Cortisone for Tennis Elbow: Does It Help—or Make It Worse?

If You Have Tennis Elbow, Should You Get a Cortisone Injection?

It’s one of the most common questions we hear from patients dealing with lateral elbow tendinopathy (tennis elbow):

“Will a cortisone shot help me heal faster?”

Short answer?

Not only does it not help long-term—it may actually make things worse.

A high-quality randomized controlled trial (RCT) sheds some serious light on this.

What the Research Looked At

A 2022 study in the American Journal of Sports Medicine followed 60 patients with chronic tennis elbow (average duration: 14 months).

All participants completed the same:

• 12-week heavy slow resistance (HSR) program
• 3x/week progressive loading

The only difference? The type of injection they received:

• Group 1: Corticosteroid (cortisone) injection
• Group 2: Tendon needling (saline, no cortisone)
• Group 3: Placebo injection (saline under the skin)

The Results at 12 Weeks (Short-Term)

At 12 weeks, all groups improved:

• Pain decreased by 2.5/10
• Function improved (DASH scores)
• Grip strength increased by 126%

Key point:
It didn’t matter whether patients received cortisone, saline, or placebo.

The exercise program drove the results.

The 12-Month Results (This Is What Matters)

Here’s where things take a turn.

At 52 weeks, the cortisone group had:

• Higher pain scores (worse by 1.8 points on NRS)
• Worse function and disability (14 points worse on DASH)

This wasn’t just statistically significant—it was clinically meaningful.

In plain terms:
Patients who got cortisone were doing worse one year later than those who didn’t.

Why Cortisone May Set You Back

Cortisone can reduce pain quickly—but that’s part of the problem.

It may:

• Temporarily suppress pain signals
• Mask underlying tendon dysfunction
• Disrupt tendon healing response
• Lead to premature overloading

Meanwhile, the tendon still lacks the strength and capacity it needs.

So while symptoms improve short-term, the long-term outcome suffers.

What Actually Works: Progressive Load

The real driver of improvement in this study?

Heavy slow resistance (HSR) training.

The program followed a structured progression:

• 3x per week
• Gradual increase from 15RM → 6RM over 12 weeks

This type of loading:

• Stimulates tendon remodeling
• Improves load tolerance
• Restores strength and function

This is how you actually treat tendinopathy.

Where Manual Therapy Fits In

Exercise is essential—but it’s not the whole picture.

At our clinic, we combine:

• Manual therapy to improve joint and soft tissue mobility
• Targeted loading programs to rebuild tendon capacity
• Movement correction to reduce overload patterns

This approach helps:

• Reduce strain on the lateral elbow
• Improve force distribution through the arm
• Accelerate recovery without shortcuts

Clinical Takeaway

If you’re dealing with chronic tennis elbow:

Progressive loading is your primary tool

Consistency beats quick fixes

Cortisone does not improve outcomes

Long-term, it may actually make things worse

When Should You Seek Physical Therapy?

If you’re experiencing:

• Persistent elbow pain (>6–8 weeks)
• Pain with gripping or lifting
• Weakness in the forearm
• Symptoms that keep returning

It’s time to address the root cause—not just the symptoms.

Ready to Fix Your Tennis Elbow the Right Way?

At our clinic, we focus on:

• Long-term tendon health
• Evidence-based treatment
• Hands-on care combined with progressive loading

Schedule an evaluation today and get back to pain-free strength—without relying on temporary fixes.

References

Couppé, C., et al. (2022). Corticosteroid injection combined with exercise versus exercise alone in lateral elbow tendinopathy: A randomized controlled trial. American Journal of Sports Medicine, 50(10), 2787–2796.

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