When an archer's elbow hurts, the outer side is the spot most often affected

The summary today

Two independent samples, far apart in time and discipline, put the outer side of the elbow at the top of the list. In 1971, among 122 kyudo practitioners, pain at the lateral epicondyle, where the forearm extensors originate, appears in 12 cases, twice as many as at the medial epicondyle (6) and at the olecranon, where the triceps inserts (6). In 2018, among 62 national and European-level Olympic archers, overuse injuries of the arm are 23.5% of the total, two in three on the bow side, and at the elbow the authors report mostly lateral epicondylitis, without counting it. In neither study was the elbow the subject: these are distributions of injury sites among archers who already had complaints, gathered by questionnaire and, in the second study, without diagnoses confirmed by a doctor, so the status stops at reported. A 2025 ultrasound study of 12 elite archers complicates the picture slightly: compared with athletes from the other sports, the archers' lateral epicondyle is not thicker, while the medial one is. It is a preprint, and a thickened tendon is not a painful elbow, but it is a reminder that the load of shooting reaches the inner side too.

Also phrased as: "archer's elbow"; "tennis elbow in archery"; "lateral epicondylitis in archers"; "elbow pain in the bow arm"

Evidence

• 1971
  For Kyudo archers Published later

  A questionnaire on 122 kyudo practitioners, with clinical and X-ray examination of the 30 with the most marked complaints: among elbow symptoms, pain at the lateral epicondyle, origin of the forearm extensors, appears in 12 cases, against 6 at the medial epicondyle, origin of the flexors, 6 at the olecranon, where the triceps inserts, and 2 at the radio-ulnar joint; another 4 have limited elbow movement.

  An orthopaedical analysis of the kyudo athlete · Masanobu Tomizawa, Hitoshi Furuya, Sadayoshi Toriyama, Tadahiko ONO

• 1971
  Context Kyudo archers Published later

  In the 30 practitioners with the most marked complaints, X-rays show 4 cases of elbow osteochondromatosis with osteophytes, including one archer aged 34 with 12 years of practice and five to six hours of shooting a day. It is a finding in a subgroup chosen for its symptoms, not an estimate of how common it is.

  An orthopaedical analysis of the kyudo athlete · Masanobu Tomizawa, Hitoshi Furuya, Sadayoshi Toriyama, Tadahiko ONO

• 2016
  Context Archers Published later

  239 recurve and compound archers in Florida, surveyed at competitions and in clubs: among those injured the elbow appears in 18.8% of cases, third after the shoulder (70.3%) and the back (31.7%) and ahead of the wrist (15.8%) and fingers (12.9%). The abstract does not say which side of the elbow or which arm.

  Prevalence And Characteristics Of Archery-related Injuries In Archers · Bryan Prine, Amanda Prine, Trevor Leavitt, Joseph Wasser, Heather K. Vincent

• 2018
  For Archers Published later

  62 national and European-level Olympic archers, with a retrospective questionnaire covering their whole career: there are 12 overuse injuries of the arm, 23.5% of the total, two thirds of them on the bow side, and at the elbow the authors report mostly lateral epicondylitis, which they also call archer's elbow. They do not count the cases, and the diagnoses are those reported by the archers, without medical confirmation.

  Acute and Overuse Injuries in Elite Archers · Claudia K. Niestroj, Volker Schöffl, Thomas Küpper

• 2025
  Context Archers Published later

  Ultrasound of twenty entheses per side in 87 elite athletes from seven sports and 49 sedentary controls, including 12 archers: lateral epicondyle thickness is greater in track and field, cycling and climbing, not in archers, while medial epicondyle thickness is greater in archers than in the other sports (p = 0.009). It is a preprint not yet peer reviewed, and it measures tendon adaptation, not pain.

  Sport-Specific Loading Drives Ultrasound-Detected Entheseal Adaptations in Elite Athletes Questionable venue · Sibel Bakirci, Tuba Melekoglu, Gufat Arslan, Seyyid Bilal Acıkgoz, Yilmaz Sungur, Sibel Zehra Aydin

Status history

1. 1971 Reported The question starts in kyudo. Among 122 practitioners, those with elbow pain feel it most often on the outer side, where the forearm extensors originate: 12 cases against 6 on the inner side and 6 at the olecranon. In the thirty with the most marked complaints, X-rays also find four elbows with osteochondromatosis. It is a single study, on a kyudo sample, and the elbow is one of the sites listed rather than the subject of the research: reported.
2. 2016 Reported Among 239 recurve and compound archers in Florida, the elbow is the third site named by those who have been injured, in 18.8% of cases, after the shoulder and the back. It confirms that the elbow matters outside kyudo too, but the abstract does not say which side hurts or on which arm, so it adds nothing to the question about the outer side: the status stays reported, resting on the kyudo sample alone.
3. 2018 Reported A second sample arrives, this time of Olympic recurve archers: among 62 German and European archers, overuse injuries of the arm are almost a quarter of the total, two in three on the bow side, and at the elbow the authors report mostly lateral epicondylitis. Two independent samples point the same way and none points the other, but the status does not rise: in both the elbow is a secondary site, described by questionnaire by archers who already had complaints, and in the second study the cases of epicondylitis are not even counted.
4. 2025 Reported An ultrasound study of elite athletes from seven sports looks at tendons rather than pain, and in its 12 archers finds the medial epicondyle thickened, not the lateral one. It is a preprint with few archers, and an adapted tendon is not a painful elbow, so it counts neither for nor against. It is a reminder, though, that the load of shooting reaches the inner side too, and the status stays reported.

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