New to shockwave or in pain for more than 3 months? Book a Telehealth to see if we can help you!
Elbow pain can really disrupt your daily life – whether it’s a dull ache when you grip a coffee mug or a sharp twinge when you try to lift something heavy. We understand how frustrating and worrisome this elbow pain can be, especially when it lingers despite your best efforts. You’re not alone: many people develop elbow pain from overuse (think repetitive work or sports) or an injury that never fully healed. The good news is, with the right approach, most elbow pain can improve. In this post, we’ll demystify why your elbow might be hurting, what the latest research says about effective relief, and how our team at Unpain Clinic takes a whole-body, evidence-based approach to get you back to living pain-free. (Disclaimer: This content is for educational purposes only and is not a substitute for professional medical advice. Always consult a licensed healthcare provider for your specific condition. Individual results may vary.)
Elbow pain often boils down to two main categories: overuse injuries and acute injuries. Overuse injuries develop gradually from repeated strain on the elbow tendons and muscles, whereas acute injuries result from a sudden incident (like a fall or impact). Let’s focus on the overuse side – the common culprits behind that nagging elbow pain:
Tendinopathy (Tennis Elbow & Golfer’s Elbow): Repetitive motions can cause tiny micro-tears in the tendons around your elbow. For example, tennis elbow (lateral epicondylitis) is an overuse injury of the tendons on the outer side of your elbow, often caused by repetitive wrist extension or gripping tasks (not just tennis – painters, mechanics, even heavy computer mouse use can get it). Golfer’s elbow (medial epicondylitis) affects the inner side of the elbow from repeated wrist flexing or gripping (you don’t have to golf to get it – any forceful repetitive motion like throwing, carpentry, or weight training can strain those tendons). Over time, the initially inflamed tendon can undergo degenerative changes (tendinosis) if it’s not allowed to heal properly. This is why the pain persists: the tendon tissue becomes disorganized and weak, so it won’t fully heal simply with a brief rest. In chronic tennis or golfer’s elbow, there may be little to no inflammation left – instead the tendon is frayed and irritated, requiring active rehabilitation to remodel and strengthen it.
“Weightlifter’s Elbow” (Triceps Tendonitis): Pain at the back of the elbow, especially during pushing movements, could be triceps tendonitis (sometimes nicknamed weightlifter’s elbow). This involves the tendon that connects your triceps (back of upper arm) to the point of your elbow. Activities like heavy bench press, push-ups, or repetitive throwing can overload this tendon, causing micro-tears and inflammation. If the strain continues without adequate recovery, the tendon can thicken, develop scar tissue or even calcifications, and healing gets “stuck” in a chronic state. That’s why you might feel elbow pain when bending or straightening your arm – the damaged tendon protests against those movements.
Other Causes: Not all elbow pain is tendon-related, though tendinopathies are very common. Joint issues like olecranon bursitis (inflammation of the bursa at the tip of the elbow) or arthritis inside the joint can cause pain, particularly if you feel a deep ache or stiffness when you bend or straighten the elbow. Nerve compression can play a role too – for instance, an irritated ulnar nerve can cause inner elbow pain with tingling down to the ring and pinky fingers (ever hit your “funny bone”? That’s the ulnar nerve). If your elbow is swollen, very hot/red, or you can’t move it at all, those are red flags pointing to something more severe like an acute injury (fracture or dislocation) or infection – in such cases, seek prompt medical attention.
Why pain from overuse tends to linger: Tendons have a notoriously poor blood supply, so they heal slowly. When you repeatedly stress an elbow tendon (through work, sports, or even daily chores), microscopic damage accumulates faster than the body can repair it. The result is a cycle of re-injury – the tissue never fully regenerates before being strained again. Over weeks and months, the tendon’s structure changes: instead of strong, neatly aligned fibers, you get weaker, messy tissue that doesn’t tolerate load well. Simply taking a short break or wearing a sling often isn’t enough to reverse those changes. That’s why people are often frustrated when rest and ice give only temporary relief – as soon as they return to activity, the pain flares up because the underlying tendon issue is still there. In short, if elbow pain from overuse is sticking around for more than a few weeks, it likely means the root issue (tendon health and mechanics) hasn’t been fully addressed.
The encouraging news is that these elbow overuse injuries – tennis elbow, golfer’s elbow, triceps tendonitis – can heal with proper treatment. They rarely require surgery; in fact, around 90% of cases improve with conservative care (therapy, exercises, etc.). The key is targeted treatment that jump-starts the stalled healing process and corrects any contributing factors (like muscle imbalances or technique problems). In the next sections, we’ll explore what research says about effective treatments and how Unpain Clinic leverages that knowledge to help you finally break the cycle of pain.
Modern research has shed a lot of light on how to effectively treat chronic elbow pain. Here are some of the big takeaways that guide our approach:
Conservative Care Works (and Surgery Is Rarely Needed): Most people do not need surgery to recover from tennis or golfer’s elbow. A large review found about 90% of tennis elbow cases resolve with non-surgical treatments. Similarly, chronic triceps tendonitis is usually self-limiting with proper management; surgery is reserved only for severe tears that don’t heal otherwise. This is great news for patients – it means that with patience and evidence-based therapy, you have a very strong chance of recovery without invasive procedures. It may take some weeks or a few months, but improvement is the norm, not the exception.
Exercise Therapy – Eccentric Strengthening: Therapeutic exercise is a cornerstone of elbow pain rehab. Studies consistently show that a structured exercise program can significantly reduce pain and improve function in tendinopathies like tennis elbow. In particular, eccentric strengthening exercises – where you focus on the slow lowering phase of a movement – have proven highly effective. For example, slowly lowering a dumbbell in a wrist extension exercise, or using a flex-bar (rubber bar) to do eccentric twists, helps stimulate tendon remodeling. One clinical study in stubborn golfer’s elbow found that adding daily eccentric wrist exercises led to dramatic improvements in pain and grip strength, even when other treatments had failed. Why eccentrics? The controlled tension as the muscle lengthens appears to signal the tendon to rebuild collagen and increase its load tolerance. Over time, this can strengthen the tendon’s “scaffolding” so it withstands stress better. It’s important to note: exercise has to be graded properly – too much too soon can aggravate the tendon, so guidance from a physiotherapist is key. But done right, exercise not only helps heal the tendon, it can also address contributing factors (for instance, strengthening your shoulder or core can take strain off your elbow). A well-rounded rehab will often include stretching tight muscles and progressive strengthening, which together restore flexibility and resilience. (Gentle stretches for the forearm muscles – such as a wrist extensor stretch 30 seconds, 3x/day – are commonly recommended to relieve tension, though once a tendinopathy is established, strengthening has greater long-term benefit than passive stretching.)
Bracing and Supports: You might be wondering, “Should I wear a brace or strap for my elbow?” Braces (like the forearm band often used for tennis elbow) can provide temporary relief by reducing load on the tendon. For example, a counterforce strap applied a bit farther down the forearm can change the point of tension and offload the injured site, which many patients find eases pain during activities. However, research on their effectiveness is mixed. A high-quality 2017 randomized trial found that wearing a forearm band daily for lateral epicondylitis offered no significant improvement over doing exercises alone – the group with braces didn’t heal faster or have less pain than the no-brace group at 1, 3, 6, or 12 months. The authors concluded the brace’s effect might be mostly placebo. Our take: an elbow strap or over-the-counter elbow sleeve can be a helpful adjunct if it makes your day-to-day tasks less painful – there’s no harm in using one for short-term relief. Just don’t let it be a crutch that replaces rehab. Braces don’t cure the problem, they only manage symptoms. We often tell patients: it’s fine to use a support if it allows you to perform needed activities with less pain, but be sure you’re still addressing the underlying tendon healing through exercise or therapy. And make sure any brace fits well; a healthcare provider can help choose the right type (for tennis elbow, a forearm counterforce strap; for golfer’s elbow, sometimes a wrist brace; etc.) and ensure it’s worn correctly.
Steroid Injections – Quick Fix, But Not Long Term: Cortisone (steroid) injections have been a go-to for many elbow pain sufferers looking for quick relief. They do often provide a short-term decrease in pain and inflammation. However, multiple studies have shown that steroid shots do not lead to better long-term outcomes in elbow tendinopathy. For example, a trial in golfer’s elbow found that while a steroid injection beat out other treatments for pain relief in the first 6 weeks, by 3 months and beyond there was no advantage – the pain often came back as bad or worse. Steroids can also weaken tendon tissue if used repeatedly. Notably, in the case of triceps tendonitis, steroid injections are usually avoided because they’ve been linked to a risk of tendon rupture in that area. Emerging treatments like platelet-rich plasma (PRP) injections aim to actually stimulate healing rather than just mask pain, but evidence on PRP is still evolving and it’s typically considered only after simpler measures fail. The bottom line: a steroid shot can be an option for severe pain, but it’s generally a temporary Band-Aid. Most experts now recommend focusing on active rehab and regenerative therapies first, since they treat the cause, not just the pain. In fact, one of our podcast guests put it plainly regarding chronic pain: approaches like braces or repeated cortisone shots “only mask symptoms…they don’t fix the underlying issue.”
Shockwave Therapy – Restarting the Healing Process: One of the most exciting advances in treating chronic elbow injuries is extracorporeal shockwave therapy (ESWT). Shockwave therapy involves sending high-energy acoustic waves into the injured tendon area to stimulate repair. It might sound high-tech, but there’s robust evidence behind it now. A 2025 umbrella review (synthesizing multiple studies) concluded that shockwave therapy significantly relieves tennis elbow pain better than placebo, better than standard ultrasound therapy, and even better than steroid injections when looking at longer-term outcomes. Patients who received shockwave had greater pain reduction and functional improvement sustained over time, whereas steroids tended to only help early on. How does it work? The sound waves induce micro-trauma that triggers your body’s natural healing mechanisms – basically a “wake-up call” to a stubborn injury. Blood flow increases, growth factors and stem cells flood the area, and the formation of new blood vessels is stimulated. It also helps break apart scar tissue and calcifications in the tendon. Over a series of treatments, this can coax a chronic tendon injury out of its failed healing cycle and back into healing mode. In one clinical study of 300+ patients with various tendinopathies, shockwave therapy significantly reduced pain and improved function compared to a control, with benefits still present at follow-ups. In head-to-head trials, shockwave’s results after ~8 weeks were as good as or better than cortisone injections for chronic elbow pain – it just takes a bit longer to see the effect, since it’s prompting biological repair rather than chemically numbing the pain. Another bonus: unlike injections or surgery, shockwave is non-invasive and low-risk (side effects are usually limited to temporary soreness).
Complementary Therapies (EMTT and More): Beyond shockwave, there are other newer modalities showing promise. One is EMTT (Extracorporeal Magnetotransduction Therapy) – essentially a pulsed magnetic field therapy. EMTT uses high-frequency electromagnetic pulses applied around the painful area to reduce inflammation and encourage tissue regeneration at the cellular level. It’s painless (you typically just relax while a loop or pad emits magnetic pulses) and has been used as a complement to shockwave. Think of shockwave as actively stimulating tissue healing, and EMTT as calming the inflammatory overdrive and sensitization. A recent trial in 2025 found EMTT (applied once a week for 8 weeks) significantly improved pain and function in people with chronic tendon and joint issues, compared to a sham treatment. At Unpain Clinic, we often pair EMTT with shockwave for stubborn elbow cases – the combination can accelerate relief by both regenerating the tendon and soothing the surrounding tissues.
Another tool is neuromodulation. Chronic pain doesn’t just involve the local tissue – it also involves the nervous system (when pain lasts for months, your nerves can become hypersensitive). Non-invasive neuromodulation therapies aim to “reset” that sensitivity. One example is the NESA® microcurrent treatment, which applies extremely low-intensity electrical currents through pads on your skin to rebalance the autonomic nervous system’s activity. Early evidence has shown that calming the “fight or flight” response via such microcurrents can reduce pain in chronic conditions. Patients often don’t feel anything during the treatment – it’s very gentle – but it can help dial down pain signaling. While more research is ongoing, neuromodulation is a promising add-on, especially for those with highly sensitized nerves or pain that hasn’t responded to local treatments alone.
Hands-On Therapy and Holistic Approach: Finally, studies and clinical experience alike support that a combined approach works best. Manual therapy techniques (like targeted massage, myofascial release, or joint mobilization) can improve elbow mobility and tissue quality. For instance, adding hands-on therapy to exercise has shown better outcomes in some musculoskeletal conditions than exercise alone. A holistic perspective is crucial: sometimes an “elbow problem” isn’t just about the elbow. Research has noted links between shoulder weakness or neck issues and tennis elbow. In our clinic, we often find that treating the entire kinetic chain – not just where it hurts – yields the best results. If your elbow pain stems from an imbalance (say, a stiff upper back or weak rotator cuff causing overload on the elbow), then addressing those areas is key to lasting relief. This echoes a core theme we discuss in our podcast “Pain and Beyond: Exploring the Body’s Complexities” – pain in one spot can be caused by dysfunction elsewhere, so effective treatment finds and fixes that root cause. In short, multimodal care – combining exercise, regenerative therapies like shockwave, possibly bracing for support, and addressing alignment/movement issues – is backed by evidence as the smartest way to conquer chronic elbow pain.
At Unpain Clinic, our approach to elbow pain treatment blends these proven strategies into a personalized plan. We don’t believe in a one-size-fits-all fix; instead, we assess why your elbow hurts – often uncovering contributing factors that might surprise you – and then target those issues directly. Here are the main treatment modalities we may use to get you relief:
We often start with shockwave therapy as a cornerstone for stubborn elbow injuries. Unpain Clinic specializes in advanced True Shockwave™ (focused shockwave), which penetrates deep into tissues. Shockwave delivers pulses of energy that stimulate your body’s own healing processes. It increases local blood flow, helps break up scar tissue, and triggers the production of new collagen in the tendon. Essentially, it jump-starts a stalled repair cycle. Many patients with chronic tennis or golfer’s elbow who failed other treatments finally experience improvement with shockwave. Research shows significant pain reduction and functional gains after a course of shockwave for lateral epicondylitis and other tendinopathies. Typically, a series of 4–6 weekly sessions is recommended. The treatment itself is quick (a few minutes of pulses to the area). It can cause some discomfort during application – often described as a tolerable tapping sensation – but our therapists adjust the intensity to keep you comfortable. No anesthesia or needles are needed, and you can resume light activities immediately after. Over the following weeks, as your body lays down healthier tissue, you should notice pain subsiding and strength returning. Shockwave at Unpain Clinic is always performed by trained physiotherapists or chiropractors, and we’ve seen excellent outcomes even in cases that had lasted many months. (Fun fact: Uran Berisha, our clinic founder and shockwave expert, has performed over 35,000 shockwave treatments and teaches other practitioners worldwide, so you’re in experienced hands!)
Extracorporeal Magnetotransduction Therapy (EMTT) is one of the newer offerings we have for tough cases. If you haven’t heard of EMTT, it’s a device that emits high-frequency magnetic pulses to the injured area. You’ll sit or lie comfortably with a loop applicator around your elbow, and the magnetic pulses go to work deep in the tissues. What does EMTT do? It appears to reduce inflammation and swelling, improve circulation, and encourage tissue regeneration at the cellular level. Think of it as sending a calming signal to an over-stressed tissue. It’s completely painless – you might not feel much aside from maybe a mild warming. We often pair EMTT with shockwave in the same session: shockwave actively disrupts the degenerative tissue and kick-starts repair, while EMTT immediately follows up by soothing the area and further boosting cellular healing. This one-two punch can accelerate relief. For example, in a patient with chronic triceps tendonitis, shockwave can target the tendon fibers and EMTT can help relax the tight muscles and decrease any joint irritation around the elbow. Patients love that EMTT is quick (usually about 10–15 minutes) and has no downtime. While EMTT is relatively new, clinical trials (including one in 2025 on knee arthritis and shoulder tendinopathy) showed significantly better pain relief and function with EMTT vs placebo. It’s a safe, drug-free addition to our toolkit, especially for cases with a lot of inflammation or for folks who want to avoid steroid medications.
Pain isn’t just physical; there’s a nerve component, especially when pain has been around for a while. Neuromodulation therapy aims to recalibrate your nervous system’s response to pain. At Unpain Clinic, we use a non-invasive neuromodulation device (the NESAⓇ system) that sends ultra-low microcurrents through adhesive pads on your limbs. You simply relax for 30–40 minutes while these gentle currents work on balancing the autonomic nervous system. It’s targeting the “software” of pain – those overactive pain signals – rather than the “hardware” (the tendon) alone. Why might we include this? If you’ve had elbow pain for many months, your nervous system can become hyper-alert, amplifying pain signals or causing that area to be extra sensitive. Neuromodulation helps calm down that sensitization. Early studies in chronic pain (like fibromyalgia) have shown reduced pain and even improved sleep with this kind of therapy. During the treatment you usually feel nothing or maybe a slight tingling – it’s very gentle and safe, with no known side effects. By combining neuromodulation with our other treatments, we address both the physical injury and the nervous system’s response, which can be especially helpful for chronic, stubborn elbow pain that hasn’t responded fully to local treatments.
Our therapists are highly skilled in manual therapy, which means using hands-on techniques to relieve pain and improve function. Depending on your assessment, this could include myofascial release and massage to reduce muscle tension in the forearm, elbow, and even shoulder; Active Release Techniques (ART) or instrument-assisted scraping (like Graston) to break down scar tissue and adhesions; gentle joint mobilizations if your elbow joint is stiff; or nerve gliding techniques if a nerve is irritated. Manual therapy can provide immediate relief by improving blood flow and releasing tight structures. For instance, if you have a lot of forearm muscle tightness with your tennis elbow, we’ll work to loosen those muscles and fascia to reduce pull on the tendon. If your elbow pain is partly due to a stiff shoulder or wrist, we’ll treat those areas too to restore proper movement patterns. Studies have found that combining manual therapy with exercise can yield better results than exercise alone in many cases – likely because it helps remove mechanical barriers to healing. Plus, patients often simply feel better and move easier after a good hands-on session. Our clinicians might also use techniques like dry needling (using acupuncture-like needles to release trigger points) or taping (kinesiology tape to support the muscles and tendons) as adjuncts. These can all contribute to pain reduction and improved mobility as you heal.
No rehab is complete without exercise – it’s truly the linchpin of long-term recovery. After we reduce your pain enough to start moving comfortably, we’ll guide you through a tailored exercise program targeting your elbow and any contributing weaknesses. This usually includes eccentric strengthening drills for the wrist and forearm muscles (research-backed to help tendon healing, as discussed above). We might use a Therabar (flexible rubber bar) for tennis elbow eccentric twists, or eccentric wrist curls with a light dumbbell. Early on, we may also use isometric exercises – these are exercises where you contract the muscle without moving the joint (for example, pushing your hand against a wall without bending the elbow). Isometrics can relieve pain by temporarily dampening pain signals and gently loading the tendon in a safe way. As you progress, graduated strengthening is introduced – not just for the elbow, but often for the shoulder, upper back, and even core. Why? Because a stronger shoulder and core can take strain off your elbow during work or sport. We’ll also show you stretching and mobility exercises if you have any stiffness (common in the wrist or elbow joint after a period of pain). Flexibility work, like forearm stretches or triceps stretches, helps ensure your tissues stay supple as they heal. Importantly, we educate you on ergonomics and technique: if your elbow pain came from, say, your tennis swing or your desk setup, we’ll coach you on adjustments (grip size, posture, keyboard position, etc.) to prevent re-injury. The goal of therapeutic exercise is not just to get rid of pain, but to build back stronger – so you return to your activities with more resilience than before. We want you to not only heal, but also fix the “why” behind the injury, whether that was weak stabilizer muscles or poor form or simply doing too much too soon.
By combining these therapies – shockwave, novel technologies like EMTT and neuromodulation, skilled manual therapy, and targeted exercise – Unpain Clinic aims to cover all bases. It’s a holistic, one-stop approach: we treat the injured tissues, calm the nervous system, correct biomechanical issues, and empower you with the tools to keep your elbow healthy.
It’s easy to get discouraged when you’ve “tried everything” for your elbow pain. To show that recovery is possible, let’s share a quick real-life example (name changed for privacy).
Andy is a 42-year-old recreational tennis player and avid DIY enthusiast. Over one summer, he spent weekends building a backyard deck (lots of hammering and drilling) and kept up his weekly tennis matches. Not surprisingly, Andy developed a nagging pain on the outside of his right elbow. At first, he brushed it off as a sore muscle. But soon, he struggled to even grip his coffee mug or twist a doorknob without pain. Frustrated, Andy tried the usual remedies on his own: rest, ice, and an elbow brace he bought from the pharmacy. He even got a steroid injection from his doctor when the pain wouldn’t subside. The cortisone shot did give relief – but only for about a month. Then the elbow pain roared back, worse than before. By the time Andy came into Unpain Clinic, he’d been dealing with elbow pain for nearly a year and was at his wit’s end.
During his initial assessment at Unpain, we took a whole-body approach. We confirmed he had classic lateral epicondylitis (tennis elbow) in that right arm. But we also found contributing factors: Andy’s forearm muscles were extremely tight and knotted from all the repetitive work, and he had some weakness in his shoulder stabilizer muscles. In other words, his elbow was taking a beating because other areas weren’t pulling their weight. We created a tailored plan for Andy that combined focused shockwave therapy and EMTT for the elbow (to regenerate the tendon and reduce local inflammation), along with specific exercises to stretch his forearm and strengthen his shoulder and upper back. We also used some manual myofascial release to loosen up those tight forearm muscles and gave him guidance on modifying activities (for a few weeks, he avoided heavy gripping and used power tools with his left hand when possible to not aggravate the elbow).
The result? After about 4 weekly sessions, Andy’s pain had reduced dramatically. He reported he could grip a frying pan and even do light hammering with only minimal discomfort – these were things that had been impossible for months prior. Encouraged by the progress, he slowly resumed tennis drills, focusing on proper form and taking breaks before fatigue set in. By around 8 weeks from starting treatment, Andy was essentially pain-free. He was back to playing recreational tennis matches and working on home projects, but now equipped with knowledge of how to warm up properly and not overdo it. In Andy’s own words, “Shockwave and the other treatments were the only things that actually addressed the problem. I’m back to tennis, and I couldn’t be happier.” He was especially relieved that he avoided more invasive measures like surgery. Andy’s story is just one example – every patient is unique, of course, and recovery timelines vary – but it shows that even if you’ve been in pain for a long time, the right approach can truly turn things around. We’ve seen many patients who felt stuck finally get their life and activities back, which is the most rewarding part of what we do.
(If you’re interested, you can hear more success stories and patient experiences on our site and YouTube – like Andy’s elbow recovery which is featured in our testimonials – proof that healing is possible even for chronic cases.)
While professional treatment is crucial for resolving persistent elbow issues, there’s a lot you can do at home to support your recovery (and prevent future flare-ups). Here are some patient-friendly tips and exercises for elbow pain self-care:
Relative Rest & Activity Modification: In the early stages of healing, give your elbow a break from the aggravating activities. This doesn’t mean you must completely stop using your arm – in fact, gentle movement is good – but avoid the motions that spike your pain. For example, if push-ups or heavy lifting cause pain, substitute or modify those exercises (you might do wall push-ups or use lighter weights for a while). If typing bothers your elbow, ensure your workstation is ergonomic (forearms supported, neutral wrist position) and take regular breaks to stretch. Listen to your body’s signals. Cutting back on painful activities for a few weeks can help calm the cycle of re-injury, while you focus on healing.
Ice or Heat for Relief: For a very irritable elbow (especially right after activity), ice can help reduce pain and inflammation. Apply a cold pack wrapped in a cloth to your elbow for 10-15 minutes at a time. This is particularly useful if you notice swelling or warmth in the area (common in acute irritation). On the other hand, if your elbow feels stiff and achy (like those chronic morning aches), heat might be more soothing – a warm towel or shower can loosen tissues and promote blood flow. Some people alternate ice and heat. Neither will “cure” the underlying issue, but they can provide symptomatic relief and improve comfort to allow you to do your exercises.
Gentle Stretching: Keep the muscles and tendons around your elbow flexible with simple stretches. One classic stretch for tennis elbow is the wrist extensor stretch: straighten your affected arm in front of you with the elbow locked, palm facing down, then use your other hand to gently pull the affected hand downward (flexing the wrist) until you feel a stretch along the top of your forearm. Hold ~30 seconds, release, and repeat 2-3 times. For golfer’s elbow (inner side), do the opposite: extend your arm with palm facing up, and gently pull your hand downward to stretch the inner forearm. A triceps stretch (hand overhead, bend elbow, use opposite hand to push the elbow back) can help the back of the arm. Stretching should be gentle – you should feel a pull, not sharp pain. It’s normal for it to be a bit uncomfortable on a tight tendon, but don’t force it. Doing these a few times a day can improve your range of motion and relieve tension. (Note: If stretches aggravate your pain, hold off and consult your therapist – sometimes very acute tendons need a bit of rest before starting stretches.)
Strengthening Exercises: Eccentric strengthening, as mentioned, is one of the best things you can do for a tendinopathy once you’re past the very painful stage. One home exercise we often recommend (with guidance on form) is using a TheraBand flex bar for eccentric wrist twists (commonly known as the Tyler Twist for tennis elbow). If you don’t have a flex bar, you can use a light dumbbell: for tennis elbow, sit and rest your forearm on a table with your palm facing down holding the weight. Use your other hand to help curl the weight up, then slowly lower it down with the affected arm alone. That slow lowering works the extensor tendons eccentrically. Do 10-15 reps, once daily, as long as it’s tolerated without sharp pain (muscle soreness is okay). For golfer’s elbow (palm-up variation) or triceps tendonitis (overhead dumbbell lowers), ask your physio for the exact technique so you target the right tendon safely. Start very light – even just a water bottle can be enough at first – and gradually increase as it gets too easy. Over a few weeks, these exercises stimulate the tendon to rebuild strength. Consistency is key: doing a bit each day or every other day beats a marathon session once a week. Think of it like rehab homework that pays off in faster healing.
Other Home Remedies: Anti-inflammatory gels or creams (e.g. diclofenac gel) can be applied to the tender area if approved by your doctor or pharmacist – some patients find they take the edge off pain. If you’re comfortable with it, self-massage can be helpful: use your opposite hand or a massage ball to gently knead along the forearm muscles and around the elbow to improve circulation. You might also try contrast baths (alternating dipping the arm in warm then cool water) to pump blood through the area. Ensure you’re getting enough rest and sleep, since tissue healing happens most at night – consider using a pillow to support your arm if elbow pain bothers you at night. For “elbow pain after sleeping,” check your sleep position: avoid keeping your arm tightly bent under your pillow (which can irritate the ulnar nerve). Instead, try to sleep with your arm in a more relaxed, straight or slightly bent position; you can even wear a soft elbow splint at night to prevent full flexion if nerve compression is an issue. And of course, maintain a balanced diet and stay hydrated – your body needs nutrients to repair tissues (adequate protein, Vitamin C, etc., support tendon healing).
Remember, these tips complement the care you receive at the clinic. Always follow the specific home exercise program and advice your therapist gives, as they’ll tailor it to your condition. If any home exercise significantly worsens your pain, pause and consult your provider. Healing is a gradual process, so celebrate small improvements – maybe you can lift a bit more, or your morning stiffness is a bit less – those are signs you’re on the right track. With time and the right approach, you can get your elbow back to normal.
Over-the-counter supports like elbow braces, straps, or compression sleeves can provide some relief by stabilizing the joint or offloading the tendon. A common option for tendon-related elbow pain is a counterforce brace (a band that wraps around the forearm just below the elbow). By applying pressure on the muscle, it changes the force transmission and can reduce stress on the injured tendon – many people with tennis or golfer’s elbow find their pain decreases during activities when using such a strap. A simple elastic elbow sleeve can also keep the area warm and provide mild compression, which some find comforting for achy joints. When choosing a support, ensure it’s comfortable and not too tight (you don’t want to cut off circulation). It’s a bit of trial and error – some individuals prefer a strap, others like a sleeve or even kinesiology tape applied in supportive patterns. Keep in mind: these supports are mainly for symptom relief and support during tasks; they won’t cure the underlying issue. Studies suggest that wearing a forearm strap doesn’t necessarily speed up healing compared to doing rehab exercises alone. So, use supports as a tool – for example, wear the brace during tennis or during a long day at the keyboard if it helps – but also continue your therapeutic exercises and treatments. And if you’re unsure which brace is right, consult with a physiotherapist; at Unpain Clinic we often help patients fit and choose the proper brace for their needs.
Physical therapy (physiotherapy) is often the first-line treatment for chronic elbow pain, and for good reason. A physical therapist’s job is to find out why you’re in pain and address those factors. For elbow issues, a PT will perform a thorough evaluation to pinpoint which tendon or structure is affected, assess your arm strength, flexibility, and even look at your shoulder, neck, or wrist to see if they’re contributing. They then design a customized rehab program for you. Key ways PT helps include: Targeted Exercises – a therapist will prescribe specific strengthening and stretching exercises (like eccentric loading for tendons) that research shows are effective for healing tendinopathies. They ensure you do them with proper form and progress them appropriately as you get stronger. Manual Therapy – the therapist can use hands-on techniques to reduce your pain and improve motion (for example, massage to loosen tight muscles, or joint mobilization if your elbow is stiff). This one-two of exercise plus manual work often yields better results than either alone. Modalities – physical therapy clinics may apply therapeutic modalities such as ultrasound, low-level laser, or TENS for pain relief, though these tend to give short-term relief. More advanced clinics (like Unpain Clinic) offer regenerative modalities like shockwave therapy, which a trained physiotherapist can administer as part of your treatment plan. Education and Ergonomics – a huge part of PT is teaching you about your condition and how to manage it. They’ll advise you on how to modify activities to promote healing (e.g. proper lifting technique, or how to set up your workstation to reduce elbow strain). They’ll also discuss pacing – how to gradually return to activities so you don’t flare up. Preventing Recurrence – once your pain is better, a physio helps you understand maintenance exercises and strategies to keep the problem from coming back. Overall, physical therapy addresses the root causes of your elbow pain (weakness, overuse, biomechanical issues) rather than just temporarily masking it. In fact, clinical research shows that with proper physio-led rehab, the vast majority of chronic elbow pain cases improve without needing surgery. It’s a collaborative process: you’ll work together with your therapist, and with time and consistency, PT can significantly reduce pain, improve your elbow’s function, and get you back to the activities you love.
For tennis elbow (lateral epicondylitis), the most commonly recommended brace is a forearm counterforce strap. This is a band (often with a velcro strap) that you place around the forearm about 1–2 inches below the elbow joint. It works by absorbing some of the tension from the contracting muscles, effectively “redirecting” force away from the injured tendon on the elbow’s outer side. When properly used, a counterforce brace can reduce pain during gripping or lifting activities – many tennis players or manual laborers with tennis elbow find it helpful, at least temporarily. Another type of brace is an elbow sleeve with a strap or pad built-in. Some sleeves have a gel pad that you position over the forearm muscle to achieve a similar offloading effect with the added benefit of compression warmth. In certain cases (especially if there’s concurrent wrist pain or tendon issues), a therapist might recommend a wrist splint to limit wrist motion and give the extensor tendons a rest. The best brace for you can depend on your daily activities and comfort: if you’re playing tennis, a simple strap might suffice; if you’re at a computer all day, a soft sleeve might be more comfortable. Research shows that braces do not fix tennis elbow, but they can make it more manageable. One study found no significant long-term difference between patients who braced versus those who didn’t – everyone needs to do rehab exercises for real recovery – but in the short term, both groups improved, suggesting that exercise was the key factor. So, use a brace as a support tool, particularly during activity that normally triggers pain. Make sure it’s snug (you may need to tighten it a bit when you’re active and loosen or remove it at rest) but not cutting off circulation (your hand shouldn’t go numb or cold). And place it correctly: typically the strap goes on the forearm muscle bulge, not directly on the painful epicondyle. If in doubt, ask your physiotherapist to show you the right placement. They can also recommend reputable brands. Finally, if a brace isn’t helping you at all or is uncomfortable, don’t force it – some people do just as well without one, focusing instead on other treatments.
Waking up with elbow pain or stiffness can be surprisingly common, especially if you have an underlying elbow issue. There are a few possible reasons for elbow pain after sleeping. One is simply inactivity overnight – when you’re not moving your arm for hours, the elbow joint can stiffen a bit and the tendons may get a little tight. People with tennis or golfer’s elbow often report morning stiffness that improves after “warming up” the arm. Gentle movement in the morning (slowly bending and straightening the elbow, or using a heating pad for a few minutes) can help loosen things up. Another factor is sleep position. Many of us sleep with our arms bent – for instance, curling a pillow or tucking an arm under the head. Keeping the elbow in a tightly bent position for a long time can irritate the ulnar nerve (inside of the elbow) or increase joint pressure, leading to that achy or tingling feeling when you wake. If you notice your ring and pinky fingers also feel numb or tingling in the morning, it’s likely from bending your elbow during sleep (this narrows the cubital tunnel where the ulnar nerve runs). To alleviate this, you can try to modify your sleep posture: avoid sleeping directly on the affected arm, and consider using a small pillow or rolled towel to keep your elbow a bit more extended. There are even lightweight night splints (often used for cubital tunnel syndrome) that prevent full flexion – basically a soft brace that keeps your elbow at about a 30-degree bend. If your elbow pain is due to inflammation (like bursitis or arthritis), you might also feel it more at night or morning due to fluid build-up when the arm is still. In such cases, elevating the arm on a pillow can help, and talking to your doctor about an anti-inflammatory regimen might be wise. Overall, elbow pain after sleeping is usually due to stiffness or nerve compression from positioning. It should improve as you start moving in the morning. If it consistently doesn’t, or wakes you up at night with severe pain, let your healthcare provider know – they may investigate if there’s an underlying issue like nerve entrapment or advanced arthritis that needs targeted treatment.
Shockwave therapy for elbow conditions (like tennis elbow or triceps tendonitis) is generally well-tolerated, but you might feel some discomfort during the treatment. Here’s what to expect: when the shockwave device delivers pulses to your injured tendon area, it produces a sensation often described as a rapid “tapping” or “pulsing” feeling on the skin. As the energy penetrates to the tendon, it can provoke a deep ache or a sharper twinge, especially if it hits a very sensitive spot or an area of scar tissue. The intensity of sensation can vary; some patients say it’s mildly uncomfortable but not bad at all, while others find certain moments briefly painful. The good news is that the discomfort is temporary and intermittent – each pulse is very short, and therapists typically deliver them in a series (for example, 2000 pulses over 3-5 minutes). We can adjust the intensity and frequency of the waves to your tolerance. Usually, we start at a moderate setting and check in with you, then may increase intensity as you acclimate, ensuring it’s within your pain tolerance. Most people find that as the treatment goes on, it actually feels less painful – possibly because of the pain-relieving effect shockwave has (it releases substance P and other pain modulators that start dulling the pain response). After the session, your elbow area might feel a bit sore or achy, similar to post-deep-massage soreness, for a few hours up to a day. This is normal and usually mild; you can ice the area afterwards if needed, but we often encourage letting the body’s natural healing response work uninterrupted. Serious pain or significant bruising is uncommon with proper technique. In fact, many of our patients are surprised: “That’s it? I was worried it would really hurt, but it wasn’t bad at all,” is a common reaction. And when they experience the relief in the days following, the momentary discomfort of the treatment is well worth it. If you’re particularly pain-sensitive, let us know – we can use a numbing gel or start with a low energy setting. Rest assured, shockwave therapy at Unpain Clinic is applied by experienced professionals who prioritize your comfort. Our goal is to make it as easy as possible on you while delivering effective results.
In most cases, no – surgery is a last resort for chronic elbow conditions like tennis elbow, golfer’s elbow, or tendonitis. The vast majority of patients get better with conservative treatments (physiotherapy, medications, injections, etc.). Orthopedic surgeons usually only consider operating if you’ve had many months (typically 6-12+ months) of severe pain that hasn’t responded to anything, and if the issue is clearly identified (for example, imaging shows a significant tendon tear or degeneration that might be helped by surgery). Even then, it’s often optional. Common elbow surgeries for chronic issues include: lateral or medial epicondyle release (removing the degenerated tendon tissue and reattaching normal tendon) for stubborn tennis or golfer’s elbow, or triceps or biceps tendon repair if there’s a partial tear causing ongoing pain and weakness. These are usually outpatient procedures but do require rehabilitation afterwards, and there’s no guarantee they’ll be more effective than non-surgical care. In fact, research shows outcomes between well-managed non-surgical treatment and surgery for tennis elbow tend to even out in the long run – meaning many people heal with time and proper therapy. Surgery might bring relief faster for some, but it also carries risks (infection, prolonged recovery, loss of strength). Our philosophy at Unpain Clinic is to exhaust all non-invasive options first. We’ve had patients who thought they had “no choice” but surgery, and after treatments like shockwave and exercise, they improved and never needed it. Of course, if you have a distinct issue like a completely torn tendon or loose fragment in the joint, surgical repair may be necessary – but those cases are more the exception than the rule for chronic elbow pain. Always discuss with your doctor; they can help you weigh the decision. And remember, even if you do end up opting for surgery, the rehab principles (strengthening, etc.) still apply post-op. Whether you heal naturally or with surgical help, the goal is the same: get you pain-free and functional again.
Elbow pain from overuse can be stubborn – it might have taken months or years to build up, so it requires a thoughtful, persistent approach to resolve. The important thing to remember is that elbow pain doesn’t have to be permanent. By understanding why it hurts (tendon overuse, poor mechanics, etc.) and addressing those factors head-on, you can break free of the pain cycle. We’ve looked at how evidence-based treatments like exercise and shockwave therapy can jump-start healing, and how a whole-body approach finds the why behind your sore elbow. Whether it’s playing with your kids, getting back to the gym, or just sleeping through the night without throbbing elbow pain, relief is possible. At Unpain Clinic, our passion is helping you get there – combining the latest medical research with genuine care and a whole-body approach so you can not only get rid of the pain, but also fix the underlying issues for good. Don’t let elbow pain keep you from doing what you love. If you’re ready to finally address that nagging ache or injury, we’re here to help every step of the way.
Book Your Initial Assessment NowAt Unpain Clinic, we don’t just ask “Where does it hurt?” — we uncover “Why does it hurt?”
If you’ve been frustrated by the cycle of “try everything, feel nothing,” this assessment is for you. We take a whole-body approach so you leave with clarity, not more questions.
✅ What’s Included
Comprehensive history & goal setting
Orthopedic & muscle testing (head-to-toe)
Motion analysis
Imaging decisions (if needed)
Pain pattern mapping
Personalized treatment roadmap
Benefit guidance
🕑 Important Details
60 minutes, assessment only
No treatment in this visit
👩⚕️ Who You’ll See
A licensed Registered Physiotherapist or Chiropractor
🔜 What Happens Next
If you’re a fit, we schedule your first treatment and start executing your plan.
🌟 Why Choose Unpain Clinic
Whole-body assessment, not symptom-chasing
Root-cause focus, not temporary relief
Non-invasive where possible
No long-term upsells — just honest, effective care
🎯 Outcome
You’ll walk out knowing:
What’s wrong
Why it hurts
The fastest path to fix it
Author: Uran Berisha, BSc PT, RMT, Shockwave Expert
1. Pavan, P. et al. Comparison of extracorporeal shockwave therapy, ultrasound therapy, and corticosteroid injections for lateral epicondylitis: an umbrella review of meta-analyses. J Orthop Traumatol. 2025; 26(1): 12. PMID: 40824407
2. Popovic, N. et al. Clinical effectiveness of shockwave therapy in lateral elbow tendinopathy: systematic review and meta-analysis. Clin Rehabil. 2021; 35(10): 1383-1396.
3. Page, P. A New Exercise for Tennis Elbow that Works! N Am J Sports Phys Ther. 2010; 5(3): 189–193.
4. Fan, G. et al. Effects of shockwave vs. ultrasonic therapy and deep friction massage in lateral epicondylitis: a randomized trial. Sci Rep. 2024; 14: 11927
5. Unpain Clinic – Tennis Elbow: Causes, Symptoms & Treatment Options (Blog Article, 2026)
6. Unpain Clinic – Golfer’s Elbow Pain: When Rest Isn’t Enough, What to Do Next (Blog Article, 2025)
7. Unpain Clinic – Triceps Tendonitis: Why Your Arm Pain Isn’t Going Away (Blog Article, 2026)
8. Nishizuka, T. et al. Efficacy of a forearm band in addition to exercises compared with exercises alone for lateral epicondylitis: a RCT. J Orthop Sci. 2017; 22(2): 289-294.
9. Coombes, B.K. et al. Effective treatment options for tendinopathy (tennis elbow). Lancet. 2020; 395: 190-198.
10. Unpain Clinic Podcast – “Pain and Beyond: Exploring the Body’s Complexities” (Episode #15, 2024)
11. Unpain Clinic – How to Treat Tennis Elbow in Edmonton (All Treatments Guide, 2023)
12. Unpain Clinic – Shockwave Therapy Edmonton (Service Page)
13. Unpain Clinic YouTube – Shockwave & EMTT Success Stories – Andy’s Elbow (Patient Testimonial, 2025)
