Tennis Elbow Treatment: How Non-Operative Options Compare – And Why Exercise Therapy Stands Out

Tennis elbow—also known as lateral epicondylitis—is one of the most common overuse injuries affecting the forearm and elbow. Whether caused by racquet sports, manual labour, desk work, or repetitive gripping tasks, it can be frustrating and persistent.

With so many treatment options available, patients are often unsure which approach will give the best results.

Recent research from 2023–2025 provides clear direction:

Exercise therapy and physiotherapy-led rehabilitation consistently produce the most significant improvements in pain and long-term function.

Understanding Tennis Elbow

Tennis elbow is a tendinopathy of the wrist-extensor tendon group, particularly the extensor carpi radialis brevis (ECRB).

It is not caused by acute inflammation, but by tendon overload, reduced capacity, and changes in neuromuscular control.

That is why treatments focused solely on reducing inflammation often fail and why treatments that build strength, coordination, and load tolerance tend to succeed.

Comparing Non-Operative Treatments

1. Exercise Therapy and Physiotherapy (The Most Effective Option)

What it includes:

• Eccentric or heavy-slow resistance loading

• Isometrics for pain relief

• Progressive strengthening

• Forearm, shoulder, and grip strengthening

• Neuromuscular or “neuroplastic” tendon training

• Activity and load modification

• Education for long-term management

What the research shows:

A major umbrella review from 2023 and several recent trials, including a 2025 neuroplastic tendon training RCT, found that exercise therapy consistently improves pain, grip strength, and long-term function—more reliably than passive treatments or injections.

Key advantages:

• Most effective at 6–12+ weeks

• Highest long-term success

• Low risk and cost-effective

• Improves tendon health and movement patterns

Bottom line:

Exercise therapy is the most proven non-operative treatment for tennis elbow.

2. Shockwave Therapy (ESWT)

Shockwave therapy can help some patients—especially in chronic cases—by stimulating tendon healing, but results across studies are mixed.

Pros:

• May reduce pain in the short term

• Can enhance outcomes when combined with exercise

Cons:

• Not consistently superior to exercise alone

• Effects may be temporary without strengthening

Best used as an adjunct rather than a standalone treatment.

3. Ultrasound, Laser, and Other Passive Modalities

Passive tools such as therapeutic ultrasound, laser, and TENS are widely available but supported by inconsistent evidence.

Pros:

• Can produce short-term symptom reduction

• Useful early when pain limits exercise tolerance

Cons:

• Do not improve long-term tendon health

• No strong evidence that they outperform exercise therapy

Best considered short-term comfort tools rather than long-term solutions.

4. Injection Therapies (Steroid, PRP, Autologous Blood)

Injection treatments remain common but require careful interpretation.

Corticosteroid Injections

• Effective for short-term pain relief

• Associated with high rates or re occurrence

  
  

  Not recommended as a first-line treatment for a sustainable recovery, but can help manage symptoms while building strength with physiotherapy.

PRP and Autologous Blood

• Evidence is mixed

• May be helpful for chronic cases

• Best outcomes occur when combined with structured rehabilitation

• More costly, with inconsistent superiority over exercise alone

5. Bracing and Supports

Counterforce braces or wrist splints may reduce pain during gripping or repetitive tasks.

Pros:

• Helpful for daily activities or work

• Reduce strain during aggravating tasks

Cons:

• Provide only short-term relief

• Do not influence long-term recovery

Useful as a supportive aid during rehabilitation.

Overall Comparison

Most Effective (Strong Evidence)

• Exercise therapy and physiotherapy

• Load management and education

• Neuromuscular tendon training

Moderately Effective (Mixed Evidence)

• Shockwave therapy

• PRP or autologous blood injections

Short-Term Relief Only (Weak Long-Term Evidence)

• Corticosteroid injections

• Ultrasound, laser, and other passive modalities

Why Exercise Therapy Outperforms Other Treatments

Exercise therapy stands out because it:

• Rebuilds tendon capacity

• Restores coordination and neuromuscular control

• Improves grip function and load tolerance

• Reduces recurrence

• Provides lasting improvements rather than temporary relief

It empowers patients to participate actively in their recovery rather than relying on passive or short-lived treatment options.

Final Takeaway

Tennis elbow can be a stubborn condition, but strong evidence consistently supports a structured physiotherapy and exercise-based approach as the most effective non-operative treatment. Other interventions—such as shockwave therapy, PRP, or bracing—can play supportive roles, but none replace the benefits of progressive strengthening and active rehabilitation.

For anyone experiencing tennis elbow, the best first step is a comprehensive physiotherapy assessment and a personalised exercise program designed to restore tendon health, improve function, and prevent recurrence.