Tennis Elbow: Why It Lingers and How Shockwave Helps

It usually starts small. A twinge on the outside of your elbow after a long padel session, or after a week of moving house. Then it’s still there the next morning. Before long you feel it lifting the kettle, opening a jar or shaking someone’s hand. Picking up a coffee mug becomes a careful, two-handed job.

We see tennis elbow almost every week, and most of the people who come in with it don’t play tennis at all. The good news is that it gets better, and there’s a lot we can do to help it along.

What’s actually going on

The muscles that lift your wrist and fingers attach to a small bony point on the outside of your elbow. Tennis elbow is what happens when that tendon has been asked to do more gripping than it was ready for. It gets sore, sensitive and less able to handle load.

You’ll sometimes hear it called “epicondylitis”, which suggests inflammation. That’s a bit misleading. It’s better thought of as a tendon that’s been overloaded and needs to be built back up, which is why rest alone rarely sorts it out.

Who gets it

We see it most in people in their 40s and 50s, and usually there’s a clear change in load behind it:

Padel players. A review of padel injuries found the elbow was the most commonly injured part of the body (Dahmen et al., 2023). The backhand is usually the culprit, especially with a stiff wrist and a tight grip.
Desk workers who spend long days on a mouse and keyboard
New parents carrying car seats and lifting little ones all day
Gym-goers who’ve added a lot of pulling or gripping work
Weekend DIYers and gardeners after a big job

How it feels

Pain on the outside of the elbow that can spread down the forearm
Pain when gripping, especially with your arm straight
Pain lifting things palm down, like a kettle, pan or full mug
A weaker grip, or dropping things more easily
A tender spot when you press on the outside of the elbow

Will it go away on its own?

Sometimes, but it often takes many months, and it can flare up again just when you think it’s gone. That’s a long time to struggle with your grip, your work or your game. The right treatment helps you get there sooner.

How we treat it

Tennis elbow can be stubborn, so we don’t rely on one thing. We tackle it from several angles at the same time: shockwave therapy, dry needling, other hands-on care and a home rehab programme. Each one does a different job, and together they help your elbow settle and stay settled.

Shockwave therapy

Shockwave is a big part of how we treat tennis elbow, and the research behind it is encouraging.

It uses a handheld applicator to send pressure waves into the sore tendon. It feels like fast, firm tapping. It can be uncomfortable over the tender spot at first, and we adjust the intensity so it stays manageable. Each session takes a few minutes, there are no needles and no downtime, and most people go straight back to work.

Here’s what the latest research shows:

It eases pain. A 2025 review that pulled together nine earlier meta-analyses found shockwave reduced tennis elbow pain more than a placebo treatment. It also did better than cortisone injections and ultrasound therapy (Zhu et al., 2025).
The benefit builds over time. When shockwave was compared directly with cortisone across six trials, cortisone was ahead at one month. By three months, people who’d had shockwave had less pain, a stronger grip and better function, and the gap in pain and grip was still there at six months (Zhang et al., 2024).

You can read more about shockwave therapy for tennis elbow, including what a course involves.

Dry needling

We often add dry needling to release the tight, overworked muscles in the forearm. In a 2025 trial, people who had dry needling alongside their exercises had less pain and better hand function after a month than those who took anti-inflammatories with their exercises (Sánchez-Milá et al., 2025).

Other hands-on care

The nerves that supply the elbow come from the neck, so we look beyond the sore spot and treat the elbow, neck and upper back. In a 2024 trial of 143 people with tennis elbow, adding manipulation of the neck and elbow and dry needling to a standard rehab programme led to less pain and better function after three months than the programme alone (Dunning et al., 2024).

Home rehab

Tendons respond to load, so what you do between visits matters. A 2024 analysis comparing tennis elbow treatments found that exercise-based rehab helped pain more than placebo over the medium term (Lowdon et al., 2024).

We’ll give you simple exercises to do at home, such as the Tyler Twist with a flexible rubber bar, and progress them as your elbow settles. They keep the tendon getting stronger while the in-clinic treatment helps it calm down.

Getting back on court

If padel or tennis brought it on, a few changes take the pressure off while you recover:

Ease off, don’t stop. Mild pain while you play that’s gone by the next morning is generally fine. Pain that builds or lingers is a sign to cut back.
Loosen your grip. A stiff wrist and a tight grip on the backhand load the tendon. A lesson with a coach can make a big difference.
Check your racquet. A heavy or head-heavy racquet adds strain.
Build up gradually. A weekend tournament or a holiday on court is a classic trigger.

Our 60-second padel injury screen and guide to common padel injuries have more tips.

What about a cortisone injection?

Cortisone can give quick relief, which is why it’s popular. It’s worth knowing that the early advantage doesn’t seem to last: in the trials comparing it with shockwave, cortisone was ahead at one month, but shockwave was ahead at three and six months (Zhang et al., 2024).

If your elbow isn’t responding the way it should, we’ll talk you through the other options and refer you on where it makes sense.

When it might be something else

Not all elbow pain is tennis elbow. Get it assessed promptly if:

It started with a fall or a hard knock, especially if it’s swollen or you can’t straighten it
You have numbness, tingling or weakness in your hand
It’s hot, red or swollen, or you feel unwell or feverish
It locks or catches

We’ll examine it and, if anything points to a fracture, infection or nerve problem, arrange the right imaging or referral.

How we can help

At your first visit we’ll examine your elbow, test your grip and check your neck and upper back, so we know exactly what we’re dealing with. If it’s tennis elbow, we’ll build a plan around your work and your sport that usually combines shockwave, dry needling, other hands-on care and home rehab.

We’ll measure your grip strength as we go, so you can see the progress for yourself. If anything doesn’t add up, we’ll talk to you about a scan or a specialist opinion.

If your elbow is holding you back, read more about elbow pain and shockwave therapy for tennis elbow, or book an appointment at our Sandton practice.

Frequently Asked Questions

Does shockwave therapy work for tennis elbow?

The research is encouraging. A 2025 review that pulled together nine meta-analyses found shockwave eased tennis elbow pain more than a placebo treatment and more than cortisone injections (Zhu et al., 2025). We use it together with dry needling, other hands-on care and home exercises rather than on its own.

Does shockwave therapy hurt?

It feels like fast, firm tapping over the sore spot on the outside of your elbow. It can be uncomfortable over the tender part of the tendon at first, and we adjust the intensity so it stays manageable. Each session only takes a few minutes and most people go straight back to work afterwards.

How long does tennis elbow take to go away?

It can settle on its own, but that often takes many months. The right treatment helps you get there sooner, and a plan that combines shockwave, dry needling, other hands-on care and home rehab tackles it from several angles at once.

Should I stop playing padel with tennis elbow?

Not always. Tendons usually do better with the right amount of load than with complete rest. Many people can keep playing a bit less while they rehab, as long as the pain stays mild and has settled by the next morning. We'll help you find that balance.

Is shockwave better than a cortisone injection for tennis elbow?

They work on different timelines. Cortisone tends to give faster relief in the first month, but in a 2024 review of six trials, people who had shockwave had less pain and a stronger grip at three and six months (Zhang et al., 2024). If your elbow isn't responding to treatment, we'll talk you through the other options and refer you on where it makes sense.

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