Tennis Elbow: Steroid Injection or Physiotherapy? What Works in the Long Run
Your outer elbow hurts every time you lift a cup, turn a key or click a mouse. Someone suggests a steroid injection: "One shot and it's gone." It is one of the most common quick fixes for tennis elbow, and it does often work fast. But clinical trials show a surprising twist: the fastest relief is not always the most lasting. This guide compares the main options using research, so you can choose with full information.
Medically reviewed by [Dr. Hardik Patel (PT)](/best-physiotherapist-in-ahmedabad) | Updated November 2026 | 8 min read
MEDICAL DISCLAIMER
Why Tennis Elbow Is So Common Now
Tennis elbow (lateral epicondylalgia) is an overload problem of the tendon that attaches the wrist-extensor muscles to the outer elbow. Despite the name, most patients we see in Ahmedabad have never held a tennis racket.
Modern triggers we see every week:
- Long hours on a mouse and keyboard with the wrist bent upwards
- Heavy gym grip work: deadlifts, rows and farmer's carries without building up slowly
- Racket sports boom: badminton, padel and pickleball with the wrong grip size
- Home and trade work: chopping, wringing clothes, using screwdrivers or hammers
- Constant phone use with a tight one-handed grip
The pain usually builds slowly. Mornings feel stiff, gripping feels weak, and the outer elbow bone is tender to touch.
Injection vs Physiotherapy vs Wait-and-See: What the Research Shows
A well-known randomised trial in the BMJ followed 198 adults with tennis elbow for one year. Each person got one of three approaches. The numbers below show the share who reported being "completely recovered" or "much improved".
One-Year Outcomes Compared
Share of patients reporting recovery or major improvement
Steroid Injection
78% improved at 6 weeks, but down to 68% at 52 weeks. Fastest early relief, highest relapse rate.
Physiotherapy
65% improved at 6 weeks, rising to 94% at 52 weeks. Manual therapy combined with graded exercise.
Wait and See
Only 27% improved at 6 weeks, reaching 90% at 52 weeks. Recovery happens, but slowly.
What this tells us:
- The injection gave the quickest relief, but many patients relapsed later.
- Physiotherapy gave good early relief and the best result at one year.
- Many cases settle with time, but waiting means months of pain.
A later trial in JAMA (2013) with 165 patients found a similar pattern. At one year, 54% of people who had a steroid injection saw their pain come back, compared with 12% in the placebo injection group.
This does not mean injections are never right. A doctor may still advise one in specific cases. But for most people, loading the tendon gradually is the safer long-term bet.
Why Exercise Works Better Than Rest
Tendons do not heal well with complete rest. They adapt to load. When you stop using the arm, the tendon gets weaker, and the pain returns as soon as you go back to work or sport. Graded strengthening teaches the tendon to tolerate gripping and lifting again.
At Complete Care, the first assessment for tennis elbow treatment in Ahmedabad includes the Cozen, Mill and Maudsley tests, grip-strength measurement and a review of your work setup. We also check the neck and the radial nerve, which can mimic or worsen elbow pain.
If you want the broader picture of how treatment is delivered, read our guide on how a physio can help tennis elbow.
How the Physiotherapy Plan Progresses
Most patients need 6 to 10 sessions of 35 to 45 minutes. Pain usually eases in 1 to 3 weeks, while full grip strength can take 6 to 10 weeks.
The Four-Stage Recovery Plan
Settle the pain
Calm the irritated tendon with Class IV laser therapy, isometric grip holds, and a counterforce brace or taping.
Free up movement
Reduce forearm tightness using Mulligan mobilisation with movement, IASTM and dry needling for trigger points.
Build tendon strength
Restore grip and lifting with eccentric wrist extensions, the Tyler Twist using a flex bar, and resisted forearm rotation.
Return to work and sport
Prevent recurrence through workstation changes, a racket grip review and a gradual return to gym lifts.
A Simple Home Routine
Do these only after your physiotherapist has checked your elbow. Mild discomfort (up to 3 out of 10) is fine; sharp pain is not.
- Isometric wrist hold: rest your forearm on a table, palm down. Press the back of your hand up against your other hand for 30 to 45 seconds. Repeat 5 times.
- Eccentric wrist lowering: use your good hand to lift a light dumbbell up, then slowly lower it with the sore wrist over 3 to 4 seconds. Do 3 sets of 10 to 15.
- Grip squeezes: squeeze a soft therapy ball for 5 seconds, 10 times.
- Forearm stretch: with the elbow straight, gently bend the wrist down for 30 seconds.
Do's and Don'ts for Tennis Elbow
What Helps and What Sets You Back
Lift with your palm up
Do not lift a heavy bag or kettle with the palm facing down, which loads the sore tendon directly.
Use a vertical mouse
Keep the forearm supported. Avoid typing with your wrist bent up and floating in the air.
Stay active within limits
Keep the arm moving in comfortable ranges rather than resting it completely for weeks.
Build gym grip work slowly
Do not return straight to heavy deadlifts or pull-ups after a painful spell.
Check your racket grip size
A grip that does not suit your hand increases load. Never play through sharp pain to finish a match.
Give strengthening 6 to 12 weeks
Do not expect one injection or a single session to fix a tendon problem.
When to See a Professional
See a physiotherapist if outer elbow pain lasts more than 1 to 2 weeks or makes gripping, typing or lifting difficult.
Seek urgent medical care
Frequently Asked Questions
Book Your Elbow Assessment
Complete Care is led by Dr. Hardik Patel (PT), with 16+ years of orthopaedic physiotherapy experience and a team of GSCPT-registered physiotherapists. Visit us at Thaltej, Gota, South Bopal or Nikol in Ahmedabad, or our Mehsana and Ankleshwar centres, Monday to Saturday, 8 AM to 8 PM. Home physiotherapy is also available.
Book now: call or WhatsApp +91 8980 676 676.
This article is published for patient education and does not replace an in-person clinical assessment. For personalized diagnosis and treatment planning, contact our physiotherapists on +91 8980 676 676 or visit any of our six centres across Gujarat.
