If your elbow or shoulder pain keeps resolving and then returning every time you pick the racket back up, the problem was likely never fully treated in the first place. That’s not a reason to give up on tennis. It’s a sign that the treatment needs to go deeper than rest and a few weeks of physical therapy. Dr. Ilana Etelzon, MD, double board-certified in Physical Medicine & Rehabilitation and Interventional Pain Management, sees this pattern constantly in tennis players, and she’s found that once the actual cause is addressed, most patients get back to full play and stay there.
How Common This Actually Is
Tennis elbow has a reputation for being minor, but research puts lifetime prevalence among recreational tennis players at 40 to 50 percent. Shoulder pain is just as common. One often-cited figure found that about 24 percent of junior players report shoulder pain, climbing to roughly half of players in older age groups, and a recent systematic review puts shoulder tendinopathy at 25 to 48 percent of presentations in players over 18.
The two conditions also show up together more often than most players realize, and that’s not a coincidence. Tennis strokes rely on a kinetic chain, the sequence that transfers force from the legs and core through the shoulder and into the arm and racket. When that chain breaks down anywhere, from fatigue, poor mechanics, or a weak core, the shoulder and elbow end up absorbing the extra load. A shoulder that’s compensating for a breakdown elsewhere in the chain puts more strain on the elbow, and vice versa, which is part of why the two so often get treated as one problem instead of two separate ones.
What’s Actually Happening in the Tendon
Despite the name, tennis elbow usually isn’t inflamed in the way most people picture inflammation. Research on the tissue itself shows something closer to angiofibroblastic degeneration, meaning the collagen fibers break down and lose their normal structure. That distinction matters because it explains why rest alone, which is built to calm inflammation, often doesn’t fix a tendon that has already started to degenerate.
Dr. Etelzon has seen this play out directly with patients. She describes a tennis player who had already been through physical therapy, with the pain settling down temporarily and then returning every time he went back to play. “PT was helping somewhat, but every time they went back to playing, the pain returned,” she says. An ultrasound told the rest of the story. “We looked more closely at the tendon with ultrasound and identified changes consistent with chronic tendinopathy,” Dr. Etelzon explains. “At that point, it wasn’t necessarily about doing more PT. We needed to address the underlying tendon problem.” That’s where treatments like PRP come in, paired with a more targeted rehab program built around what the tendon actually needs.
Why Standard Treatment Often Doesn’t Finish the Job
Conservative treatment resolves most cases of tennis elbow, but recurrence is a well-documented problem. One randomized trial found that corticosteroid injections delivered strong short-term relief and then reversed course, with 72 percent of patients experiencing a recurrence at one year, compared to 8 percent after structured physical therapy. The pattern Dr. Etelzon sees in her own patients lines up with that research, and it usually starts long before anyone walks into her office.
“One thing I’ve noticed is how many tennis players continue playing through pain for months before seeking treatment,” Dr. Etelzon says. “By the time they come in, what may have started as a relatively minor issue has become a chronic problem.” The location of the pain can also be misleading. “The pain isn’t always coming from where they think it is,” she explains. “Someone comes in complaining about their elbow, but you also have to look at their shoulder, wrist, and even their neck.” Given how much the kinetic chain connects these joints, that pattern tracks with what the research on tennis shoulder and elbow injuries shows. Treating the elbow in isolation, without looking at what’s happening up the chain, is part of why the pain comes back even after a course of PT that seemed to be working.
How to Actually Know Treatment Is Working
Pain scores alone can be misleading, since a tendon can feel quiet for a while and still be far from healed. Dr. Etelzon looks past what a patient reports in the moment and focuses on what they can actually do. “It’s not just when a patient tells me their pain is better,” she says. “It’s important to know what they’re actually able to do that they couldn’t do before. Can they grip their racket without pain? Can they play longer? Are they recovering better after playing?”
She also tracks measurable markers during exam, including strength, range of motion, and tenderness at the site of the injury. The real test comes over time, not in a single visit. “When they’re gradually getting back to playing without the same symptoms returning afterward, that’s when I know we’re making progress,” Dr. Etelzon says. That standard, real function sustained over time, is what separates a tendon that’s actually healed from one that’s just temporarily calm.
Treating the Root Cause
Corticosteroid injections are still common for tennis elbow and shoulder pain because they work fast. The tradeoff shows up later. Multiple randomized trials comparing the two have found that corticosteroids outperform PRP in the first few weeks, then fall behind, with PRP patients continuing to improve over months while corticosteroid patients decline. A two-year follow-up of the same trial found PRP’s advantage held steady well beyond the first year.
The difference comes down to what each treatment is actually doing. A corticosteroid injection calms the area down. PRP injections use concentrated platelets drawn from a patient’s own blood to trigger the body’s repair process directly inside the degenerated tissue, giving the tendon a real chance to rebuild instead of just quieting down for a while. For shoulder involvement tied to the same kinetic chain breakdown, the same regenerative approach often applies, paired with rehab that addresses the chain as a whole instead of treating the elbow and shoulder as two unrelated problems.
What Dr. Etelzon Wants Every Player to Know
After years of treating tennis players, Dr. Etelzon has a few things she repeats often enough that she considers them essential, even though they rarely make it into general articles about tennis injuries. The first is that tolerating pain is not the same as being safe from damage. “Just because you can play through the pain doesn’t mean you should,” she says. “A lot of athletes think that if they can tolerate the pain, they’re not doing any additional damage.”
The second is that calming pain down and actually healing the tendon are two different processes. “There’s a difference between reducing inflammation and actually improving the health of a tendon,” Dr. Etelzon explains. “Sometimes taking a short break and addressing the problem early can prevent months of frustration.” And the goal, she’s clear, was never just about getting through a match without pain. “My goal isn’t just to get them pain-free. It’s to get them back on the court and keep them there.”
If tennis elbow or shoulder pain keeps resolving and then coming back every time you return to play, it’s worth having the tendon actually evaluated instead of starting another round of rest and bracing. Schedule a consultation with Dr. Etelzon’s team to find out what’s really driving the pain and what it will take to put it behind you.