Tennis Elbow That Won’t Go Away: Why Rest and Shots Stall, and What Helps

The story below is a composite of real experiences; details changed.

Marco can wire a whole floor. Lately, a coffee mug beats him.

He’s 44, a commercial electrician. He pulls wire, twists wire nuts and drives screws overhead from 6:30 until the gang box gets locked.

Seven months ago, the outside of his right elbow started to burn. Now it flares when he squeezes his lineman’s pliers or shakes the foreman’s hand. Rows at the gym light it up too.

Two weeks off over the holidays calmed it. The first Monday back undid it. A cortisone shot in month four bought five good weeks. Then it came back worse.

If that’s your elbow, you did what you were told. It came back anyway.

Here’s why that often stalls, what the trials found, and how to keep working while the tendon catches up.

Why it hangs on when your hands are your living

Tennis elbow is pain at the bony bump on the outside of your elbow. That’s where the forearm muscles that extend your wrist and fingers attach. You may also hear lateral epicondylitis or lateral elbow tendinopathy.

Most people who get it are 30 to 50. Painters, plumbers and carpenters are particularly prone. (AAOS OrthoInfo)

A 2022 physical therapy guideline reports rates as high as 29% in some hand-heavy jobs. That’s nearly one in three workers, at the top of the reported range. (JOSPT clinical guideline)

Its risk list reads like a job description: heavy tools and loads, hours of repeated wrist and elbow bending, and twisting or screwing.

Rest lowers the irritation, so time off feels like progress. But it doesn’t build the tendon up. And Monday asks for the same grips all day.

If you lift too, here’s why your job and your workouts are loading the same injury.

Time off calms it. It doesn’t get it ready for Monday.

What the shot actually buys you

Cortisone works fast. Three trials tracked what happens over a year.

Sources: The Lancet; BMJ; JAMA.

In plain terms, the shot won the first six weeks. By one year, it trailed PT or a placebo shot in all three trials, each under 200 people.

AAOS says steroid shots “should be used very sparingly” for tennis elbow. Excessive use can weaken the bony bump the tendon anchors to. (AAOS OrthoInfo)

A shot can buy a few good weeks. In these trials, people paid for them at the one-year mark.

Waiting it out vs. doing the work

Time helps most people. In the 2002 trial, about 8 in 10 (83%) of the wait-and-see group were a success at one year. An NHS leaflet says symptoms clear within a year in nine of ten cases. (Newcastle Hospitals NHS)

But at 6 to 12 months, 20% to 38% aren’t fully clear or have relapsed, the 2022 guideline says. That’s one in five to nearly two in five, across studies. (JOSPT)

PT gets people better sooner, but the gap closes. In the 2006 and 2013 trials, PT and no PT were about level at one year. (BMJ; JAMA)

A 2021 review of 30 trials found exercise beat passive treatments, but “the effect is small.” It also beat steroid shots on nearly every measure except short-term pain, on low-certainty evidence. (British Journal of Sports Medicine)

The guideline backs isometric, concentric and/or eccentric wrist-extensor exercises. That means holds, lifts and slow lowers. It doesn’t crown one type. (JOSPT)

Weeks of exercises and nothing moving? Read why tendons plateau.

Exercise isn’t magic. It’s the option that doesn’t borrow against next year.

Straps, PRP and surgery: where they fit

• The strap. The guideline says a forearm strap or wrist brace may be worn during activity for quick relief. For the long run, the evidence conflicts. (JOSPT)
• PRP. Platelet-rich plasma comes from your own blood. AAOS says some studies look promising and others are inconclusive. A 2021 Cochrane review of 32 trials found it probably gives little or no meaningful benefit over a placebo shot. (AAOS OrthoInfo; Cochrane)
• Surgery. About 80% to 95% of people do well without it: at least 8 in 10. It usually comes up only after 6 to 12 months of nonsurgical care. (AAOS OrthoInfo)

A 2018 trial tested surgery against a sham. Twenty-six people with stubborn tennis elbow got either the real operation or an incision with the tendon left alone.

Both groups improved. There was no significant difference at any point, up to two and a half years. (American Journal of Sports Medicine)

The trial was small and stopped early, so it can’t rule out a small benefit.

Each has its moment. None replaces loading the tendon.

How to keep working without feeding it

The goal is fewer hard grips and less force in each one.

• Palms up. Lift with your palms facing up, like carrying a tray, to ease strain on the wrist muscles. (Newcastle Hospitals NHS)
• Lighter tools, bigger handles. The same leaflet suggests lightweight tools with a larger grip, regular breaks from repetitive tasks and, if needed, lighter duties for a while.
• Fewer twists. Where a powered tool can take over a long run of hand twisting, let it.
• Strap for the hard part. Save it for the tasks that set the elbow off.

You don’t have to stop working. You have to stop paying full price for every grip.

A two-minute check, once a week

Your numbers, not your worst day, tell you whether the plan is working.

What to ask at your next appointment

1. Are you sure it’s the tendon, and not a pinched nerve in my neck or forearm? The guideline lists both as look-alikes.
2. If you’re offering a shot, what do the one-year results mean for me?
3. Can I start a progressive exercise plan with a PT, and how will we measure it?
4. What should I change at work, and for how long?

“Rest it” isn’t a plan. Leave with exercises, a work change and a way to measure both.

What changes for Marco

Marco holds off on a second shot and books a physical therapist. On site, he carries conduit palms up and lets the driver handle long runs of screws.

His first mug test is a 6. Six weeks later, it’s a 3. He still feels it after a long day. But the mug is losing, and he has the numbers to prove it.

Your next step: pick a day this week, run the two-minute check and write the numbers down.

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Marco is a composite, drawn from the kinds of stories tradesmen and lifters describe with tennis elbow that won’t settle. The details are illustrative. Nothing here is medical advice.