Tennis Elbow: Causes, Symptoms & Non-Surgical Treatment in San Francisco
Tennis elbow, or lateral epicondylitis, is pain and tenderness on the outside of the elbow where the forearm tendons attach, usually from repeated gripping and wrist extension rather than tennis itself. Most cases improve without surgery using activity changes, targeted soft tissue work, and shockwave therapy. Here is what causes it, how to tell it apart from golfer's elbow, and what actually helps.
What Is Tennis Elbow?
Tennis elbow is an overuse injury of the tendons that attach to the lateral epicondyle, the bony bump on the outside of your elbow. These tendons control wrist extension, the motion of bending your wrist backward, and repeated strain causes small tears and degeneration in the tendon fibers rather than classic inflammation. That is why it is more accurately called a tendinopathy than tendinitis.
In San Francisco, most of the tennis elbow we see has nothing to do with tennis. It shows up in people who spend all day on a laptop and mouse, climbers working the crimps at Dogpatch Boulders or Movement, people who just picked up pickleball, and anyone doing repetitive manual work with their hands. Only a minority of cases come from racquet sports, and most of those are from technique issues like leading with the elbow on a backhand rather than the sport itself.
What Causes Tennis Elbow?
Repetitive wrist extension
Typing, mousing, and gripping tools all load the same forearm tendons thousands of times a day, which adds up even without a single acute injury.
Poor ergonomic setup
A mouse positioned too far away, a keyboard that forces wrist extension, or a chair with no forearm support all increase tendon load during ordinary desk work.
Racquet and paddle sport technique
A late or off-center backhand, an undersized grip, or over-tight strings transfer more force through the wrist extensors than a clean stroke does.
Sudden increase in grip-heavy activity
Starting a new climbing routine, a home renovation project, or any task with a lot of gripping and lifting before your tendons are conditioned for it.
What Are The Symptoms Of Tennis Elbow?
- Pain and tenderness centered on the bony bump on the outside of the elbow, sometimes radiating down the forearm.
- Pain that worsens with gripping, shaking hands, lifting a coffee cup, or twisting a doorknob.
- A weaker grip on the affected side, especially when the wrist is extended.
- Stiffness in the elbow that is often worse first thing in the morning.
- Symptoms that build gradually over weeks, rather than appearing after one specific injury.
See a doctor sooner if: you have significant swelling, numbness or tingling into the hand, or elbow pain following a fall or direct blow. Those point toward a different problem, such as a fracture or nerve involvement, rather than tennis elbow.
How Is Tennis Elbow Treated Without Surgery?
The large majority of tennis elbow resolves without surgery. At Truspine we lean on two therapies in particular because they target the degenerated tendon tissue directly rather than just managing the pain around it:
- Shockwave therapy: focused acoustic wave pulses delivered to the damaged tendon fibers to stimulate blood flow and collagen repair. This is usually our first-line treatment for tennis elbow that has not settled with rest and activity changes alone, since it is well supported in the research specifically for lateral epicondylitis that has become chronic.
- Graston technique: instrument-assisted soft tissue work along the wrist extensor tendons to break up restricted tissue and improve local blood flow. We typically pair it with shockwave therapy and loading exercise rather than using it alone.
- Activity modification and bracing: short-term changes to grip-heavy tasks, ergonomic adjustments at your desk, plus a counterforce brace to offload the tendon during activities you cannot avoid.
- Progressive strengthening: starting with gentle stretching, then moving into eccentric and isometric loading of the wrist extensors. Exercise therapy has strong evidence behind it and is what makes the gains from shockwave and Graston stick.
Most people notice meaningful improvement within six to eight weeks of consistent treatment. Surgery is reserved for the small percentage of cases that do not respond after several months of conservative care.
Could It Actually Be Golfer's Elbow Instead?
If your pain is on the inside of the elbow rather than the outside, you are likely dealing with golfer's elbow instead of tennis elbow. The two conditions are close cousins, affecting the opposite side of the same joint, and we treat both with the same two therapies, Graston technique and shockwave therapy. It is worth confirming which one you have before starting a stretching or strengthening routine, since the exercises are mirror images of each other.
Tennis Elbow FAQs
Common Questions
How long does tennis elbow take to heal?
Mild cases often improve in a few weeks with activity changes and bracing. More established cases typically take six to twelve weeks of consistent treatment, including shockwave therapy and a loading exercise program, before symptoms settle.
Can I still work out with tennis elbow?
Usually, yes, with modifications. Lower body training, cardio, and exercises that do not load the wrist extensors are generally fine. Gripping, pulling, and heavy upper body pressing movements should be scaled back or swapped out until your tendon tolerates the load again.
Do I need an X-ray or MRI for tennis elbow?
Most cases are diagnosed from your history and a physical exam alone, no imaging required. Imaging is reserved for cases that do not respond to several months of conservative treatment, or when a doctor suspects something else, like a fracture or nerve entrapment.
Does shockwave therapy actually help tennis elbow?
For tennis elbow that has become chronic, yes. Shockwave therapy has some of the best evidence of any non-surgical treatment for lateral epicondylitis, particularly when symptoms have been present for several months and have not responded to rest alone.
Will a brace cure my tennis elbow on its own?
No. A counterforce brace reduces strain on the tendon during activity and can ease day-to-day pain, but it does not address the underlying tendon degeneration. It works best alongside treatment like shockwave therapy and a progressive strengthening program, not as a standalone fix.
Sources
- American Academy of Orthopaedic Surgeons, OrthoInfo: Tennis Elbow (Lateral Epicondylitis)
- Yao G, et al. Efficacy of Extracorporeal Shock Wave Therapy for Lateral Epicondylitis: A Systematic Review and Meta-Analysis. Pain Research and Management, 2020.
Ready to get your elbow pain evaluated?
Dr. Supreet Shah and the team at Truspine see tennis elbow and golfer's elbow regularly at both San Francisco locations. Book a visit and we will confirm the diagnosis and build a treatment plan around shockwave therapy and Graston technique.
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