Shockwave Therapy for Tennis Elbow: What a 2025 Research Review Found
By Dr. Derek Lund, DC, Cert. MDT | Marathon Spine & Wellness | Marathon City, Wisconsin
Picking up a coffee cup. Turning a wrench. Carrying groceries. Drawing a bow.
When these everyday movements hurt the outside of your elbow, the problem can interfere with far more than a tennis match.
At Marathon Spine & Wellness in Marathon, Wisconsin, our approach to tennis elbow combines a careful evaluation with progressive strengthening and, when appropriate, focused shockwave therapy and myofascial release. We want to help you feel better and build confidence using your arm again.
A 2025 research review adds useful information to the conversation about treatment choices.
What is tennis elbow?
Tennis elbow, also called lateral epicondylitis or lateral elbow tendinopathy, is a painful condition involving the tendons on the outside of the elbow. These tendons connect the forearm muscles that extend your wrist and fingers to the upper arm bone.
Symptoms commonly include tenderness at the outer elbow, pain with gripping or lifting, and reduced grip strength. Symptoms often develop gradually. Repeated gripping and wrist activity can aggravate them, whether you play tennis, work with tools, or perform physically demanding tasks. [2]
For people around Marathon, Wausau, Edgar, and Athens, that might mean trouble with farm chores, construction work, yard work, or recreational activities.
The name “tennis elbow” describes the condition—not a requirement that you play tennis.
What did the 2025 shockwave review find?
Zhu and colleagues published “Comparison of extracorporeal shockwave therapy, ultrasound therapy, and corticosteroid injections for treatment of lateral epicondylitis: an umbrella review of meta-analyses” in the Journal of Orthopaedics and Traumatology on August 18, 2025.
An umbrella review evaluates existing research reviews. This one included nine meta-analyses and searched literature through August 2024. [1]
Comparison | Reported finding |
Shockwave versus placebo | Lower pain scores; mean difference −0.68 |
Shockwave versus therapeutic ultrasound | Lower pain scores at one month (−1.42) and three months (−1.65) |
Shockwave versus corticosteroid injection | Pooled pain results favored shockwave |
Grip strength versus placebo | Improvement was statistically significant but not clinically important |
Resisted wrist-extension pain test | No significant difference |
The researchers concluded that shockwave favored pain relief. However, substantial variation between studies, overlapping trials, and differing protocols limit certainty. Their evidence classification labeled the ultrasound and injection comparisons as weak evidence. [1]
Our interpretation: these findings support discussing shockwave as an option; they do not establish universal superiority, guarantee recovery, or prove that our specific combination of treatments is better.
Why do pain relief and functional recovery both matter?
Imagine your elbow feels better when you are resting, but carrying a feed bucket still brings the pain back. That improvement matters, but it does not yet meet your goal.
In our office, we ask what your arm needs to do. For one person, that is typing comfortably. For another, it is using a chainsaw, lifting at the gym, or returning to racquet sports.
We track those activities along with symptoms. A useful treatment plan should answer:
Can you grip with less discomfort?
Can you complete more of your usual work?
Are symptoms settling more predictably after activity?
Can you tolerate progressively greater resistance?
That is why we include rehabilitation rather than judging success only by how the elbow feels immediately after a treatment.
How do we treat tennis elbow at Marathon Spine & Wellness?
Our treatment recommendations depend on the examination, symptom irritability, previous care, and your goals. We do not automatically recommend every service for every elbow.
1. Start by confirming the likely source of pain
Pain near the outer elbow deserves an assessment before selecting treatment. Our evaluation considers the elbow, wrist, forearm, and—when indicated—the neck and nerves.
We ask about your workload, recent changes in activity, symptom duration, and movements that reproduce the discomfort. We also look at grip tolerance and resisted movements.
This helps us decide whether your presentation fits tennis elbow, whether additional testing is appropriate, or whether a referral would better serve you. Clinical guidelines emphasize differential diagnosis and assessment of relevant impairments. [3]
2. Consider focused shockwave for persistent symptoms
Extracorporeal shockwave therapy, or ESWT, delivers acoustic energy through the skin. At Marathon Spine & Wellness, we use the Storz Duolith focused shockwave system.
For an appropriate patient, we may recommend shockwave as part of a plan for persistent elbow tendon pain. We discuss the expected treatment experience, cost, suitability, and how we will reassess progress.
A typical initial shockwave course in our office may involve approximately four to six sessions, adjusted to the individual. This is our clinical approach, not a protocol established by the umbrella review.
The device used in our office should also be distinguished from the broader research category. Studies of shockwave use different devices and settings; a favorable review does not establish that one brand produces the same result for everyone.
We explain the treatment without promising that it will “regrow” a tendon or permanently eliminate symptoms. Its practical value is assessed through your response.
3. Use myofascial release when it helps movement and comfort
Myofascial release is a hands-on soft tissue treatment. We may work with the forearm muscles and surrounding tissues when the examination suggests this could help you move or exercise more comfortably.
The 2022 lateral elbow pain guideline allows soft tissue mobilization, including manual release, for chronic lateral elbow tendinopathy. It also recommends resisted wrist-extension exercise combined with other interventions. [3]
We use hands-on treatment as an adjunct. We do not describe it as mechanically breaking apart scar tissue or repairing the tendon.
The evidence deserves perspective: a 2024 Cochrane review found that manual therapy and exercise may provide small short-term improvements compared with minimal care, with low certainty and benefits that were not sustained. That review evaluated varied interventions and does not establish the effectiveness of our exact myofascial technique. [4]
Our reason for including it is practical: if it helps you tolerate useful movement, we can pair that temporary improvement with active rehabilitation.
4. Progressively load the arm
Progressive loading means gradually increasing the resistance or workload your arm can tolerate.
In our office, exercise selection is individualized. We choose a starting point that fits your current symptoms, then adjust resistance, repetitions, movement range, or task duration as your tolerance changes.
The clinical guideline supports isometric, concentric, and eccentric wrist-extensor resistance exercises for subacute or chronic lateral elbow tendinopathy. [3]
These terms describe different ways a muscle works:
Isometric: holding a position against resistance.
Concentric: lifting the resistance.
Eccentric: controlling the lowering phase.
An example progression might begin with a manageable wrist-extension hold, advance to controlled lifting and lowering, and later include gripping, carrying, and work-specific tasks. This is an illustration, not a universal home prescription.
We also consider the demands of your day. A farmer’s rehabilitation should eventually reflect farm work. A recreational athlete’s plan should prepare the arm for the sport.
We give you guidance on acceptable symptoms and recovery after exercise. If the plan causes a sustained increase in pain or interferes more with daily activities, we modify it. More resistance is useful only when it fits your response.
Do you need to stop using your arm?
Our usual starting point is to identify the tasks that are most provocative and adjust their dose.
That may mean shorter work intervals, alternating tasks, changing how you grip a tool, or temporarily reducing heavy one-handed lifting. These decisions are individualized.
For example, instead of repeatedly testing whether a heavy bucket still hurts, we might choose a lighter load you can manage and build from there.
We want patients to leave with a clear answer to three questions: what can I keep doing, what should I temporarily modify, and how will I work back toward my normal activity?
Is a cortisone injection a good choice for tennis elbow?
Corticosteroid injections can provide early symptom relief, but the longer-term results for tennis elbow deserve careful consideration.
A separate randomized trial published in JAMA in 2013 followed 165 adults with symptoms lasting more than six weeks. At one year, recurrence was 54% after corticosteroid injection versus 12% after placebo injection. Complete recovery or substantial improvement was also lower in the corticosteroid group: 83% versus 96%. Physiotherapy did not significantly improve the trial’s one-year outcomes. [5]
Those numbers describe that trial—not your personal likelihood of recurrence. They also do not represent a direct comparison with our shockwave program.
If you are considering an injection, discuss the expected short- and long-term benefits, risks, and alternatives with the prescribing clinician.
Is therapeutic ultrasound the same as diagnostic ultrasound?
No. Therapeutic ultrasound applies sound-wave energy as a treatment. Diagnostic ultrasound produces images that can help assess tissues.
The treatments compared in the review included therapeutic ultrasound. Its findings should not be interpreted as criticism of diagnostic imaging.
The 2022 clinical guideline found conflicting evidence and could not recommend therapeutic ultrasound as a stand-alone treatment for lateral elbow tendinopathy. [3]
Frequently asked questions about tennis elbow treatment
Can a chiropractor treat tennis elbow?
At Marathon Spine & Wellness, we assess elbow pain and offer conservative treatment that may include exercise rehabilitation, soft tissue treatment, and focused shockwave. Recommendations depend on the findings, and we refer when appropriate.
Does everyone with tennis elbow need shockwave?
No. We select treatments based on your presentation and preferences. Some patients begin with activity adjustments and an exercise plan; others may benefit from discussing additional options.
How many shockwave sessions will I need?
Our typical initial course is approximately four to six sessions, with reassessment. Your response determines whether continuing makes sense. A session count is not a guarantee of recovery.
How long does recovery take?
We cannot promise a fixed timeline. Your symptom duration, workload, starting function, and response to care help guide expectations. We look for measurable progress and revise the plan when that progress is missing.
What if treatment is not helping?
We reassess the diagnosis, exercise dose, daily demands, and treatment choices. Continuing the same plan without meaningful progress is not our goal.
When should elbow pain be assessed promptly?
Significant trauma, a hot swollen joint with fever, or new substantial weakness warrants prompt medical assessment. Numbness or symptoms that do not fit a typical tendon problem also deserve evaluation.
Tennis elbow treatment near Marathon and Wausau, Wisconsin
If gripping, lifting, or working keeps bringing back your elbow pain, Marathon Spine & Wellness can help you understand the problem and discuss your options.
We serve patients from Marathon, Wausau, Edgar, Athens, Mosinee, and surrounding communities. Our approach combines practical self-care with treatment selected for your needs.
This article provides general education. Treatment recommendations require an individual assessment.
Research references
Zhu P, Tang P, Su J, et al. Comparison of extracorporeal shockwave therapy, ultrasound therapy, and corticosteroid injections for treatment of lateral epicondylitis: an umbrella review of meta-analyses. Journal of Orthopaedics and Traumatology. 2025;26:55. Read the review.
American Academy of Orthopaedic Surgeons. Tennis Elbow (Lateral Epicondylitis).
Lucado AM, Day JM, Vincent JI, et al. Lateral Elbow Pain and Muscle Function Impairments. J Orthop Sports Phys Ther. 2022;52(12):CPG1–CPG111. Clinical practice guideline.
Cochrane. Manual therapy and exercise for treating tennis elbow. 2024.
Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013;309(5):461–469.
Comments