If Tennis Elbow Won't Go Away

Tennis elbow doesn’t only affect tennis players. Most patients with the condition haven’t picked up a racquet in years. The same goes for golfer’s elbow — most patients aren’t golfers. These are repetitive strain injuries that affect anyone who uses their hands and arms heavily: tradesmen, computer workers, gym-goers, gardeners, parents lifting young kids.

If you’ve been managing chronic elbow pain with bracing, ice, ibuprofen, and rest for months without resolution — there’s a reason. Tendon tissue heals slowly, and most chronic elbow tendinopathy has additional drivers in the cervical spine and shoulder that aren’t getting addressed by elbow-only treatment.

This page covers what’s actually happening in chronic elbow pain, why standard treatment so often fails, and what works when the diagnosis is correct.

What to Do Right Now

• Stop the activity that aggravates it. Continuing through pain prolongs healing.
• Skip the elbow brace unless prescribed. Long-term bracing can cause other problems.
• Avoid daily NSAIDs. Long-term ibuprofen use slows tendon healing.
• Ice the elbow for 15 minutes after aggravating activities.
• If you have sudden weakness, can’t extend or flex the elbow fully, or have visible swelling and bruising — that’s likely an acute injury and needs imaging.

Common Causes of Elbow Pain

Lateral Epicondylitis (Tennis Elbow)

Pain on the outside of the elbow, worse with gripping, lifting, and wrist extension activities. The tendons that extend the wrist have become chronically inflamed where they attach to the elbow. Common in computer workers, tradesmen, and anyone with repetitive forearm work. Despite the name, most cases aren’t from tennis.

Medial Epicondylitis (Golfer's Elbow)

Pain on the inside of the elbow, worse with gripping, lifting, and wrist flexion. The wrist flexor tendons are chronically inflamed at their elbow attachment. Less common than tennis elbow but similar pattern. Common in golfers, throwers, and anyone with repetitive gripping work.

Cubital Tunnel Syndrome

Numbness and tingling in the ring and pinky fingers, often with pain on the inside of the elbow. The ulnar nerve is being compressed at the elbow. Symptoms worse with elbow flexion (talking on phone, sleeping with bent elbow). Different from tennis elbow despite some overlapping pain location.

Cervical Radiculopathy

Elbow pain that’s actually originating from a pinched nerve in the neck. Often combined with shoulder pain, hand symptoms, or specific neck movement triggers. Common cause of “chronic tennis elbow” that doesn’t respond to local treatment because the source is the cervical spine.

Bicep Tendinopathy and Triceps Tendinopathy

Pain in front (bicep) or back (triceps) of the elbow. Less common than the lateral and medial epicondyle issues but worth differentiating because treatment approach differs.

Why Tennis Elbow Doesn't Respond to Standard Treatment

Most tennis elbow patients go through this progression: rest, ice, ibuprofen, brace, physical therapy, cortisone injection, more cortisone, eventually being told to consider surgery. The reason this progression is so common is that standard treatment focuses entirely on the elbow itself — but most chronic tennis elbow has additional drivers:

• Cervical spine dysfunction creating altered nerve signaling to the affected muscles
• Shoulder dysfunction changing the load distribution down the arm
• Forearm muscle imbalances that aren’t addressed by general wrist exercises
• Postural patterns (forward head, rounded shoulders) that increase forearm tension
• Repeated cortisone injections that actually weaken the tendon over time

Patients who address only the local elbow problem often see brief improvement that doesn’t last because the upstream factors keep reloading the elbow. Patients who address the whole chain typically see lasting results.

How We Diagnose Elbow Pain

• Specific elbow tests — Cozen’s, resisted middle finger extension, golfer’s elbow tests
• Cervical spine exam — Gonstead motion palpation, Spurling’s test for nerve root involvement
• Shoulder evaluation — range of motion, rotator cuff testing
• Neurological testing — reflexes, sensation, strength to identify nerve involvement
• Soft tissue palpation along the entire kinetic chain
• DMX for complex cases where cervical instability is suspected

Treatment Plan

• Specific Gonstead adjustments to the cervical spine and shoulder if upstream dysfunction is contributing
• Soft tissue work on forearm muscles, focusing on trigger points and tendon attachments
• Eccentric strengthening — the most evidence-based exercise approach for tendon healing
• Piezo shockwave therapy — particularly effective for chronic tennis elbow and golfer’s elbow
• Postural correction work for ergonomic and computer-related cases
• Activity modification with specific guidance on what to avoid and what’s safe

Most patients feel meaningful change within 4-6 visits. Chronic cases — especially patients who’ve had cortisone injections — typically take 8-12 visits because tendon healing is slow. Shockwave therapy can accelerate this significantly. We measure progress objectively at each visit.

Why Our Meridian Office for Elbow Pain

• Three Gonstead-trained doctors with combined 65+ years of experience
• Whole-chain diagnostic approach — we treat upstream causes, not just the elbow
• Idaho’s only Digital Motion X-Ray clinic
• Piezo shockwave on-site for chronic tendon cases

Related Conditions We Treat

• Neck pain — frequently underlies chronic elbow tendon problems
• Shoulder pain — shoulder dysfunction often co-exists with elbow problems
• Carpal tunnel — wrist symptoms frequently accompany elbow pain
• Sports injuries — elbow injuries common in throwing and racquet sports

Frequently Asked Questions

My doctor wants to give me another cortisone shot. Should I get it?

Generally no, especially if you’ve already had one or two. Cortisone gives short-term pain relief but actually weakens tendon tissue with repeated use, and chronic cortisone use is associated with eventual tendon rupture. The medical literature has become more cautious about cortisone for chronic tendinopathies for this reason. Shockwave therapy provides better long-term outcomes without the tissue damage. If you’re stuck in a cortisone cycle for elbow pain, that’s exactly the case shockwave is designed for.

How long until tennis elbow goes away with treatment?

Most patients feel meaningful improvement within 4-6 weeks of starting proper treatment. Full resolution typically takes 8-12 weeks for chronic cases because tendon tissue heals slowly. Acute cases (a few weeks of pain) often resolve faster. Patients who’ve had it for years and have already had cortisone injections take longer because the tissue has accumulated more damage. Shockwave therapy added to the treatment plan can substantially shorten timelines for chronic cases.

Why does my elbow hurt when my neck is the problem?

Cervical nerve roots that exit between vertebrae C5-C6, C6-C7, and C7-T1 send nerve signals to the muscles that control elbow and forearm function. When those nerve roots are irritated by joint dysfunction or disc problems, the signaling to forearm muscles changes — they become weaker, more prone to fatigue, and more likely to develop chronic strain. Standard elbow treatment can’t fix this because the elbow tissue is responding to bad signals from upstream. Treating the cervical source restores normal function and the elbow recovers.

Should I keep working out?

Avoid grip-intensive and push exercises that aggravate the elbow — typically pulldowns, rows, deadlifts with hooks, push-ups, and direct biceps work. Continue lower body, core, and pain-free upper body work. Light, pain-free forearm work is often beneficial because complete rest doesn’t accelerate healing. We give specific guidance based on what we find and what aggravates your elbow. Returning to full activity happens in stages.

Is my insurance going to cover this?

Most major insurance plans cover chiropractic care for diagnosed elbow conditions. We accept Blue Cross Idaho, Regence, Pacific Source, Aetna, Cigna, United Healthcare, Medicare. Shockwave therapy is typically out-of-pocket but is often the difference between resolution and surgery for chronic tennis elbow. We verify benefits up front.

Can I just rest it and let it heal?

Not for chronic cases. Tendinopathy isn’t an injury that heals with rest — it’s a tissue that has gotten stuck in chronic dysfunction. Rest alone often produces what feels like temporary relief because you’re not aggravating it, but the underlying tissue dysfunction remains and the pain returns when activity resumes. Active treatment that addresses the cause and stimulates proper tendon repair is what actually resolves the condition. Six months of rest with no improvement should be a sign to seek active treatment.

My elbow clicks. Is that bad?

Painless clicking is usually not concerning — most clicks are tendons or ligaments moving over bone with no underlying problem. Painful clicking, clicking with locking sensations, or clicking with weakness warrants evaluation. The combination of pain plus functional change is what matters clinically, not the click itself.

What's the difference between tennis elbow and golfer's elbow?

Both are tendon problems at the elbow but on different sides. Tennis elbow (lateral epicondylitis) affects the outside of the elbow where the wrist extensor tendons attach. Golfer’s elbow (medial epicondylitis) affects the inside where the wrist flexor tendons attach. Pain pattern, treatment, and aggravating activities differ. Both respond to similar treatment principles — proper diagnosis, addressing upstream factors, eccentric loading, shockwave for chronic cases. The names refer to the most stereotypical activity that causes them, but in reality both conditions show up in non-athletes far more often than in their sport namesakes.