Should I Get a Steroid Injection for Tennis Elbow?
Effective short-term but not recommended long-term. Tennis elbow is not “inflammation” but tendon “degeneration.” Steroid injections reduce pain for 1-2 weeks but interfere with collagen synthesis, making tissue weaker long-term.
Tennis Elbow Is Not “Inflammation”
Histological Research Findings
Under microscope, chronic tennis elbow tissue shows the following.
- Inflammatory cells: Rarely found
- Actual tissue appearance. It shows excessive fibroblast proliferation, disorganized blood vessel formation, and degenerated collagen structure
This is called “tendinosis,” the result of chronic load-management failure.
Effects and Limitations of Steroid Injections
| Timeline | Effect | Side Effects |
|---|---|---|
| 1-2 Weeks | Possible temporary pain reduction | – |
| 4-6 Weeks | Pain returns | Tendon collagen synthesis begins to decline |
| 3-6 Months | Pain may recur | Tendon tissue weakened, higher recurrence rate |
| 1 Year Later | Worse than non-injection group | Accelerated tendon degeneration, chronification |
Research Results
In a 1-year follow-up study, the steroid injection group had much higher recurrence rates than the non-injection group, and tendon tissue was weaker long-term.
Why Steroids Weaken Tendons
1. Reduced Collagen Synthesis
Interferes with collagen production that forms tendons, decreasing tendon strength.
2. Suppressed Fibroblast Activity
Inhibits activity of cells that repair tendons, reducing recovery capacity.
3. Impaired Blood Vessel Formation
Blocks blood vessel formation that supplies nutrients and oxygen to tendons, delaying healing.
Then How Should It Be Treated?
In tendinosis, treatment requires appropriate mechanical stimulation to realign collagen structure.
We bring the swelling down
Circulation HD is used to address adhesions around tendons and may help ease excessive tension.
We wake the muscles up
Gradually apply appropriate load to tendons through isometric exercises, progressing to eccentric exercises.
We make the movement stick
Assess the kinetic chain to identify factors that may contribute to elbow overload.
Circulation Therapy That Strengthens Tendons
Rather than eliminating inflammation, the aim is to assess the tendon and address load management and function together.
- Circulation HD:
- Addresses adhesions at tendon attachment sites
- Supports blood circulation around the tendon
- Aims to reduce nerve sensitivity
- Circulation PT:
- Progressive isometric and eccentric exercise stages
- Kinetic chain recovery (core, thoracic spine, scapula)
- Shock absorption capacity training
Related Questions
References
- Coombes BK et al. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy. Lancet. 2010;376(9754):1751-1767. PMID 20970844
- Bisset L et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939.
- Smidt N et al. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002;359(9307):657-662.
- Gaujoux-Viala C et al. Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomised controlled trials. Ann Rheum Dis. 2009;68(12):1843-1849. PMID 19054817