You've been doing the exercises. You've modified your activities. You've been patient with the process. But three months later, your elbow still aches when you grip anything or reach for objects.
If this sounds familiar, you're probably wondering what else might help. Maybe you've heard about shockwave therapy but aren't sure what it involves or whether it's worth considering.
This article explains what treatment for tennis elbow typically involves, why some cases take longer to settle, and when additional options like shockwave therapy might be helpful for stubborn symptoms.
What You'll Learn in This Post
The most effective treatments for tennis elbow and why they work
Why some cases are slower to respond to standard care
What shockwave therapy actually involves and how it works
Whether you might be a candidate for this treatment
How to decide what's right for your situation
Physiotherapy and Exercises: The Foundation of Tennis Elbow Treatment
Most tennis elbow cases respond well to physiotherapy-led treatment. This isn't just about exercises, it's a comprehensive approach that addresses why your elbow became painful in the first place.
Education and Understanding
The starting point is understanding what's happening in your elbow. Tennis elbow affects the tendons that help you grip and extend your wrist. These tendons can become irritated and painful when overloaded, but they're also capable of healing and becoming stronger with the right approach.
Progressive Loading and Exercise
This forms the backbone of effective tennis elbow treatment. Rather than complete rest, controlled exercises help the tendon adapt and recover.
This typically includes:
Eccentric strengthening (lengthening exercises that build tendon strength)
Progressive grip work
Wrist and forearm flexibility
Gradual return to activities
Activity Modification
Instead of stopping everything, physiotherapy for tennis elbow focuses on smart modifications. This might mean adjusting your tennis grip, improving your desk setup, or changing how you lift objects while your elbow recovers.
Manual Therapy
Hands-on treatment can address muscle tension, joint stiffness, and movement restrictions that often accompany tennis elbow.
Most people begin to see improvements within 4-8 weeks with this approach, though complete resolution often takes 3-6 months.
Why Some Cases Are Slower to Heal: Underlying Causes of Tennis Elbow
Despite following the right approach, some cases prove more stubborn. Several factors can influence this:
Work Demands
Jobs involving repetitive gripping, computer work, or manual tasks can make recovery challenging. One patient explained: "I work in construction, so even with modifications, my elbow gets aggravated daily. It feels like I'm taking one step forward and two steps back."
Delayed Treatment
The longer tennis elbow persists before appropriate treatment begins, the more entrenched the problem can become. Tendons that have been painful for many months often need more intensive intervention.
Previous Unsuccessful Treatments
Multiple cortisone injections, prolonged rest periods, or inappropriate exercises can sometimes complicate recovery.
Individual Factors
Some people's tendons simply take longer to respond, regardless of how well they follow treatment recommendations.
What Is Shockwave Therapy?
Shockwave therapy uses acoustic pulses - high-energy sound waves - delivered directly to the affected tendon. These pulses are thought to stimulate the body's natural healing processes by:
Increasing blood flow to the area
Breaking down scar tissue
Encouraging new tissue growth
Reducing pain signals
The treatment involves a handheld device that delivers these pulses through your skin to the painful area. Sessions typically last 5-10 minutes and are usually performed weekly for 3-6 weeks.
What does it feel like? Most people describe it as uncomfortable but tolerable - like someone tapping firmly on your elbow. The intensity can be adjusted based on your comfort level.
Does Shockwave Therapy Work for Tennis Elbow? Diagnosis and Clinical Considerations
Research on shockwave therapy for tennis elbow shows mixed but often positive results, particularly for cases that haven't responded to other treatments.
Studies suggest that shockwave therapy can be effective for:
Cases that have persisted for several months
People who haven't responded adequately to exercise therapy alone
Those looking to avoid more invasive treatments
The success rates vary, but many studies show 60-80% of people experience significant improvement when shockwave is used for chronic tennis elbow.
One patient told us: "I'd been struggling with tennis elbow for eight months. My physio suggested trying shockwave alongside my exercises, and within a few weeks I noticed the constant ache was finally starting to settle."
However, it's important to note that shockwave therapy isn't a magic bullet. It works best when combined with appropriate exercises and activity modification, not as a standalone treatment.
Is Shockwave Therapy Right for Me?
Shockwave therapy isn't typically a first-line treatment for tennis elbow. We usually consider it when:
You might benefit if:
You've been doing appropriate exercises for 8-12 weeks without sufficient improvement
Your symptoms have persisted for several months
You're motivated to continue with your exercise programme
You want to try conservative options before considering more invasive treatments
It might not be suitable if:
You haven't tried a proper exercise-based programme yet
You're pregnant
You have certain medical conditions (your physiotherapist will assess this)
You're expecting immediate results - shockwave still requires patience
Our senior physiotherapist explains: "We often reserve shockwave for patients whose symptoms haven't responded to other care after a reasonable time. It's not about replacing good rehabilitation, it's about giving that rehabilitation the best chance to work. When we get the timing right, it can be the nudge their recovery needs."
What to Expect if You Try Shockwave Therapy
Before Treatment
Your physiotherapist will assess whether you're a suitable candidate and explain what to expect. They'll also ensure you're continuing with appropriate exercises, as shockwave works best as part of a comprehensive approach.
During Treatment
Sessions are typically weekly for 3-6 weeks
Each session lasts 5-10 minutes
The intensity is adjusted to your tolerance
You can usually return to normal activities immediately after
After Treatment
Some people experience temporary soreness for 24-48 hours
Benefits often become apparent over several weeks rather than immediately
You'll continue with your exercise programme throughout and beyond treatment
Other Treatment Options to Consider – From Bracing to Surgery
Shockwave therapy is just one option for persistent tennis elbow. Other approaches that might be considered include:
Dry Needling
This involves inserting fine needles into trigger points in the muscles around your elbow to reduce tension and improve function.
Bracing
While not a cure, a tennis elbow brace can sometimes help manage symptoms during activities.
Injection Therapy
While cortisone injections provide temporary relief, newer options like platelet-rich plasma (PRP) are being researched for tennis elbow.
Surgical Options
Very rarely needed, tennis elbow surgery might be considered if conservative treatments haven't helped after 12+ months.
Making the Right Decision for Your Tennis Elbow
The key to successful tennis elbow treatment is finding the right combination of approaches for your specific situation. This might be:
Exercise therapy alone for newer cases
Exercise plus manual therapy for straightforward cases
Exercise plus shockwave for persistent cases
A combination approach for complex situations
The most important factor is working with someone who can guide you through the options and help you make informed decisions about your care.
Frequently Asked Questions
Is shockwave therapy painful? Most people find it uncomfortable but tolerable. The sensation is often described as firm tapping. The intensity can be adjusted, and any discomfort during treatment is brief.
How quickly does shockwave therapy work? Benefits typically develop over several weeks rather than immediately. Some people notice improvements after 2-3 sessions, while others need the full course of treatment.
Can I have shockwave therapy alongside other treatments? Yes, shockwave works best when combined with appropriate exercises and activity modification. It's designed to enhance your rehabilitation, not replace it.
What if shockwave therapy doesn't help? If shockwave doesn't provide sufficient benefit, there are other options to explore. Your physiotherapist can guide you through the next steps based on your individual situation.
Moving Forward with Your Tennis Elbow Recovery
Tennis elbow can be frustrating, especially when it doesn't respond as quickly as you'd hoped to initial treatment. The good news is that even stubborn cases usually do settle with the right approach and patience.
Whether that involves standard physiotherapy, shockwave therapy, or other treatments depends on your individual circumstances. The key is working with someone who can assess your specific situation and guide you through the options.
Key Takeaways
Most tennis elbow cases respond well to physiotherapy-led treatment combining exercises, activity modification, and manual therapy
Shockwave therapy can be helpful for cases that haven't responded to standard care after 2-3 months
It works best as part of a comprehensive approach, not as a standalone treatment
The decision about whether to try shockwave should be based on your individual circumstances and response to other treatments
If you're struggling with persistent tennis elbow and wondering about your options, we're here to help. Our team can assess your situation and discuss whether treatments like shockwave therapy might be appropriate for you. Contact us to book an assessment or have a conversation about your next steps.
