The correct tennis elbow treatment depends on what stage your injury is in, and there is no one-size-fits-all recipe. Get it wrong, and the treatment will be ineffective or even make your elbow pain worse. This article explains what tennis elbow home treatments work best for each stage and shares specific advice for office workers and gym goers. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.
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With tennis elbow, the tendons that attach the wrist extensor muscles in your forearm (the muscles that bend you wrist back) to the outer elbow bone are injured. You can find a detailed discussion about what causes tennis elbow and how to diagnose it here.
Can tennis elbow heal by itself?
Yes, absolutely. Several studies have reported that many cases of tennis elbow can recover without active treatments (e.g. massage, exercises, and injections).
👉 However, this does not mean that you can just carry on as normal and expect your tennis elbow to heal. You do have to reduce the load on that area temporarily – I discuss this in more detail below, under load management.
The stages of tennis elbow
Overuse tendon injuries, like lateral elbow tendinopathy, can be in one of three stages:
Reactive stage – this is when your symptoms have been present for only a few days or weeks, and the tendon’s structure has not changed.
Dysrepair stage – the symptoms have been present for a few months, and there are some changes to the tendon structure.
Degenerative stage – the symptoms have been present for quite a few months or perhaps even years, and the injured part of the tendon has undergone significant changes in structure.
You can read more about these stages and what it means for healing here. I’ll highlight below which treatments are most effective for each stage.
However, it’s worth noting that there is no universally effective treatment that works equally well for all cases in a given stage of injury.
Tennis elbow treatment is more likely to be effective if it is tailored to the individual and adapted from time to time according to how the injury responds to the treatment.
If you’ve used a treatment for six weeks without seeing any improvement, you should try something else. In most cases you can expect very slow improvement, and that still counts. It is no improvement that means a change of treatment may be warranted.
This is why it can be useful to work with a physiotherapist who will help you to figure out the best treatments for you.
Using pain to guide your treatment
The current research suggests that tennis elbow treatments are most effective when they don’t cause a significant increase in a patient’s pain during and in the hours after the treatment.
So, regardless of the type of treatment:
it is OK if you experience a slight increase in discomfort during or after the treatment (you’re just a bit more aware of it than normal)
but it should not increase your pain significantly, and any increased pain must settle back to its previous levels within 24 hours.
🏆 Load management – The most important treatment for all stages of tennis elbow
Load management consists of two overlapping elements:
Relative rest: For your injury to settle and start healing, you must temporarily reduce the loads or forces that go through that area. But you usually don’t have to rest it completely – more on this below.
Careful reloading: As your pain starts to calm down and settle, you gradually start using the arm more. This helps to restore the strength and function of the injured tendon and related muscles. It includes your daily activities as well as your rehab exercises (see below).
Mistakes that people often make are:
They don’t rest their elbow enough – they read on the Internet that they should do exercises and start these when the injury isn’t yet ready for it,
or they over-protect their elbow by resting it too much and for too long, which leads to unnecessary loss of strength plus increased pain in the long run,
or they ramp up activity too quickly once the pain has calmed down, and this causes a flare-up in pain (we call this a boom-and-bust cycle).
👉 What you want to do instead is to reduce or adapt the activities that aggravate your elbow pain. If adapting them doesn’t work, you may have to cut them out altogether for a short while.
Then, once your tennis elbow pain has settled down, you gradually start easing back into those activities, testing short sessions or durations and observing how it affects your elbow.
Simple adjustments that can help your elbow “rest” throughout the day include:
Lifting things with your thumb or palm facing up – these positions use your wrist flexor muscles rather than your wrist extensors.
Limiting repetitive movements.
Not carrying things with the injured side – even low-level gripping (e.g. light shopping bags) can aggravate tennis elbow pain if you carry it for a long period.
Using your other hand to lift, push, or pull things if possible.
If playing backhands in tennis hurts but other strokes are OK, continue playing but leave the problematic ones out for now.
💻 Load management for office workers
If working on a computer or using a mouse aggravates your tennis elbow, resting it completely is usually not an option because you’ve got to work. However, adapting your work set-up can make a significant difference:
Get an ergonomic mouse – using a mouse with your wrist turned outwards uses different muscles than the traditional palm down position (which uses your wrist extensors). Switching to an ergonomic upright mouse can also help if you usually use the trackpad on your laptop.
Have your keyboard slightly lower (make your chair higher or table lower) so your wrists don’t have to extend (bend up) as you type but rather stay in a neutral position or bend slightly downwards – this reduces the amount of work your wrist extensor muscles have to do.
Get the right size keyboard for your body size – if your keyboard is too wide or too narrow, it will require you to do excessive repetitive wrist movements when typing, which can make things worse.
Take regular breaks to move and stretch – even the perfect office set-up will not be enough to solve your elbow pain if you work hours on end without taking a break.
You can find more advice on the best desk and chair set-up for office workers here.
💪 Load management for gym goers
The problem with doing weight training is that every single exercise that requires you to grip a weight works the muscles that are attached to the injured tendon in tennis elbow. So, you have to keep in mind the total volume of exercise you do as well as the specific exercises.
👉Your first aim is to see whether you can find a volume of exercises that does not increase your pain during or after you’ve done them.
Adjustments that might help include:
Cutting out all the exercises that require very strong gripping and where you can’t adjust the weights; bodyweight pull-ups, for example.
Reducing the number of arm exercises and also the weights you use. E.g. instead of doing six exercises for your upper body, do two or three and make the weights much, much lighter.
If your elbow pain increases even with very light exercises, you will have to stop all exercises that require you to grip, push, or pull until your elbow has recovered somewhat.
Once you feel ready to restart your training, test it carefully by adding only one or two exercises, and make the weights much lighter than normal – you know you’re doing it right if you feel slightly embarrassed to do such light weights in the gym.
Then gradually increase your training load over time, taking care not to aggravate your symptoms. View this as rehab rather than fitness training – ramping the intensity up much more gradually than when you’re simply training for fitness usually works best.
Treatments for short-term tennis elbow pain relief
The treatments in this section can help to reduce your pain. However, they don’t bring about healing.
🤷So, why bother?
Pain can make your life miserable and interfere with your sleep, work, and social life. It can also stop you from doing the things that are needed for healing, e.g. your rehab exercises.
So, despite not being strictly necessary for healing, these treatments can be super useful as part of a comprehensive treatment plan. Test them and see what works best for you.
Sleep and sitting position
Sleeping with your elbow straight is usually a gamechanger. There is something about keeping the elbow bent for long periods that irritates tennis elbow and makes the pain worse.
It can be a bit challenging to figure out how to keep your elbow straight while tossing and turning in bed, but my patients who manage this report big improvements in their pain.
The same goes for sitting with your elbow bent – if you can avoid having it very bent up during the day, it can help reduce your elbow pain more quickly.
Massage for tennis elbow
Massage can help relax your wrist extensor muscles and reduce your pain. However, you can also make your elbow pain worse if you’re too aggressive.
For newly flared up tennis elbow (in the reactive stage), avoid hard massage or using a massage gun over the tendons. At this point, the tendons are really irritated, and strong pressure over them usually just makes it worse (like pressing on a new bruise).
For chronic tennis elbow pain (when it has been present for a long time), you usually can use stronger pressure and massage or use a massage gun over the tendons as well. Aim for a “comfortably uncomfortable” pressure – if you’re too aggressive or cause too much pain during the treatment, it can also cause a flare-up in pain.
For massage guns, I recommend:
Using low frequencies – 2,400 percussions per minute or lower.
Doing it for only 2 to 3 minutes, covering the whole area.
Applying “comfortably uncomfortable” pressure.
Leaving at least 48 hours between treatments to allow your body to adapt and recover.
Here are some massage guns available on Amazon:
I’ve previously discussed when it is better not to use a massage gun.
🤷 What about “breaking down the adhesions” with massage tools?
There is currently no evidence that this works, and for every person who swears by it, I’ve seen at least one whose tennis elbow pain was much worse after. The research clearly shows that the main problem in the tendon is that it degrades and loses strength. Hence, I favour treatments that are well-researched and help restore the strength and tendon structure and are less likely to flare my patients up.
Braces and straps
There are three types of brace or support that people use for tennis elbow:
Wrist splints – These force you to rest your wrist extensor muscles and are particularly useful for very painful cases. The research shows they work.
Tennis elbow straps – These reduce the pull on the injured part of the tendon, thereby reducing your pain. The research shows that they can be very effective for some people but make others worse.
Soft elbow sleeves – These have not been researched and are not that useful in my opinion.
👉 You can find a detailed discussion about the different types of tennis elbow brace, how to decide which type to use, and when to wear them here.
Taping
So far, researchers have identified two taping techniques that can reduce tennis elbow pain. One uses kinesiology tape and one rigid zinc oxide tape.
👉You can find a step-by-step explanation on how to apply these taping techniques for tennis elbow here.
Reapplying the tape repeatedly can be a bit of a pain, so I prefer using a brace or strap. However, if you have some tape lying around, this is definitely something you can try.
Ice or heat for tennis elbow?
There is no evidence that either ice or heat speeds up healing. However, it might help reduce your pain in the short term.
It’s usually better to use ice if your tennis elbow pain only started a few days ago, as heat might make it worse if your case has an inflammatory component (not all cases have).
You can usually use heat or ice for ongoing cases that have been painful for longer than a couple of weeks.
However, overcooling or overheating tissue can be counterproductive, so only apply the ice or heat for 10 minutes at a time and don’t use extreme temperatures.
Medication
Anti-inflammatory medication may help to reduce pain in reactive tendinopathy. However, these type of drugs must only be used:
If really needed for pain relief – they do not actually help healing.
For a very short period – they can have negative effects on your stomach.
For acute cases (reactive tendinopathy) – it is not useful in ongoing cases and may reduce the effectiveness of your rehab exercises.
Where pain is severe in ongoing cases (that have been present for several months), your doctor may prescribe drugs that work on the central nervous system (e.g. antidepressants or antiepileptic drugs) since it can help to calm the general pain system.
Dry needling and acupuncture
Acupuncture and dry needling both use the same type of thin sterile needle. The main (and simplified) difference is that with acupuncture, the needles are inserted into “energy points”, while with dry needling they are inserted into painful spots (also called trigger points) in the muscles.
Two recent reviews of the literature agree that dry needling can benefit tennis elbow. Navarro-Santana et al. (2020) focused only on trigger point dry needling while Ma et al. (2024) also included other types.
Ma concluded that trigger point dry needling was more effective at reducing pain than other types and that the ideal frequency of treatment appeared to be two to three times per week. In my experience, once a week also gets good results.
For acupuncture, two recent reviews also reported that it appears to be an effective treatment for reducing pain compared to placebo and other treatments like medication.
👉 However, all of these reviews rated the level or quality of evidence of the included studies as low to moderate, which suggests these treatments might be useful, but we can’t be 100% certain.
Electrotherapies
Despite physios and other clinicians regularly using electrotherapy treatments in clinic, many of these methods are supported by very little evidence or low-quality evidence. So, bear this in mind when reading this section.
High-intensity laser has been shown to reduce pain.
Low-level laser therapy may be of benefit, but the research supporting it is not of good quality.
TENS does not seem to be effective.
Ultrasound – The evidence for ultrasound is conflicting and of low or very low quality.
Joint mobilisation
There is evidence that manual therapy techniques where your physiotherapist moves your joints can help to provide short-term pain relief. Your physio may use joint mobilisation on your elbow as well as your neck and upper back if their assessment identified those areas as part of the problem.
Joint mobilisation is not the same as joint manipulation (the typical cracking of a neck with a quick thrust movement) – the former is gentler and done with more control. Personally, I am not a fan of joint manipulations since they can cause serious injuries and I don’t feel the reward (short term pain relief) is worth the risk.
🏆 Rehab exercises – the best treatment for long-term pain relief
There are quite a few types of exercise that can be used for tennis elbow treatment. Your stage of tendinopathy, pain levels, and physical assessment will determine what exercises are most appropriate for you.
The biggest mistake people make with rehab exercises for tennis elbow is to jump in too quickly and overdo things, and then it just makes the injury worse. The best treatment for a very painful tennis elbow that recently flared up is relative rest, not exercise.
We discuss the various types of exercise for tennis elbow (with examples) in detail in another article, but here’s a quick summary.
👉 Exercises that might be useful for all stages of lateral elbow tendinopathy:
Stretches for the wrist extensors – reduce muscle tension and help the muscles relax.
Mobility exercises for the rest of the arm and neck – these are especially useful in ongoing cases or if your physiotherapist suspects that those areas may be part of the cause of your elbow pain.
Neural mobilisation (exercises that slide the nerves) – helps the radial nerve (that runs along the outer elbow) to slide and move more freely.
👉 Exercises that should usually only be started in the dysrepair and degenerative stages:
Strength training exercises for the wrist extensors – these can help to restore the tendon structure and reduce the load on the injured part of the tendon by strengthening the rest of the tendon.
👉 For sportspeople:
Technique drills specific to your sport.
Making sure all the parts of your kinetic chain is strong and can move freely.
Shoulder stability exercises.
Tennis elbow recovery times with conservative treatment
The research shows that the vast majority of tennis elbow cases recover within 3 to 12 months with conservative treatments (so, the treatments explained above), but for some people it might take longer.
If conservative treatment doesn’t work
The treatments discussed below should only be used if you’ve tried at least 12 weeks of load management and some of the other treatments mentioned above without making much progress.
Shockwave
The evidence suggests that shockwave therapy may be more effective than injections for tennis elbow. However, it doesn’t work for everyone.
Shockwave should only be considered for tennis elbow cases that have entered the dysrepair or degenerative stage – it will very likely flare your injury up if you use it in the reactive stage.
Injections
Here’s what the research has found about the types of injection typically used for tennis elbow:
❌ Steroid injections
Corticosteroid injections are thought to work by reducing inflammation. However, we’ve seen that inflammation is only really present during the first few weeks of tennis elbow, and in any event, it is thought to be part of the healing process rather than the cause.
These days researchers seem to agree that it’s best to avoid steroid injections for tennis elbow. Despite providing good short-term pain relief, they can actually lead to poorer long-term recovery.
Platelet rich plasma (PRP) and autologous blood injections
These injections use the person’s own blood. For PRP injections, the blood is spun at high speeds to separate out the platelets. The theory is that by injecting a person’s own blood into the affected tendon you can stimulate the healing process.
Current research reports contradictory results for these types of injection – some reviews show that they are effective while others can’t find any difference between them and placebo injections.
This is also what I observe in practice – some of my patients find them extremely helpful while others are no better off. Importantly, they don’t seem to have any lasting negative effects.
When they do bring about positive change, the improvement is usually gradual and most noticeable after about six weeks.
Hypertonic dextrose injections
Substances like hypertonic dextrose (prolotherapy) is thought to bring about healing by artificially irritating the injury site, causing inflammation, which then triggers tendon repair and healing. There is also evidence that it can reduce pain by affecting the nerve endings in that area.
The current research suggests that dextrose injections can reduce pain but likely does not improve function. So, they are best used in combination with other treatments (like strength training exercises) that can help to improve tendon and muscles strength and function.
Botox injections
Botox (botulinum toxin) is a protein that temporarily paralyzes muscles. Botox may work in one of two ways:
It is thought that by temporarily paralyzing the wrist extensor muscles it allows them to rest and helps the tendons to recover.
But there is also evidence that your body releases certain substances in reaction to the injection that might help with pain relief.
The current research shows that Botox may provide pain relief for up to six months but does not bring about changes in strength.
Stem cell injections
The theory behind stem cell injections is that they are meant to stimulate healing. There is currently very little research available, and where it does exist, the studies used very small sample sizes. So, we don’t know whether it is truly effective.
Hyaluronic acid injection
Hyaluronic acid is the primary component of synovial fluid and provides lubrication and shock absorption for joints. It’s not clear how it is meant to help with tendinopathies.
There is also a lack of quality research into the effectiveness of hyaluronic acid injections and the studies that do exist show contradictory results.
Surgery
It has been reported that only about 5% of tennis elbow cases require surgery.
The research shows that open surgery, arthroscopies, as well as minimally invasive techniques, i.e. percutaneous ultrasonic tenotomy (Tenex), can help to reduce tennis elbow pain but do not necessarily lead to complete recovery.
A benefit of the less invasive techniques is that they might allow you to return to work more quickly than open surgery would.
How we can help
Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.