longer than your last gym membership

This is why Tennis Elbow myofascial release, Golfer’s Elbow manual therapy, or even forearm trigger point therapy help only partially unless the scapula is restored.

The Anatomical Chain Reaction

Let’s break the chain down in JANMI-style clarity.

1. Scapula fails to stabilise

Weak serratus anterior and lower traps = poor scapular upward rotation and retraction.

2. Shoulder moves poorly

The humerus doesn’t glide cleanly.

The rotator cuff works overtime.

3. Forearm tries to stabilise the entire arm

The extensors (tennis elbow) or flexors (golfer's elbow) become compensators.

4. Tendons overload at the elbow

Because the tendons are small and not designed to handle full-arm stability, irritation begins.

5. Pain becomes chronic

Especially with repetitive gripping, typing, lifting, carrying, or gym work.

This is why so many people say:

“It came out of nowhere.”

It didn’t.

It came from your scapula quietly taking early retirement.

A Typical JANMI Case Study

A client comes in with tennis elbow.

Desk job.

Gym three times a week.

No sport. No tennis racquets.

Elbow has been hurting for 6 months.

But when I assess, the real picture shows:

• Winged scapula

• Tight pec minor

• Weak lower traps

• Overactive upper traps

• Thoracic stiffness

• Wrist extensors overloaded from stabilising a bad shoulder

The elbow is simply the last link breaking.

Once we:

• Release the shoulder fascia

• Free the thoracic spine

• Re-activate serratus and lower traps

• Release the overworked forearm

• Teach proper load transfer from scapula → shoulder → elbow

…suddenly the elbow “mysteriously” improves.

This is not magic.

This is anatomy with common sense.

Why This Matters in the Pain Pandemic

We live in a time where forearm tendon pain is exploding:

• Desk workers

• Weightlifters

• Racquet players

• Phone users

• Anyone who grips repetitively

This is a biomechanical pandemic, driven by postural collapse, overuse of the hand, and underuse of the shoulder.

The answer is not only treating the elbow.

It is restoring scapular control, a piece of evolutionary movement we’ve lost.

My Final Message to You

If your elbow hurts, don’t blame your elbow.

It has been doing its best.

Instead, look up the chain:

Your scapula has likely gone offline.

Re-awaken the shoulder’s stabilisers — reintroduce natural, evolutionary shoulder patterns — and the elbow often settles beautifully.

This is the foundation of how I treat elbow pain at JANMI Soft Tissue Therapy Marylebone.

Warm wishes,

Paulius Jurasius

JANMI Integrated Therapy, Marylebone