Tennis Elbow? Why Your Tendon Isn't Healing & Medically Approved Next Steps

If you have tennis elbow, you know how frustrating it can be. The pain lingers. It may improve slightly with rest, then flare up again when you grip, lift, or twist your forearm. Many people assume it's just inflammation that will settle down quickly. But if your tennis elbow isn't healing, there's a medical reason — and understanding it is the first step toward recovery.

Let's break down why this condition can be stubborn and what evidence-based treatments actually work.

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What Is Tennis Elbow?

Tennis elbow, medically called lateral epicondylitis, is a condition that affects the tendons attaching to the outside of your elbow. These tendons connect your forearm muscles to the bone and help you grip, lift, and extend your wrist.

Despite the name, most people who develop tennis elbow don't play tennis.

Common causes include:

• Repetitive gripping or lifting
• Frequent computer mouse use
• Manual labor (plumbing, painting, carpentry)
• Weightlifting with poor form
• Repetitive wrist extension motions

Over time, small microscopic tears develop in the tendon. When the tendon doesn't repair properly, pain becomes chronic.

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Why Your Tennis Elbow Isn't Healing

Many people assume the pain is due to inflammation. Early on, inflammation may be present. But research shows that chronic tennis elbow is usually not an inflammatory condition — it's a degenerative one.

This is an important distinction.

Instead of swelling alone, the tendon undergoes:

• Collagen breakdown
• Disorganized tendon fibers
• Reduced blood supply
• Poor healing response

This process is called tendinosis.

Because tendons naturally have limited blood flow, they heal more slowly than muscles. If you continue repetitive strain while the tendon is trying to repair, healing stalls.

Other reasons recovery may be delayed:

• Returning to activity too quickly
• Relying only on rest without strengthening
• Poor ergonomics at work
• Smoking (reduces tendon healing)
• Underlying conditions like diabetes

In short: rest alone often isn't enough.

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What Tennis Elbow Feels Like

Symptoms are usually straightforward:

• Pain on the outer part of the elbow
• Pain when gripping or shaking hands
• Weak grip strength
• Discomfort lifting objects (even a coffee mug)
• Pain when extending the wrist

The pain may start mild but gradually worsen over weeks or months.

If you're experiencing similar tendon-related symptoms elsewhere in your body or want to understand whether inflammation of the tendon sheath could be playing a role, you can use a free AI-powered Tenosynovitis symptom checker to help identify potential causes and guide your next steps.

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Medically Approved Next Steps for Tennis Elbow

The good news: most cases improve without surgery. But the treatment needs to match the biology of the condition.

1. Relative Rest — Not Complete Immobilization

You don't need to stop using your arm completely. But you do need to:

• Avoid painful repetitive activities
• Reduce heavy gripping or lifting
• Modify workstations and tools

Complete inactivity can actually weaken the tendon further.

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2. Physical Therapy (The Gold Standard)

The most effective treatment for persistent tennis elbow is targeted strengthening exercises, especially eccentric exercises (controlled lengthening of the muscle).

A physical therapist may guide you through:

• Eccentric wrist extension exercises
• Forearm strengthening
• Grip training
• Stretching techniques
• Shoulder and posture correction

Why this works: Tendons respond to controlled loading. Proper strengthening stimulates collagen repair and improves tendon structure.

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3. Bracing

A counterforce brace worn around the forearm can:

• Reduce strain on the tendon
• Decrease pain during activity

It's not a cure, but it can make daily tasks more manageable.

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4. Ice for Symptom Relief

Ice may help reduce pain after activity, especially during flare-ups. However, since chronic tennis elbow isn't purely inflammatory, ice alone won't fix the problem.

Use it as a supportive tool, not a standalone solution.

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5. Anti-Inflammatory Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce short-term pain. However:

• They don't reverse tendon degeneration
• Long-term use can cause side effects

They should be used cautiously and ideally under medical guidance.

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6. Injections: What to Know

If conservative treatment fails, your doctor may discuss injection options.

Corticosteroid injections:

• Can reduce pain short-term
• May weaken tendon structure if repeated
• Not recommended as a long-term fix

Platelet-rich plasma (PRP):

• Uses your own blood components
• Aims to stimulate healing
• Evidence is mixed but promising for some patients

This is a conversation to have with a qualified medical professional who understands tendon pathology.

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7. Shockwave Therapy

Extracorporeal shockwave therapy (ESWT) is sometimes used for chronic cases. It may stimulate blood flow and tissue repair. Research shows moderate benefit in certain patients.

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8. Surgery (Rare)

Only about 5–10% of people with tennis elbow require surgery.

Surgery may be considered if:

• Symptoms persist longer than 6–12 months
• Conservative treatments fail
• Pain significantly limits daily function

The procedure removes damaged tendon tissue and stimulates healing.

Most people recover without needing this step.

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How Long Does Tennis Elbow Take to Heal?

With proper treatment:

• Mild cases may improve in 6–8 weeks
• Moderate cases may take 3–6 months
• Chronic cases may take 6–12 months

Tendon healing is slow. Progress often feels gradual rather than dramatic.

Consistency with rehab exercises matters more than quick fixes.

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What Makes Tennis Elbow Worse?

To protect healing, avoid:

• Repetitive wrist extension
• Heavy gripping
• Poor lifting technique
• Ignoring early pain signals

Also pay attention to:

• Ergonomics at your desk
• Proper sports technique
• Gradual return to activity

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When Tennis Elbow Might Be Something Else

Not all elbow pain is tennis elbow.

Other conditions that can mimic it include:

• Nerve compression (radial tunnel syndrome)
• Arthritis
• Tendon tears
• Tenosynovitis
• Referred neck pain

If your symptoms include:

• Numbness or tingling
• Severe weakness
• Swelling or redness
• Fever
• Sudden trauma

You should seek medical care promptly.

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When to Speak to a Doctor

While tennis elbow is rarely life-threatening, you should speak to a doctor if:

• Pain lasts more than a few weeks
• Symptoms are worsening
• You lose strength significantly
• You have signs of infection (redness, warmth, fever)
• Pain interferes with work or daily life

Always speak to a doctor about anything that could be serious or life-threatening. Getting a proper diagnosis ensures you're treating the right problem.

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The Bottom Line

Tennis elbow isn't failing to heal because you're doing something wrong. It's often because the tendon needs structured rehabilitation — not just rest.

Key takeaways:

• Chronic tennis elbow is usually degenerative, not purely inflammatory
• Tendons heal slowly
• Strengthening exercises are essential
• Bracing and ice can help manage symptoms
• Injections and advanced therapies may be options if conservative treatment fails
• Surgery is rarely needed

With the right approach and patience, most people fully recover.

If you're dealing with persistent elbow pain and want clarity on whether it could be related to tendon sheath inflammation or another condition, try using a free Tenosynovitis symptom checker to get personalized insights based on your specific symptoms.

Most importantly, don't ignore persistent pain. Early evaluation and guided rehabilitation can prevent months of frustration — and help you get back to work, sports, and daily life safely.