The 3 principles of treating tennis elbow
Tennis elbow happens when a tendon is overloaded beyond what it can handle (see symptoms and causes). Effective treatment follows three principles:
- Reduce irritation: cut back on, or change, the activities that flare it up.
- Manage pain: use simple tools to stay comfortable and keep moving.
- Rebuild capacity: strengthen the tendon gradually so it can handle normal life again.
Most failed treatment plans skip step three.
At-home treatments
1. Activity modification (relative rest)
Complete rest isn't necessary and can weaken the tendon further. Instead, reduce aggravating tasks. Lift with your palm facing up rather than down, use both hands for heavy objects, take regular breaks from typing, and use tools with thicker grips. Tennis players should check their racket grip size, string tension and backhand technique.
2. Progressive exercise
This is the most important long-term treatment. Isometric holds, eccentric wrist extensions and FlexBar exercises have the strongest evidence of any conservative option. Our step-by-step guide to the best tennis elbow exercises includes a full 12-week plan.
3. Ice and heat
Ice applied for 10–15 minutes after aggravating activity can ease pain during flare-ups. Heat before exercise can reduce stiffness. Neither one heals the tendon, but both are cheap, safe ways to stay comfortable. Always wrap the pack in a cloth to protect your skin.
4. Over-the-counter pain relief
Topical anti-inflammatory gels (such as diclofenac) can give short-term relief with fewer side effects than tablets. Oral painkillers may help you sleep or work through a flare-up. Check with a pharmacist or doctor first if you have stomach, kidney or heart problems, or take other medications.
5. Self-massage
Gently massaging the forearm muscles with your fingers, a massage ball or a percussion massager can ease muscle tightness. Work on the muscle belly of the forearm rather than pressing hard on the painful bony point itself.
Devices and supports
6. Counterforce braces and straps
A strap worn just below the elbow spreads the force across the forearm muscle, reducing stress on the tendon attachment. Many people feel immediate relief during gripping tasks. Evidence suggests a modest short-term benefit. Read our tennis elbow brace guide for correct placement.
7. Wrist splints
A wrist brace that keeps the wrist in a neutral or slightly extended position rests the extensor muscles. It's especially helpful for night pain or very repetitive work.
8. TENS units
Transcutaneous electrical nerve stimulation (TENS) uses mild electrical pulses to block pain signals. Evidence for tennis elbow specifically is limited, but some people find it a helpful drug-free way to manage pain alongside exercise.
Medical treatments
9. Physiotherapy and injections
A physiotherapist can tailor your exercise programme, check your technique and may add manual therapy or taping. Physiotherapy is a recommended first step if self-management isn't working after a few weeks.
Cortisone (steroid) injections often give significant relief for a few weeks. However, large trials have found that people who had injections did worse at one year, with higher recurrence rates, than those who waited or had physiotherapy. For this reason, most guidelines no longer recommend them as routine treatment.
Platelet-rich plasma (PRP) injections use concentrated platelets from your own blood. Results across studies are mixed, and PRP is usually not covered by insurance.
Extracorporeal shockwave therapy (ESWT) delivers sound waves to the tendon. Some studies show benefit for chronic cases, but the evidence is inconsistent.
10. Surgery
Surgery, which removes damaged tendon tissue and is done either open or arthroscopically, is reserved for people who still have significant symptoms after 6–12 months of well-structured conservative care. Only a small proportion of patients reach this stage, and recovery takes several months.
Quick comparison table
| Treatment | Helps with | Evidence | Cost |
|---|---|---|---|
| Progressive exercise | Long-term recovery | Strong | Low |
| Activity modification | Reducing flare-ups | Good | Free |
| Counterforce strap | Pain during activity | Moderate (short-term) | Low |
| Ice / heat | Flare-ups, stiffness | Limited | Low |
| Topical NSAID gel | Short-term pain | Moderate (short-term) | Low |
| Wrist splint | Night pain, rest | Limited | Low |
| TENS | Pain relief | Limited | Medium |
| Cortisone injection | Short-term pain | Short-term only; worse long-term | Medium |
| PRP / shockwave | Chronic cases | Mixed | High |
| Surgery | Cases that haven't responded to other treatment | Moderate | High |
Building your treatment plan
For most people, a practical plan looks like this:
- Weeks 1–2: Change the activities that aggravate your elbow, start isometric exercises, and use a strap and ice to manage pain.
- Weeks 3–12: Move on to eccentric and full strengthening exercises, and keep using the strap during heavy tasks.
- If there's no improvement by 6–8 weeks: See a physiotherapist or doctor to review your diagnosis and programme.
Wondering how long all this will take? Read our tennis elbow recovery timeline.
Frequently asked questions
What is the fastest way to cure tennis elbow?
There is no instant cure. The fastest reliable approach combines reducing aggravating activities, a progressive strengthening programme and short-term pain relief such as a counterforce strap or ice.
Are cortisone injections good for tennis elbow?
Cortisone injections can reduce pain for a few weeks, but studies show higher rates of recurrence and worse results at one year compared with a wait-and-see approach or physiotherapy. Most guidelines no longer recommend them routinely.
When is surgery needed for tennis elbow?
Surgery is usually only considered when significant symptoms continue after 6 to 12 months of well-structured conservative treatment. Only a small minority of patients need it.