You’ve Probably Already Tried the Shot

You can’t grip a coffee mug without wincing. Opening a jar is out of the question. Shaking hands has become something you dread. You’ve been told it’s tennis elbow, and there’s a reasonable chance you’ve already had a cortisone injection. If the shot worked, you’re reading this because the pain came back. If it didn’t work, you’ve been dealing with this for weeks or months with no real answer.

This is one of the most undertreated conditions I see in the clinic. Not because patients don’t seek care, but because the first line of treatment most of them receive does not fix the underlying problem, and in many cases, repeated injections make the tendon weaker over time.

What Tennis Elbow Actually Is

Lateral epicondylitis, what most people call tennis elbow, is a tendinopathy of the extensor carpi radialis brevis, the primary muscle responsible for extending the wrist. The tendon inserts at the lateral epicondyle, the bony prominence on the outer elbow, and under repeated or excessive load, it develops the same degenerative pathology that characterizes Achilles tendinopathy, patellar tendinopathy, and plantar fasciitis.

The word “epicondylitis” is somewhat misleading, the “-itis” suffix implies inflammation, but chronic lateral epicondylitis is primarily a degenerative condition, not an inflammatory one. The collagen within the tendon is disorganized, the tissue is poorly vascularized, and the normal healing process has stalled. This is why anti-inflammatories and cortisone have limited effectiveness in chronic cases. They are treating the wrong mechanism.

Shockwave Therapy

Shockwave therapy for lateral epicondylitis has one of the strongest evidence bases of any application in our clinic. Multiple systematic reviews and randomized controlled trials support its use, with consistent findings of significant pain reduction, improved grip strength, and durable outcomes at six and twelve-month follow-up.

The mechanism is the same as other tendinopathies: acoustic pressure waves applied to the degenerated tendon tissue increase local blood flow, break up disorganized collagen and any calcific deposits present, and restart the healing cascade that chronic tendinopathy had stalled. Most patients need three to six sessions over three to six weeks. The response is often noticeable within the first two sessions, less pain with gripping, improved function, and the beginnings of genuine tissue repair.

Dry Needling

Trigger point activity in the forearm extensor muscles, particularly the extensor carpi radialis brevis, extensor digitorum, and brachioradialis, is almost universally present in lateral epicondylitis patients. These trigger points both contribute to and perpetuate the lateral elbow pain, and they do not resolve with shockwave or stretching alone.

Dry needling to the forearm extensor complex produces a local twitch response that releases the trigger point and restores normal muscle length and function. Combined with shockwave, it addresses both the tendon pathology at the epicondyle and the myofascial component in the muscle belly, a combination that resolves lateral elbow pain more completely than either modality alone.

Rehab and Strengthening

The final piece is a progressive loading program for the wrist extensor complex. The research on heavy slow resistance for tendinopathy is clear: the tendon needs progressive mechanical load to remodel its collagen structure. This begins with isometric wrist extension holds and progresses to eccentric and isotonic loading with a weight or band.

We also assess grip strength, shoulder mechanics, and thoracic mobility, because lateral epicondylitis is rarely only a local elbow problem. Restriction in the shoulder or thoracic spine frequently alters the mechanics of the arm under load and contributes to extensor overload at the elbow. Addressing the full chain prevents recurrence.

The Bottom Line

If you have lateral elbow pain that has been going on for more than six weeks, and especially if you have already tried cortisone without lasting relief, there is a better path. Shockwave, dry needling, and a targeted loading program address the actual pathology in the tendon. The results are more durable because the treatment is working on the right mechanism.

Schedule a visit at cospineandjoint.com/schedule-appointment/ and we will assess your elbow, tell you what is going on structurally, and build a plan.

 

In your corner,
Dr. Blake Richard, DC
Central Ohio Spine and Joint | Westerville, OH
cospineandjoint.com/schedule-appointment