Tennis Elbow: Why Your Pain Isn’t “Just Overuse” and Why the Usual Treatments Keep Failing You
If you’re living with tennis elbow, you already know the punchline.
It doesn’t matter if you’ve never picked up a tennis racquet in your life.
This injury hits anyone.
Typing. Lifting. Carrying groceries. Turning a doorknob.
Even holding a coffee cup can feel like your forearm is being electrocuted.
And the most frustrating part?
Everyone has an opinion… yet nothing seems to help.
You’ve probably heard some combination of:
“Just rest it.”
“Try a brace.”
“Stretch your forearm.”
“Get some shockwave.”
“Avoid lifting for a while.”
You follow the advice.
You’re patient.
You try to be sensible.
And the pain still owns your day.
Let’s talk about why.
You’re Not Dealing With a “Strained Muscle”
Tennis elbow (lateral epicondylalgia if we’re getting fancy) isn’t a simple strain or inflammation. It’s a capacity and sensitivity problem in the tendon where your forearm muscles anchor near the elbow.
That tendon becomes irritated, sensitive and less tolerant to load.
Which means everyday stuff suddenly becomes “too much.”
This is why it’s so maddening.
It flares with simple, innocent tasks.
It feels like it should be easy to fix.
But it isn’t.
Now for the Elephant in the Treatment Room
Shockwave therapy.
Let’s be honest.
It’s sold as a magic fix.
It’s marketed aggressively.
It sounds high tech.
It promises quick results.
And yet…
The clinical benefit is barely better than placebo.
Large reviews and controlled trials consistently show minimal to no meaningful long term improvement from shockwave for tennis elbow.
But here’s the controversial bit:
Many clinics still use it because it’s billable, quick and easy.
Patients want relief.
Clinicians want to offer something.
Shockwave becomes the bandaid.
Meanwhile, the tendon isn’t getting what it actually needs:
A progressive, structured loading program.
Not fluff.
Not gadgets.
Not passive treatments.
Real, graded strength work.
Why Tennis Elbow Sticks Around So Long
1. You were told to rest it
Rest makes it feel better temporarily… and weaker long term.
You lose tolerance, you lose strength, you lose confidence in the arm.
2. You avoided painful movements
Sensible on paper.
Terrible in practice.
Tendons need tension to adapt.
3. You received passive treatments only
Ice. Massage. Dry needling. Shockwave.
They may offer short term relief, but they don’t change tendon capacity.
4. No one taught you how to load the tendon properly
This is the real missing piece.
Tennis elbow rehab isn’t random wrist curls.
It’s not light theraband for 10 reps.
It’s not “stop if it hurts.”
It’s a systematic progression of:
• isometrics
• slow, heavy eccentrics
• combined concentric strength
• gripping and functional loading
• forearm, shoulder and grip chain strengthening
• load tolerance work that gradually reintroduces meaningful tasks
Done well, it transforms your tendon’s ability to handle the real world again.
Your Pain Is Real. Your Frustration Is Valid. Your Recovery Is Possible.
People living with tennis elbow often feel:
Embarrassed
because it’s a tiny body part causing huge disruption.
Misunderstood
because others assume it’s minor.
Demoralised
because simple tasks hurt.
Afraid
because it feels like it won’t get better.
But here’s the truth:
Tennis elbow responds extremely well to good rehab.
It’s fixable.
It just requires the right approach.
Let’s Call It Out: Shockwave Isn’t Rehab
Shockwave isn’t inherently evil.
It can be helpful in a small handful of conditions.
But using it as the primary treatment for tennis elbow?
It’s like washing your car when the engine is broken.
It feels productive, but fixes nothing.
Your tendon doesn’t need sound waves.
It needs load, strength, patience and progression.
A competent clinician should be able to:
Tell you exactly what’s irritated
Map out what loads flare it
Prescribe strength exercises that challenge the tendon safely
Progress the load over weeks
Integrate functional grip work
Build capacity for whatever your life or sport demands
If they’re skipping straight to shockwave, they’re skipping the part that actually works.
The Path Forward
If you’re stuck in the cycle of pain-rest-flare-repeat, the solution isn’t more passive care. It’s rebuilding your tendon like you’d rebuild any other tissue:
Gradually.
Intelligently.
With real strength work.
Your elbow isn’t fragile.
It’s just underprepared.
Give it the right stimulus and it responds.
If you’re ready to actually fix your tennis elbow rather than treat symptoms, book in with a clinician who understands tendon rehab, not just gadgets.
And if your physio reaches for the shockwave machine before they reach for a loading program…
you might be in the wrong clinic.