Tennis elbow: what helps, in which order
The pain sits on the outside of the elbow, becomes stronger when gripping and does not disappear by itself. With tennis elbow it is less the individual method that decides than the order. Here I describe how I build it up in my practice.
In short
Tennis elbow (epicondylitis lateralis) is an irritation of the tendon insertion of the extensor muscles on the outer elbow. It is persistent because this tissue has a poor blood supply and the arm hardly gets a break. Treatment usually manages without an operation. I proceed in steps: adjust the load, physiotherapy with eccentric training, shockwave therapy, an ultrasound-guided injection, PRP therapy. Surgery follows only once these steps have been exhausted.
Why tennis elbow is so persistent
The muscles that extend the hand and the fingers attach to the outer bony prominence of the elbow (epicondylus lateralis). Everything you grip, lift or turn pulls on this one point. Under continuous load the structure of the tendon changes there: not a classical inflammation, but a remodelling of the tissue (tendinosis) in which the fibres arrange themselves unfavourably. Anti-inflammatory measures alone therefore fall short.
Added to this is the poor blood supply at the tendon insertion — the remodelling takes longer there than in muscle. And the arm can hardly be kept still: keyboard, mouse, shopping bag, door handle. Despite the name I rarely see tennis players, more often people at the computer, in the trades or in strength training. The counterpart on the inner side is golfer's elbow.
Why treatment is usually without an operation
Tendon tissue can recover when it receives the right stimuli and the wrong ones fall away. That is why surgery is rare and late. What helps is not a single method, but a sequence.
The steps in the order in which I use them
I start at the bottom and only go further when the previous step is not enough. They do not replace one another: the training continues even when shockwave therapy or an injection are added.
1. Adjusting the load
First we look at what irritates the tendon insertion every day. Often it is small things: the height of keyboard and mouse, a thin tool handle, the grip size of the racket. Keeping the arm still is not the aim — a tendon that does nothing does not become more resilient. It is about taking out the peaks and keeping the movement.
2. Physiotherapy and eccentric training
This is the foundation. In eccentric training the muscles work while they give way — while a weight is slowly lowered, not while it is lifted. This stimulus orders the tendon tissue and makes it more resilient. Stretching and strengthening come with it; at the Orthozentrum Döbling, physiotherapy and exercise therapy are in the building. A pulling sensation during an exercise is fine; pain that still marks the next day means: adjust the dose.
3. Shockwave therapy
If the first two steps are not enough, shockwave therapy is added — focused and radial, in the practice. The energy acts at the tendon insertion, stimulates the metabolism and influences the processing of pain. The application is possible on an outpatient basis and without anaesthesia, but at the irritated point it is noticeable. More on this on the page about shockwave therapy in Vienna. It does not replace the training, it opens the window for it.
4. Ultrasound-guided injection
If the pain is so strong that sensible training is not possible, a targeted injection helps. I place it under ultrasound guidance: the tip of the needle and the tendon insertion can be seen on the screen. I use cortisone there sparingly, because it can indeed take the pain away quickly but, applied repeatedly, weakens the tissue. An injection is a door opener for the treatment, not a permanent arrangement.
5. PRP therapy
In persistent cases I offer PRP therapy: I take blood, prepare it and place the platelet-rich plasma at the tendon insertion under ultrasound guidance. The platelets contain messenger substances that are meant to set repair processes in motion. The evidence is mixed and I do not promise a result — before an operation I consider the attempt worthwhile. I describe the procedure under PRP therapy.
When an operation becomes a topic
I speak about it only once the conservative steps have been exhausted and the complaints continue to restrict everyday life, work or sport. Before that I clarify whether the tendon insertion really is the only problem: a narrowing around the radial nerve, an instability or a finding within the joint cause similar pain. For this I use the examination and ultrasound, and an MRI where needed.
The procedure removes the remodelled tissue at the tendon insertion — arthroscopically or open, depending on the findings. I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare. Details on the page about tennis elbow and golfer's elbow in Vienna and under elbow arthroscopy.
Why patience is part of it
Tendon tissue remodels slowly; that cannot be shortened. Many courses stall not because the treatment was wrong, but because it was changed too early or the load was increased too quickly. I deliberately give no number of weeks — in an individual case it would be worth little. What I can commit to is clear check-ups and adjusting the plan. Further conditions can be found under elbow specialist in Vienna. Whether one step is enough or the next one makes sense we decide together on the basis of the findings.
Frequently asked
Frequently asked questions about tennis elbow
A reliable number of weeks cannot be given. Tendon tissue needs time for the remodelling, and the course depends on how long the complaints have existed, how strongly the arm is demanded at work and how consistently the training is carried out. Instead of a prognosis I arrange fixed check-ups and assess at each one whether the current step is working.
An epicondylitis strap sits below the elbow and reduces the pull on the irritated tendon insertion. Many patients experience this as relief during demanding activities. It is, however, an accompanying measure and no substitute for the treatment: it does not make the tissue more resilient. I recommend it for demanding situations, not as a permanent solution.
Usually not. In most cases tennis elbow can be treated conservatively. I discuss an operation only once adjusting the load, physiotherapy, shockwave therapy, injection and, where appropriate, PRP therapy have been exhausted and the complaints continue to restrict everyday life, work or sport. Before that I clarify whether another cause at the elbow lies behind it.
Usually yes, but adapted. Complete rest does not make the tendon more resilient, it weans it off load. It makes sense to cut back those movements that clearly trigger the pain — firm gripping, lifting with a straight arm, hard strokes — and to keep the training that the arm tolerates. What is possible we determine after the examination.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.