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Tennis elbow is more than just a sports injury – it’s a frustrating condition that can affect anyone who repeatedly uses their arm and wrist. Despite the name, you don’t have to play tennis to experience this pain. If lifting a coffee mug or turning a doorknob sends a twinge through the outer part of your elbow, you know how disruptive tennis elbow can be. The ache and weakness can make everyday tasks challenging and keep you from the activities you love. In this post, we’ll dive into what causes tennis elbow, how to recognize the symptoms, and the latest evidence-based treatments (including innovative therapies like shockwave therapy) that can help you find relief. Most importantly, you’ll learn that you’re not alone – and that there are effective options to get you back to feeling like yourself. 😊
Tennis elbow, medically known as lateral epicondylitis, is an overuse injury that causes pain on the outer part of the elbow. It involves the tendons that attach your forearm extensor muscles to a bony bump on the outside of your elbow (the lateral epicondyle). These tendons – especially one called the extensor carpi radialis brevis (ECRB) – can develop tiny micro-tears from repeated strain. Over time, this leads to tendon degeneration (a tendinopathy) and inflammation at the elbow, resulting in pain and tenderness. In simple terms, the tissue that should anchor your muscle to bone becomes frayed and irritated from overuse.
Causes and Risk Factors: Tennis elbow is usually caused by repetitive motions and overloading of the forearm and wrist. Any activity that involves frequent gripping, twisting, or extending of the wrist can trigger these tendon micro-tears. Common causes include:
Sports: Racquet sports like tennis or squash (especially with poor technique) can strain the elbow tendons. In fact, up to 50% of tennis players experience at least one episode of tennis elbow in their careers.
Occupations: Jobs or hobbies involving repetitive arm use – painters, plumbers, carpenters, mechanics, chefs, or even frequent computer mouse use – can lead to tennis elbow. It’s not confined to athletes; anyone who uses those arm muscles repeatedly is at risk.
Age and Lifestyle: It’s most common between ages 30 and 50, but it can happen at any age with enough overuse. Smoking and general deconditioning may increase susceptibility.
Underlying factors: Sometimes, the issue isn’t just in the elbow. Weak shoulder or core muscles, or poor technique, can force your forearm to overcompensate. Even stiffness or dysfunction in the neck or upper back can contribute. (Interestingly, studies have linked shoulder blade (scapulothoracic) dysfunction with tennis elbow.) This is why a holistic look at your movement is important – often there’s a “why” behind that aching elbow.
Why the pain persists: Tendons have a relatively poor blood supply, so they heal slowly. If you keep stressing the tendon faster than it can repair, the injury can become chronic. Instead of a quick inflammatory injury (“-itis”), tennis elbow often turns into a degenerated tendon (“-osis”). In fact, researchers have found a lack of acute inflammatory cells in chronic tennis elbow, suggesting it’s more of a tendinopathy or tendon degeneration than a classic inflammation. This means rest alone may not fix it – the tendon actually needs to remodel and strengthen to heal. Without proper treatment, the cycle of micro-tears and incomplete healing continues, and that’s why the pain can last for months if not addressed.
Symptoms of Tennis Elbow: The hallmark is pain or burning on the bony outer elbow, which may radiate down the forearm. You might notice:
Elbow pain when using your arm – especially with gripping or lifting. For example, turning a doorknob, shaking hands, or holding a coffee cup can hurt.
Tenderness to touch on the outside of the elbow. It may feel sore or achy at rest, and sharper during activity.
Weak grip strength – you may find objects slipping from your hand or difficulty lifting even light items. The affected arm can feel notably weaker.
Stiffness – the elbow (and even the wrist) might feel stiff, especially in the morning. Some people feel they need to “warm up” the elbow before it loosens.
These symptoms usually develop gradually. Early on, you might only feel mild twinges during activity. Over time, pain can worsen or occur with smaller movements. If the elbow area becomes very swollen, red, or you can’t move the joint at all, that could indicate a different or more severe injury – in such cases, seek prompt medical evaluation. But for classic tennis elbow, there’s typically no dramatic swelling, just persistent pain and tenderness at that spot on the outer elbow.
Diagnosis: Diagnosing tennis elbow is usually straightforward. A healthcare provider (like a physiotherapist or sports medicine doctor) will consider your history and do a physical exam. They may perform tests like Cozen’s test (resisting wrist extension to see if it reproduces pain at the elbow). Usually, no special scans are needed to confirm tennis elbow. However, if your symptoms are atypical or not improving, a doctor might order an ultrasound or MRI to rule out other issues. The key is that if you have the classic symptoms and risk factors, clinical exam is often enough to identify tennis elbow.
If you’re suffering from tennis elbow, here’s the encouraging news: the vast majority of cases improve with conservative (non-surgical) treatment. Research indicates that around 90% of tennis elbow cases are resolved through nonsurgical interventions. In other words, with the right therapy and a bit of patience, most people won’t need surgery to get better.
Traditional treatments for tennis elbow have included rest, anti-inflammatory medications, bracing, steroid (cortisone) injections, ultrasound therapy, and therapeutic exercise. Many of these can provide short-term relief, but they sometimes fall short in the long run. For instance, cortisone steroid injections often give quick pain reduction, but the benefit is usually temporary and repeated injections can have downsides (like weakening the tendon). In fact, one of our podcast guests put it plainly: braces and cortisone shots “only mask symptoms…they don’t fix the underlying issue”. That’s a key insight – simply numbing the pain isn’t a cure, because it doesn’t address the tendon’s health.
So, what does the scientific evidence say is effective? Two approaches stand out: therapeutic exercise and shockwave therapy.
Exercise Therapy: Exercise – especially eccentric strengthening (slowly lowering weights) of the wrist extensors – has strong support as a first-line treatment. A systematic review noted a lack of high-quality evidence for many passive treatments but did find that exercise had clear benefits. Essentially, exercises that strengthen and stretch the forearm muscles help remodel the tendon, improving its tolerance to stress. Studies have shown eccentric exercise can reduce pain and improve function and grip strength in lateral epicondylitis. It’s believed to promote structural changes in the tendon (collagen rebuilding and increased tensile strength) and even retrain the nervous system to handle load better. Bottom line: a well-designed rehab exercise program is crucial for lasting recovery. (We’ll discuss some exercise tips in the At-Home Guidance section, and your physiotherapist will customize a program for you.)
Shockwave Therapy: Extracorporeal shockwave therapy (ESWT) is a newer, cutting-edge option that has gained attention for chronic tendon issues. Shockwave involves sending high-energy sound waves into the injured tendon area to stimulate healing. Multiple studies, including recent high-quality reviews, have found shockwave to be effective for tennis elbow – particularly for stubborn cases that aren’t improving with rest and exercise. An umbrella review published in 2025 (a study of multiple prior 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 reported greater pain reduction and higher rates of success (such as achieving 50% pain reduction) compared to those who got sham treatment or other therapies. While a steroid shot might give very fast relief for a few weeks, shockwave tends to yield more sustained improvement in pain and function by 3+ months. The added benefit is that shockwave doesn’t carry the side effects that repeated injections might.
How does shockwave help? It’s thought to jump-start the body’s natural repair mechanisms. The acoustic waves increase blood circulation in the tendon, stimulate the formation of new blood vessels, trigger the release of growth factors, and break down scar tissue. Essentially, shockwave wakes up a “stuck” healing process – it converts a chronic injury back into a state where the body can actively heal it. Some trials have shown improvements in grip strength and reduced pain after a series of shockwave sessions, comparable to or even better than cortisone injections (but without the downsides). This makes shockwave especially appealing for chronic cases that haven’t responded to rest, physio, or medications.
It’s worth noting that combining treatments can often yield the best results. For example, one meta-analysis found that exercise plus shockwave was more effective than exercise alone for stubborn patellar tendon pain. In our experience, the same principle often holds for tennis elbow – a combination of targeted exercises, shockwave, and other therapies can synergize to accelerate recovery. Every patient is different, so a tailored plan is key.
Finally, what about surgery? Surgery for tennis elbow is rare and truly a last resort if all else fails. Given that ~90% improve without it, surgery is only considered in chronic cases that haven’t improved after 6–12 months of conservative treatment. Even then, less invasive options (like platelet-rich plasma injections or needle tenotomy) may be tried before an open surgery. The good news is that with modern therapies like those offered at Unpain Clinic, we very seldom see patients needing to go to those lengths.
Research Takeaway: Most people with tennis elbow get better with a mix of rest, rehab exercise, and newer modalities. Studies support approaches that heal the tendon (like exercise and shockwave) over those that just temporarily numb the pain. By focusing on root causes and tissue healing, you can achieve long-term relief. And as always, individual results may vary – it’s important to work with a healthcare provider to find the right plan for you. (A quick disclaimer: nothing in this article constitutes medical advice; please consult a professional for your specific situation. 🙏)
At Unpain Clinic, we take a comprehensive, empathetic approach to treating tennis elbow. We don’t just ask “Where does it hurt?” – we also ask “Why does it hurt?”. When you come to us with lateral elbow pain, our first step is a thorough initial assessment (see the 📍 Initial Assessment details at the end of this article!). We examine not only your elbow, but also your overall movement patterns – shoulder, neck, posture, even your grip mechanics. This whole-body perspective is crucial because, as we discussed, often there are contributing factors away from the elbow itself. (For example, if we find your shoulder or upper back is stiff or weak, that could be forcing extra load on your elbow with every lift or swing.) After pinpointing the root causes, we create a personalized treatment plan to fix those issues and relieve your pain.
Here are the key treatment modalities we often combine for tennis elbow, tailored to your needs:
Shockwave therapy is frequently the star player in our treatment plan for tennis elbow. We use advanced shockwave devices (including focused shockwave (True ESWT) and radial pressure wave), selecting the type based on your condition. For a chronic tendon issue like tennis elbow, we typically apply focused shockwave to the painful tendon insertion at your lateral elbow. Focused shockwaves deliver high-energy sound waves deep into the tissue, right at the problem spot. This stimulates a healing response – increasing blood flow, activating cellular repair, breaking down old scar tissue, and prompting the growth of healthy new collagen. Essentially, it tells your tendon “time to rebuild!”.
We often perform a shockwave treatment in the first visit after your assessment. Most patients undergo about 3 sessions of shockwave, usually spaced a week apart, for a given issue. The treatment itself is quick – around 10-15 minutes of shockwave application per session. It’s non-invasive (nothing more than a handheld device on your skin) and no anesthesia is needed. You’ll feel some tapping or pressure sensation during the pulses. It can be a bit uncomfortable on bony areas, but we adjust the intensity to keep it tolerable. Most people describe it as strange but not really painful, and any discomfort stops immediately when the machine pauses. In fact, many of our clients say “it hurts good” – it’s the kind of soreness that actually feels like it’s doing something positive. And rest assured, focused shockwave therapy is very safe when performed by trained professionals, with a high patient tolerance noted in studies.
By the second or third session, patients often start noticing improvements – perhaps a stronger pain-free grip or less morning stiffness. Over a full course of therapy, the majority of our tennis elbow clients experience significant relief. (We always remind patients: healing takes time and everyone’s timeline is different – but seeing progress after a couple of treatments is an encouraging sign.) What’s really promising is that shockwave is treating the cause, not just numbing symptoms. Remember, it’s stimulating your body to heal the tendon. Clinical studies have shown shockwave can lead to tangible tissue healing – for example, one study even showed abnormal tendon thickness on ultrasound shrinking after shockwave treatment, correlating with pain relief. In our clinic, we’ve seen many cases of chronic tennis elbow that finally turned the corner with shockwave after months of plateauing with other treatments. (Results may vary, but the evidence – and our experience – make shockwave a game-changer for stubborn cases.)
Fun fact: Shockwave was originally used to break up kidney stones, and doctors noticed it helped bones and tendons heal. Now, it’s a go-to non-surgical therapy for tough tendinopathies around the world. It’s even used for plantar fasciitis, rotator cuff tendons, Achilles tendons, and more with great success. For tennis elbow specifically, we love that it offers a chance to avoid injections or surgery and actually fix the issue.
To complement shockwave, Unpain Clinic is proud to offer EMTT, which is a cutting-edge therapy you won’t find at most clinics. EMTT stands for Extracorporeal Magnetotransduction Therapy – in simpler terms, it’s a pulsed magnetic field therapy. Where shockwave uses mechanical sound waves, EMTT uses high-frequency electromagnetic pulses delivered to the painful area. You don’t really feel EMTT – maybe a mild warmth – but on a cellular level, it’s working to reduce inflammation and modulate pain. Think of it like an MRI-strength magnet tapping the “reset” button on a cellular level.
For a condition like tennis elbow, we often add EMTT especially if your pain is very chronic or irritable. Chronic tendon pain can cause the surrounding nerves to get sensitized – essentially, the nervous system keeps “remembering” the pain even when the tissue starts to heal. EMTT helps by telling those overactive nerves to “shhh, quiet down” while shockwave tells the tissues “time to rebuild”. This one-two punch can speed up recovery and make the process more comfortable.
Studies on EMTT are still emerging, but early research indicates benefits for musculoskeletal pain and even nerve-related pain. It’s non-invasive and has no known side effects, so there’s really no downside to including it. Many patients appreciate that EMTT therapy is completely painless – you can relax while it’s being administered. At Unpain Clinic, we’re always adopting novel, safe technologies like EMTT to help people heal faster. We were one of the first in North America to combine true shockwave with EMTT, and the results have been impressive.
Chronic pain conditions like tennis elbow don’t just involve the tendon – they can affect your nervous system, too. Over time, your nerves can become sensitized. Even after the tendon starts improving, the nerves might still be misfiring pain signals out of habit (this is a phenomenon known as central sensitization). That’s why we incorporate gentle neuromodulation techniques when needed, especially if there’s a nerve component to your pain.
For instance, with tennis elbow, sometimes the radial nerve (which runs near the lateral elbow) can be part of the picture. Long-standing lateral elbow pain might cause the radial nerve to become overactive or adhered along its path. Our therapists will assess this, and if needed, we employ methods to “reset” the nerves:
Low-level laser therapy (LLLT): This is a cold laser that can reduce nerve irritation and improve blood flow. It’s painless and can soothe irritated nerves.
Targeted electrical stimulation: We may use specific neurostimulating devices (different from a standard TENS unit) to gently encourage normal nerve function. This isn’t a jolt of electricity, but a therapeutic-level stimulus that can help normalize how the nerve is firing.
Nerve gliding exercises (nerve flossing): We might teach you exercises to mobilize the nerves in the arm. For example, slow movements that tension and release the radial nerve can free up any entrapment and reduce sensitivity.
Neuromodulation treatments are typically quite soothing. Patients often report feeling a gentle warmth or tingling, but no significant discomfort. By pairing these techniques with shockwave and EMTT, we address both the “hardware” (the tendon and muscles) and the “software” (the nerve signals). It’s a holistic way to quiet the pain loops. If your tennis elbow has been bothering you for a long time, this combined approach can make a real difference – we essentially retrain your nervous system at the same time as we heal the tissue.
No comprehensive plan would be complete without some hands-on care. Our physiotherapists and chiropractors are highly skilled in manual therapy techniques. This includes joint mobilization/manipulation, myofascial release, Active Release Techniques (ART), and other soft tissue work. For tennis elbow, manual therapy can help by:
Releasing tight muscles and fascia: We often find the forearm extensor muscles (and even the flexors on the opposite side) are very tight in those with tennis elbow. Therapists will massage and stretch these muscles to reduce tension on the tendon. Techniques like ART or instrument-assisted soft tissue release (similar to Graston or gua sha) can break down adhesions in the muscle fibers and tendon sheath.
Correcting joint misalignments or stiffness: We check joints above and below the elbow – including the wrist, shoulder, and even the neck. If your wrist is stiff or your elbow joint isn’t moving freely, it can concentrate stress on the tendon. Gentle mobilization of the elbow joint can improve its range of motion. Likewise, improving shoulder and upper back mobility can take strain off your elbow during activities. (There’s a saying: the elbow is often the “victim” of problems at the shoulder or wrist.)
Improving biomechanics: Our chiropractors can assess if any spinal or rib issues might contribute. Occasionally, a nerve root irritation in the neck (for instance at the C6 level) can predispose you to arm pain. Appropriate adjustments or mobilizations can address these contributing factors.
One patient of ours noted in a review that what impressed him was how the therapist “treated not just my elbow, but also the related areas – my shoulder and even some neck work – because they look at the whole chain.” That’s exactly our philosophy. By treating the interconnected parts of your body, we ensure we’re not just temporarily relieving the sore elbow, but also fixing any other dysfunctions that led to the injury. The result is often improved flexibility and a feeling that your arm is moving more freely and correctly. This sets you up for long-term success, not just a short-term fix.
Last but certainly not least, therapeutic exercise is a pillar of our approach. While treatments like shockwave and manual therapy can significantly reduce pain, you play an active role in maintaining those improvements. We will tailor a specific exercise program for you to do at home and/or under guidance in the clinic gym.
For tennis elbow, your exercise program typically includes:
Stretching exercises: Gentle stretches for the forearm muscles (both extensors and flexors) to improve flexibility. For example, a classic wrist extensor stretch: arm straight in front, palm facing down, then gently pull your hand downward with the other hand until you feel a stretch in your outer forearm – hold ~30 seconds. Doing this regularly can help relieve muscle tension and pressure on the tendon. We’ll ensure you know proper form to avoid aggravation.
Eccentric strengthening: These are exercises where the muscle lengthens under load – known to be very effective for tendon healing. One common exercise is the eccentric wrist extension: using a light dumbbell or resistance band, assist your wrist up with your other hand and then slowly lower the weight down with the affected wrist. This focuses on the lowering phase, which research suggests stimulates tendon repair more than standard lifting. Studies have reported that eccentric strengthening can significantly improve pain and grip strength in tennis elbow. We’ll usually start with low resistance and gradually increase as tolerated.
Isometric exercises: Early on, or during painful flare-ups, we might use isometric holds (muscle contracts without movement) to maintain strength with less irritation. An example is squeezing a stress ball or holding a light weight in a fixed position. Isometrics can reduce pain by providing a neuromuscular calming effect.
Shoulder and postural exercises: We often include some scapular (shoulder blade) strengthening or shoulder stability drills. If you have weak shoulder muscles or poor posture, your elbow may be bearing extra load. Strengthening the rotator cuff and mid-back muscles, and improving posture, can offload the elbow during daily tasks and sports.
Core and lower body (if relevant): It might surprise you, but sometimes improving your core or leg strength can help an elbow issue. For example, a tennis player with weak legs or core might be muscling their shots with the arm, again overstressing the elbow. We truly look at the whole kinetic chain. If your assessment finds deficits elsewhere, we’ll address those too (this could be as simple as some planks or as specific as rotator cuff drills – whatever fits your needs).
We will demonstrate all exercises to you and make sure you’re comfortable with them. You’ll get a clear home exercise program (often through our app or handouts) with instructions. Consistency is key: doing your prescribed exercises consistently between sessions is what cements the gains from our treatments into lasting improvements. Scientific evidence backs this up – exercise enhances the outcomes of other therapies and helps prevent recurrence.
Throughout your rehab, we adjust the exercises as you progress. If something is too easy or too hard, we’ll modify it. Our goal is to gradually load the tendon in a safe manner, so it grows stronger and more resilient. We also educate you on ergonomics – for example, how to set up your workstation or tools to reduce strain on your elbow, or proper form when lifting objects. By the end of your treatment plan, you should not only be in less pain but also armed with the knowledge and strength to keep your elbow healthy going forward.
Combining Modalities: What truly sets our approach apart is how we blend these treatments. Shockwave, EMTT, neuromodulation, hands-on therapy, and exercise all complement each other. Shockwave and EMTT jump-start healing; manual therapy ensures your joints and muscles are in optimal condition; neuromodulation calms the nervous system; and exercise solidifies the improvements. This comprehensive strategy treats the root causes, not just the symptoms. We don’t do band-aid therapy or one-size-fits-all protocols. Your program is unique to you. And we continually monitor your progress – if you’re not improving as expected, we re-evaluate and tweak the plan. The combination of advanced technology with good old-fashioned physical therapy is what helps even chronic, stubborn cases finally get better.
Sometimes the best way to understand the impact of these treatments is through a real patient’s experience. Let’s share a quick success story (name changed for privacy).
Andy is a 42-year-old recreational tennis player and avid do-it-yourselfer. Over a summer of building a backyard deck – and continuing his weekly tennis matches – Andy developed a nagging pain in his right elbow. At first, he ignored it, thinking it was just a sore muscle. But soon he struggled to even grip his tennis racket or use a screwdriver without sharp pain. He had to stop playing tennis and found even typing at work aggravated his elbow.
Frustrated, Andy tried the usual remedies: rest, ice, a brace from the drugstore, and eventually a steroid injection from his doctor. The cortisone shot gave him relief for a month, but then the pain roared back worse than before. By the time Andy came to Unpain Clinic, he had been dealing with elbow pain for almost a year. He told us, “I’ve tried everything, and nothing has fixed it. I’m starting to think I’ll never play tennis again.” We reassured him that there was hope yet!
After Andy’s initial assessment, we identified a few key factors: his tendon was indeed very irritated (classic tennis elbow), and we also noted he had very tight forearm muscles and some weakness in his shoulder stabilizers. We put together a plan combining focused shockwave therapy and EMTT for his elbow, some manual release for his forearm muscles, and a home exercise program (including stretches and gradual strengthening). We also adjusted his tennis technique slightly (through one of our partners) to reduce strain on the elbow.
The result? After about 4 weekly sessions, Andy’s pain had reduced dramatically. He reported that he could grip a frying pan and even do light hammering with minimal discomfort – things that had been impossible for months. Encouraged, he gradually resumed tennis practice with modified drills. After 8 weeks, Andy was essentially pain-free in daily life and had returned to playing doubles tennis on weekends. He was careful to warm up and do his elbow exercises, and he felt his arm was actually stronger than before.
In Andy’s 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 thankful that he avoided more invasive measures. His story is just one example – every patient is different, but seeing people get their life and hobbies back is why we love what we do.
(Please remember, this is one patient’s experience; results vary from person to person. But it’s a great example of how a whole-body, evidence-guided approach can make a huge difference even when other treatments failed.)
While professional treatment is important, there’s also a lot you can do on your own to support your recovery (and prevent future flare-ups). We always educate our patients on self-care between visits. Here are some simple, safe at-home tips for managing tennis elbow:
Activity Modification & Rest: In the initial stages, relative rest is crucial. This doesn’t mean you can’t use your arm at all – but avoid the specific movements that provoke pain. Cut back on heavy gripping, resistive lifting, or repetitive wrist motions to give the tendon a chance to calm down. If typing or mousing at work aggravates it, set up an ergonomic workstation (consider a cushioned mouse pad or an elbow support). Importantly, rest alone is rarely a cure, but it does set the stage for healing by preventing further irritation. Think of it as pressing “pause” on the aggravating activities while you rehab.
Ice and Pain Relief: For flare-ups or after intense use of the arm, ice can help reduce pain. Apply a cold pack on the outer elbow for 10-15 minutes at a time. This is especially useful if the area feels hot or inflamed after activity. Some patients find alternating ice and heat helpful – ice to quell pain, heat to relax muscles – but be cautious with heat if the elbow is acutely inflamed. Over-the-counter pain relievers or anti-inflammatory gels/creams can be used if approved by your doctor or pharmacist. They may ease your discomfort enough to do your exercises, but remember they’re a temporary aid (and always follow medical advice on medications).
Forearm Stretching and Massage: Gentle stretching of the forearm muscles can provide relief and improve flexibility. We described the wrist extensor stretch earlier (arm straight, palm down, pull hand downward). You can also stretch the wrist flexors (arm straight, palm up, gently pull fingers back). Perform these stretches daily, holding ~30 seconds, and do them for both arms for balance. Keep the stretches gentle – you should feel a pull but not sharp pain. Additionally, self-massage can help: use your opposite hand or a massage ball to rub the tight extensor muscles on your forearm (the muscle mass just below the elbow on top of your forearm). Start with light pressure and increase as tolerated. Some people use a foam roller on the forearm or even a gently rolled tennis ball against a wall to work out sore spots. This increases blood flow and can break up muscle knots.
Bracing (Counterforce Strap): You might have seen those forearm straps or elbow braces marketed for tennis elbow. A counterforce strap wraps around the upper forearm, just below the elbow. Its purpose is to dissipate the force away from the injured tendon. Using one can help reduce pain during activities by effectively “splinting” the tendon and offloading stress. It doesn’t cure the issue, but it’s a useful tool, especially in the early phase or during heavier tasks. If you use a brace, ensure it’s placed about 2-3 finger widths below the elbow joint (not directly on the elbow) and snug but not too tight (you don’t want to cut off circulation). We usually recommend wearing it during aggravating activities (e.g., tennis play, yardwork, typing) and removing at rest. Not everyone finds braces necessary, and that’s okay – they’re an optional aid. If it helps you get through work or exercise with less pain, great. If you’re unsure which type to get, ask us – we can suggest a good one and make sure it fits right.
At-Home Exercises: You can start some gentle exercises at home even before your first physio visit, as long as they’re pain-free. A couple of therapist-approved moves:
Isometric wrist extension: Place your forearm on a table, palm facing down. Use your other hand to gently resist the back of the affected hand as you try to lift it. Essentially, you’re pushing up with one hand and resisting with the other so the wrist doesn’t actually move. Hold that tension for ~10 seconds, then release. Repeat 5-10 times. Isometrics can reduce pain and maintain some strength.
Towel twist: Roll up a towel; with both hands, twist it as if wringing water out, then twist the other way. This engages the forearm muscles in a controlled way. Do it gently for time (e.g. 1-2 minutes total).
Once your pain is a bit better, you can begin eccentric wrist curls (as described earlier) with a light weight. But it’s best to get guidance on proper form for this to avoid aggravation, so we recommend doing it under a physio’s instruction initially.
Always exercise within tolerable limits – a mild increase in discomfort during rehab exercises is okay, but sharp pain is not. The saying “no pain, no gain” does not apply here. It’s more like “no pain, good gain.” Focus on quality of movement rather than heavy resistance. As you build strength over weeks, you can gradually increase intensity under professional guidance. Consistency (doing a bit each day) beats doing a marathon session once a week. Research shows therapeutic exercise is one of the most effective interventions for tennis elbow, so sticking with your exercise routine is key to recovery.
Ergonomic and Lifestyle Tips: Small changes in how you perform tasks can make a big difference in healing and prevention. If you spend long hours at a computer, ensure your wrists are in neutral (straight) and not cocked up or down – adjust your chair or keyboard height if needed. Use an ergonomic mouse that doesn’t strain your wrist. When lifting objects (groceries, weights, etc.), try to keep your palm facing your body or up (a supinated grip) rather than palm-down; this engages the biceps and reduces strain on the extensor tendon. Take breaks during repetitive activities – a 5-minute stretch break every hour can help. If you play sports, consider getting a coach or trainer to check your form. Sometimes a slight adjustment in technique (like the backhand swing in tennis or the way you grip a golf club) can offload the elbow significantly. Using equipment that’s appropriate for you (racquet with proper grip size and string tension, for example) is also important.
Gradual Return to Activity: As your pain improves, gradually reintroduce activities. Don’t jump straight back into a heavy workload or 3-hour tennis match after weeks of rest – your tendon needs time to build tolerance. Follow the principle of incremental loading: e.g., if you haven’t played tennis in 2 months, start with 10-15 minutes of hitting drills rather than a full game. If you’re returning to manual work, try shorter days or lighter duties initially. Your physiotherapist can help map out a return-to-work or return-to-sport plan. It’s normal to feel some mild soreness as you resume activity (your tendon is getting used to it again), but sharp pain is a sign to back off. By pacing yourself, you reduce the risk of setback and allow your tendon to adapt.
These at-home strategies, combined with professional treatment, give you a one-two punch in fighting tennis elbow. Many patients tell us that understanding why it hurts and what they can do empowers them and eases the fear that comes with chronic pain. You’re not helpless against tennis elbow – there’s a lot you can control. And remember, if any self-care measure seems to worsen your pain, pause and consult your provider. We’re here to guide you on the right track.
A brace (specifically a forearm counterforce strap) isn’t mandatory, but it can be helpful in many cases. By strapping it around your forearm (not directly on the elbow), it reduces the tension transmitted to the injured tendon. This often leads to temporary pain relief, especially during activities. Many patients find that wearing a strap during work or sports allows them to perform with less pain. However, it’s not a cure – think of it as a supportive aid. If you do choose to use one, have a professional show you the proper placement and fit. And don’t become too reliant on it; we ultimately want your tendon to tolerate loads without needing external support. Use it as a bridge to full recovery.
In the vast majority of cases, no. Surgery is usually considered only for severe, chronic tennis elbow that hasn’t improved after many months of proper treatment. Roughly 9 out of 10 people get better with non-surgical therapiespmc.ncbi.nlm.nih.gov. We utilize a combination of treatments like shockwave, exercise, etc., to heal your tendon. These approaches have high success rates and avoid the risks of surgery. Only if you’ve truly exhausted all conservative options (and are still in significant pain) would a specialist discuss procedures such as a tendon release surgery. Even then, less invasive steps (like a platelet injection or needling the tendon to stimulate healing) are often tried before an actual operation. So, for most people, surgery is off the table – they get better without it. Our goal at Unpain Clinic is to make sure you heal without needing any invasive interventions.
Not necessarily – complete inactivity isn’t required (and can even be counterproductive). We do recommend avoiding or modifying the specific activities that exacerbate your pain (for example, taking a break from tennis or heavy lifting), especially in the early phase. This rest gives your tendon a chance to start healing. However, you can and should stay active in other ways. Keep up your general fitness/cardio, and use the arm in pain-free ranges for light daily tasks. As your pain improves, gradually reintroduce activities rather than waiting for pain to magically vanish 100%. Our clinicians will guide you on what’s safe to do at each stage. Remember, tennis elbow is an overuse injury – so the key is optimal loading, not zero loading. We want to find the sweet spot where the tendon is being gently stimulated to heal (through rehab exercises and normal use) without being overstressed. You won’t be sidelined forever; with proper management you’ll return to the activities you enjoy. It just needs to be done thoughtfully.
Useful exercises generally fall into two categories: stretching and strengthening. Two common stretches are: 1) the wrist extensor stretch (arm straight, palm down, gently bend the wrist downward with help from the other hand, stretching the top of the forearm) and 2) the wrist flexor stretch (arm straight, palm up, gently extend the wrist back, stretching the underside of the forearm). These help maintain flexibility and reduce tension on the tendon. On the strengthening side, eccentric wrist extension exercises are often recommended – this means using a light weight or resistance band and focusing on the slow lowering phase of the wrist lift. Eccentric exercise has been shown to promote tendon healing for tennis elbow. Isometric exercises (like gripping a ball or towel without moving the wrist) can also reduce pain and build some strength early on. It’s best to learn these exercises from a physio to get the technique right. We customize the exercise program to each patient – for example, if you’re a tennis player, we might add specific forearm and shoulder drills relevant to your swing. Always do exercises within a comfortable pain range – a mild ache during or after is okay, but sharp pain means back off. With the right exercises done consistently, you can significantly speed up recovery and prevent future flare-ups.
Healing times can vary widely from person to person. For some with a mild case caught early, it might improve in a matter of weeks (~6-8 weeks) with rest and rehab. For more chronic cases (pain lasting many months), it often takes a few months of consistent treatment to truly resolve. A general ballpark for significant improvement is about 3 to 6 months of proper management. That might sound long, but remember, tendons heal slowly. The good news is you should see steady progress – for instance, pain decreasing and strength improving month by month. If you undergo advanced therapies like shockwave, you might see pain relief sooner (within a month or two) with continued gains as you strengthen the area. It’s important to keep up with your exercises and follow your therapist’s plan during this period. Even after you feel 100%, the collagen in the tendon continues remodeling for up to a year. So we often say: pain relief comes relatively soon, full tissue healing takes longer. Don’t be discouraged – with patience and the right care, you’ll get there. And if at any point your recovery isn’t on track, we’ll adjust our approach to help get past any plateau.
Shockwave therapy is considered very safe for chronic tendon injuries like tennis elbow. The most common “side effect” is some discomfort during the treatment itself – patients describe it as a rapid tapping sensation. Focused shockwave can feel intense on bony areas, but we adjust the settings to your tolerance. Any soreness during treatment stops immediately when the machine is turned off. There’s usually no lingering pain after a session, though a few patients feel a short-term ache or warmth in the area for a day or so (a sign that the body’s healing process is kicking in). We’ve had patients initially worried that shockwave would be excruciating, and they’re pleasantly surprised that it’s quite tolerable – often less uncomfortable than a deep tissue massage on a knot! As for safety, shockwave has been used for decades and research shows it has a high safety profile. There’s no radiation or anything like that – it’s mechanical sound waves. It won’t damage tissues when applied correctly; in fact, it stimulates repair. We avoid using it in certain cases (for example, over a fracture or tumor, or in pregnancy, etc.), but those are rare situations. For the typical tennis elbow patient, the main thing you’ll feel is that odd sensation during treatment, and then hopefully the feeling of improvement in the weeks that follow!
Tennis elbow can be a stubborn and painful condition, but with the right approach, you can overcome it. Understanding the causes – that it’s often due to repetitive strain and poor healing of the tendon – helps make sense of why certain treatments work. By addressing both the symptoms and the root causes, you give yourself the best chance at a full recovery. Remember that most cases resolve without surgery, and modern therapies (like shockwave therapy, EMTT, and targeted rehabilitation) have excellent track records in clinical studies.
If you’re dealing with tennis elbow, don’t lose hope. Start with the basics: rest from aggravating activities, gentle exercises, maybe a strap or some ice for comfort, and see a healthcare professional for guidance. Early intervention can shorten your recovery time; the longer you “just live with it,” the more ingrained the problem can become. On the flip side, even if you’ve had pain for a year or more, it’s not too late – we routinely help people who’ve been struggling long-term and finally experience relief with a comprehensive treatment plan.
At Unpain Clinic, we’re here to support you every step of the way. Our team of physiotherapists, chiropractors, and massage therapists collaborate to create a 360° plan tailored to you – whether you’re a competitive athlete or someone who simply wants to garden and play with your kids without elbow pain. We combine compassion with advanced expertise, because we truly care about getting you better.
Tennis elbow may have gotten its grip on you, but with proper care, you will get your grip back – stronger than before. Imagine being able to shake someone’s hand, carry groceries, swing that tennis racquet or golf club, without that familiar pain biting at your elbow. That outcome is very much achievable.
If your elbow pain has been holding you back, consider taking the next step by getting a thorough assessment and personalized treatment plan. You don’t have to tolerate the pain or rely on quick fixes that don’t last. Let’s fix the “why” behind your pain and get you on the fastest path to recovery.
Results may vary from person to person, and this journey does require some patience and effort – but you won’t be doing it alone. We’ll be with you, guiding you and cheering on each bit of progress. Don’t let tennis elbow keep you on the sidelines of life. With the right approach, you can heal, strengthen, and confidently get back to the activities you love.
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: 40824407pmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov
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.unpainclinic.com
3. Page, P. A New Exercise for Tennis Elbow that Works! N Am J Sports Phys Ther. 2010; 5(3): 189–193.pmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov
4. Scientific Reports (Nature). Effects of shockwave vs. ultrasonic therapy and deep friction massage in lateral epicondylitis: a randomized trial. Sci Rep. 2024; 14: 11927.nature.comnature.com
5. Unpain Clinic – Shockwave Therapy Edmonton: Focal vs Radial – Heel Pain Case. (Blog Article, 2025)unpainclinic.comunpainclinic.com
6. Unpain Clinic – How to Treat Tennis Elbow (Lateral Epicondylitis) in Edmonton. (All Treatments Guide, 2023)unpainclinic.comunpainclinic.com
7. Unpain Clinic Podcast – “Only Masking Symptoms vs Fixing the Cause” – Patellofemoral Pain Episode. (Hosted by Uran Berisha, 2024)unpainclinic.com
8. Froton, MR. Eccentric strengthening in the treatment of lateral epicondylitis. J Hand Ther. 2019; 32(2): 180-185.sciencedirect.com
9. Coombes, BK et al. Effective treatment options for tendinopathy (tennis elbow). Lancet. 2020; 395: 190-198.pmc.ncbi.nlm.nih.gov
10. Unpain Clinic – Shockwave & EMTT Success Stories – Andy’s Elbow (YouTube Testimonial). (UnpainClinic YouTube, 2025)youtube.com
