Tennis elbow — or lateral epicondylitis — is one of the most common overuse injuries seen in orthopaedic practice. Despite its name, the majority of people who develop it have never picked up a tennis racquet. It affects office workers, tradespeople, gardeners, and anyone who performs repetitive gripping or wrist extension activities. And for many people, it simply will not go away without proper treatment.
If you’re based in Sydney’s north-west — including Castle Hill, Norwest, or the Hills District — or in the Southern Highlands around Bowral, this guide will help you understand what tennis elbow actually is, why it’s so stubborn, and what your treatment options include.
What Is Tennis Elbow?
Tennis elbow is a condition affecting the tendons that attach the forearm extensor muscles to the bony prominence on the outside of the elbow (the lateral epicondyle). The key tendon involved is the extensor carpi radialis brevis (ECRB).
Contrary to what the name “epicondylitis” suggests, it is not primarily an inflammatory condition. Research has shown that the underlying problem is tendinosis — a degenerative change in the tendon structure involving disorganised collagen fibres, abnormal cellular activity, and a lack of normal inflammatory healing response. This is why anti-inflammatory treatments often provide only limited relief.
Symptoms of Tennis Elbow
- Pain and tenderness on the outer side of the elbow, at or just below the bony bump (lateral epicondyle)
- Pain that radiates down the forearm
- Weakness in grip strength — difficulty shaking hands, turning a door handle, or lifting a cup
- Pain with specific movements such as lifting, gripping, or using a keyboard
- Symptoms that have persisted for more than 6–8 weeks despite rest
Why Tennis Elbow Is So Persistent
The reason tennis elbow frustrates so many patients is that it becomes a chronic degenerative condition rather than a simple injury. Because the ECRB tendon has poor blood supply and is under near-constant load during daily activities, it struggles to heal itself. The degenerative tendon tissue is structurally weak, pain-sensitised, and resistant to the body’s normal repair mechanisms.
Many people spend months — sometimes years — trying rest, bracing, physiotherapy, and cortisone injections with only partial success. While these treatments are appropriate first steps, they do not address the underlying tendon degeneration.
Conventional Treatment Options
- Activity modification and rest — reducing the provocative activity gives the tendon a chance to calm down, but does not fix the underlying degeneration
- Physiotherapy — eccentric and heavy slow resistance exercises for the wrist extensors are the most evidence-backed rehabilitation approach
- Tennis elbow brace / counterforce strap — can reduce pain during activity by offloading the tendon attachment
- NSAIDs — provide short-term pain relief but may actually interfere with tendon healing if used long-term
- Cortisone injections — provide rapid but typically short-lived pain relief; multiple injections are associated with worse long-term outcomes and potential tendon weakening
- Surgery — debridement or release of the degenerated tendon is reserved for refractory cases that have failed 6–12 months of conservative treatment
PRP for Tennis Elbow
Because tennis elbow is fundamentally a problem of failed tendon healing rather than ongoing inflammation, treatments that stimulate the tendon’s own biological repair process make scientific sense. This is where Platelet-Rich Plasma (PRP) therapy comes in.
PRP is prepared from a small sample of your own blood, concentrated to increase the platelet count, and injected under ultrasound guidance directly into the degenerated area of the tendon. The growth factors released by the platelets — particularly PDGF, TGF-β, and VEGF — stimulate fibroblast activity, collagen production, and the formation of new, healthier tendon tissue.
Tennis elbow is one of the best-studied indications for PRP. Multiple randomised controlled trials and systematic reviews have found that a single PRP injection produces significantly better long-term outcomes than cortisone injection for chronic lateral epicondylitis, with benefits that are maintained at 1–2 year follow-up. While the initial response may be slower than cortisone, the durability of improvement is considerably better.
Is PRP Right for Your Tennis Elbow?
PRP is best suited to patients with chronic tennis elbow (symptoms lasting more than 3–6 months) who have not achieved lasting relief from physiotherapy and cortisone injections. It is a minimally invasive, low-risk procedure using your own blood, with no systemic side effects.
At Dr John PRP, we use ultrasound-guided injection technique to ensure accurate placement and optimal results. We work with patients from across Sydney’s north-west including Castle Hill, Norwest, Kellyville, and Baulkham Hills, and from the Southern Highlands including Bowral and Mittagong.
If tennis elbow has been holding you back, book a consultation to discuss whether PRP is appropriate for your situation.
For further information, see Healthdirect Australia’s guide to tennis elbow.