Tennis Elbow Not Getting Better? 5 Reasons and What to Do Differently

If you’ve been struggling with Tennis Elbow (or Lateral Epicondylitis) pain that just won’t go away, you are not alone. Many people find themselves in a cycle of pain, rest, and relapse, unsure of why their condition isn’t improving, despite their best efforts.

Research on recurrence rate of Tennis Elbow shows that a whopping 34-74% of people who get a corticosteroid injection (cortisone shot) for Tennis Elbow will have a relapse. This shows that treating only the symptom may be another reason for your Tennis Elbow not getting better.

But you can break the cycle with a root-cause approach. In this post, we’ll look at the top five possible reasons your Tennis Elbow might not be getting better and share tips on what you can do to achieve lasting recovery.

Tennis Elbow is a repetitive stress injury affecting the extensor carpi radialis brevis (ECRB) tendon. When you repeatedly over-stress this tendon, it reacts with pain and inflammation. A common stressor is the combination of a gripping and rotating motion through your wrist and elbow.

This is especially challenging if the affected arm is your dominant one and the stressors are related to your job or daily activities - these situations make it difficult to reduce or eliminate the cause of the stress.

To better manage your elbow stressors, identify and modify the activities that exacerbate your condition. Use ergonomic tools and techniques to reduce strain on your elbow. Even when you can't completely eliminate the movements that trigger your Tennis Elbow pain, you can still reduce the load with a purpose-built Tennis Elbow brace, like the one included in our Tennis Elbow System.

Using the wrong equipment or having poor form can exacerbate your Tennis Elbow. Whether you’re playing tennis, typing, playing a musical instrument, or performing other repetitive tasks, incorrect form or subpar equipment that forces you to move in a stressful form can contribute to Tennis Elbow not healing - or even getting worse.

Evaluate your body positioning, equipment, and technique. If you’re playing tennis, ensure your racket is the correct size and weight for you, and check your grip and swing technique. Reviewing a recording of your play can be enlightening. Pay particular attention to arm, wrist and hand movements where your wrist is extended (the back of your hand comes up toward the back of your forearm).

For other activities, seek ergonomic solutions and consider professional advice to correct your form and reduce avoidable stress on your elbow. If your Tennis Elbow is job-related, check to see if your employer has a team that assists with ergonomic adjustments.

Many doctors recommend a “rest, wait, and see” approach for Tennis Elbow. While resting can temporarily relieve pain, it doesn’t address the underlying issue. When you resume the activity after a period of rest, the pain returns because the damaged tissue hasn’t been properly treated.

Even worse, you may have lost some of the arm strength if you've been waiting for a while for the pain to dissipate. That reduces your ECRB's capacity to take the load, making it more susceptible to aggravation.

Instead of relying solely on rest, make sure to use active treatment strategies. Progressive strengthening exercises, designed by a physical therapist, rebuild strength through the surrounding muscles, increasing your tolerance to stress and load. Just 15 minutes a day of the Tennis Elbow exercise program is usually enough to engage the muscles throughout the wrist, elbow, and shoulder and prevent the pain from recurring when you return to your activities.

In the United States, access to high-quality physical therapy can be limited due to geographical, logistical, or financial barriers. Even in areas where good physical therapists are available, they may be booked up for weeks, and co-pays can add up quickly. On average, it takes more than three weeks to get a first appointment with a physical therapist in the United States. In some areas with a PT shortage, it can be even longer before you can get your first appointment.

A course of Tennis Elbow physical therapy takes at least 6-8 weeks. Taking time off work and rearranging home life for PT visits for that long is a challenge for many of us.

At-home physical therapy treatment options do exist. Most of these options focus on just one aspect of the complete Tennis Elbow treatment, but they can help you overcome the access barrier.

Many people rely solely on elbow braces or cortisone shots for Tennis Elbow relief - and that's often the treatment that comes recommended by medical professionals, too. While both can temporarily alleviate pain, they don’t address the underlying cause. For effective treatment, you need a comprehensive approach that includes more than just bracing or masking of the pain.

From research and clinical practice in physical therapy, we know that an effective tennis elbow treatment plan should include three key components:

• Managing the Load with a Brace: A well-designed elbow brace relieves pain immediately, improves your grip strength, and reduces stress on the affected tendon by changing the direction of the load, not just by applying circumferential pressure.
• Transforming the Scar Tissue: Utilize instrument-assisted soft tissue mobilization (IASTM) techniques to transform the scar tissue within the tendon. This deep tissue massage method, used in advanced physical therapy, directly targets the injured tendon to promote healing.
• Progressive Strengthening: Engage in exercises that build strength throughout the entire chain of movement, supporting the injured tendon, increasing loading capacity and preventing flare-ups.

In contrast to most Tennis Elbow home treatments that are stand-alone tools, our at-home Tennis Elbow treatment system incorporates all three pillars of physical therapy. This systemic approach is what makes the Alleviate Method unique - it brings the evidence-based gold standard of physical therapy to everyone's home, at a fraction of the cost and time it takes to access an in-person physical therapy program.

When you feel frustrated that your Tennis Elbow is not getting better, consider this: you may not be seeing how far you've come.

Quantifying your progress toward your goal is a powerful way to get a clear picture of how far you've come. Use the test-intervention-retest approach to track your pain levels. Here's how it works:

• Before starting your treatment routine—whether it’s wearing a brace, using an elbow massager, or performing exercises—do the Tennis Elbow test, called Maudsley's Test. Note your pain score.
• After you complete the treatment routine, repeat the same test, and record your pain score.
• Keep track of your pain scores over time as you stick with your treatment routine, and you should see a trend of decreasing pain.

Alleviate was founded by a patient-and-clinician duo to bring the effective chronic pain treatment from physical therapy offices to everyone's home. With our Tennis Elbow System that includes the Guided Recovery Program, you can use the Alleviate Method to recover from Tennis Elbow at home. No co-pays, no office visits.