Shockwave Therapy for Golfer's Elbow: How It Works and What to Expect

Shockwave therapy for golfer's elbow is a non-invasive treatment that uses focused acoustic pressure waves to stimulate healing in the damaged tendons on the inner side of your elbow. Also called extracorporeal shockwave therapy (ESWT), this treatment targets the inflamed medial epicondyle where the forearm flexor tendons attach to the bone. If you have been dealing with persistent inner elbow pain that will not go away with rest, ice, or bracing, shockwave therapy may be the treatment that finally gets you past it.

Golfer's elbow (medial epicondylitis) affects far more people than just golfers. Anyone who repeatedly grips, twists, or flexes their wrist can develop this condition. Construction workers, desk workers who type all day, weightlifters, and tennis players are all common candidates. According to the American Academy of Orthopaedic Surgeons, medial epicondylitis accounts for 10 to 20 percent of all epicondylitis diagnoses, and it most commonly affects adults between the ages of 40 and 60 (AAOS, 2023).

How Does Shockwave Therapy Work on Golfer's Elbow?

Shockwave therapy delivers rapid pulses of high-energy acoustic waves through the skin and into the damaged tendon tissue at the inner elbow. A handheld applicator is placed directly over the sore spot, and the device fires between 2,000 and 3,000 pulses per session. These pressure waves do three things at the cellular level:

• Increase blood flow: The waves cause microtrauma that triggers your body to send fresh blood supply to an area that typically has poor circulation. Tendons heal slowly because they receive limited blood flow compared to muscles. Shockwave therapy forces the body to redirect resources to the damaged site.
• Break down calcification: Chronic tendonitis often leads to calcium deposits forming within the tendon. The acoustic waves physically break apart these deposits so your body can reabsorb them.
• Stimulate collagen production: The controlled micro-injuries caused by shockwave therapy kick-start collagen synthesis. Over the following weeks, your body rebuilds the tendon with new, properly aligned collagen fibers instead of the disorganized scar tissue that was causing pain.

A 2021 systematic review published in the Journal of Orthopaedic Surgery and Research found that ESWT produced significant pain reduction and functional improvement in patients with medial epicondylitis compared to placebo treatments (JOSR, 2021). The study noted that most patients experienced improvement without any of the risks associated with surgery or repeated cortisone injections.

Who Is a Good Candidate for Shockwave Therapy?

Shockwave therapy works best for patients who have had golfer's elbow for at least six weeks and have not responded to conservative treatments like rest, physical therapy exercises, or anti-inflammatory medications. It is particularly effective for chronic cases where the tendon has started to degenerate rather than just being inflamed.

"I see a lot of patients who have tried everything for their elbow pain. They have worn the brace, they have iced it, they have rested it for weeks, and it comes right back the moment they return to normal activity," says Dr. Austin Elkin, Doctor of Chiropractic at City of Palms Chiropractic in Fort Myers. "Shockwave therapy works because it addresses the actual tendon damage instead of just masking the symptoms."

Good candidates include:

• Patients with golfer's elbow lasting longer than six weeks
• People who want to avoid cortisone injections or surgery
• Athletes dealing with recurring elbow tendon pain
• Workers whose jobs require repetitive gripping or wrist flexion
• Patients who have tried physical therapy without lasting results

Shockwave therapy is generally not recommended for pregnant women, patients with blood clotting disorders, people with infections near the treatment site, or anyone with a pacemaker. Your provider will review your full health history before recommending treatment. If you are unsure whether you qualify, a consultation can help determine the right path forward.

What Does a Shockwave Therapy Session Feel Like?

Each session takes about five to ten minutes of active treatment time. Here is what to expect during a typical appointment at our Fort Myers clinic:

• Setup: Your provider applies ultrasound gel to the inner elbow area. This helps the shockwave applicator transmit energy smoothly into the tissue.
• Treatment: The applicator is pressed against the skin and activated. You will feel a rapid tapping or pulsing sensation. When the waves hit the most damaged area of the tendon, you will likely feel a sharp but brief spike in discomfort. Most patients describe it as a 3 to 5 out of 10 on the pain scale.
• Adjustment: Your provider may adjust the intensity based on your feedback. The goal is to treat at the highest energy level you can tolerate without causing excessive pain.
• Post-treatment: You can drive yourself home and return to most daily activities right away. You may feel some soreness or mild swelling at the treatment site for 24 to 48 hours.

There is no downtime. Most patients return to work the same day. However, you should avoid heavy gripping, lifting, or any activity that stresses the elbow for 48 hours after each session. Your provider will give you specific guidance based on your job and activity level.

How Many Sessions Will You Need?

Most treatment protocols call for three to six sessions spaced one week apart. The number of sessions depends on how long you have had golfer's elbow and how much tendon damage is present. Mild cases caught within the first few months often respond well to three or four sessions. Chronic cases that have lingered for six months or longer may need the full six treatments.

Pain relief is not always immediate. Some patients feel better after the very first session, but most notice gradual improvement over weeks two through four. The real healing happens in the weeks between and after treatments as your body rebuilds the damaged tendon. Full recovery typically takes six to twelve weeks from the start of treatment.

At City of Palms Chiropractic, shockwave therapy is often paired with corrective care to address any spinal or postural issues that may be contributing to the problem. A misaligned thoracic spine or restricted shoulder mobility can change how forces travel through the arm, putting extra strain on the elbow tendons. Treating the elbow alone without looking at the full picture often leads to re-injury.

Shockwave Therapy vs. Cortisone Injections for Golfer's Elbow

Cortisone injections have been the go-to treatment for elbow tendonitis for decades. They work fast, reducing pain within days. But the relief is temporary, and repeated cortisone use comes with real downsides.

A 2020 study published in the American Journal of Sports Medicine compared ESWT to cortisone injections in patients with chronic tendinopathy. At the three-month mark, both groups reported similar pain reduction. But at six and twelve months, the shockwave group maintained their improvement while the cortisone group experienced significant relapse (AJSM, 2020). The researchers concluded that ESWT produced superior long-term outcomes because it promoted tissue repair rather than simply suppressing inflammation.

Key differences between the two treatments:

• Cortisone: Fast pain relief (days), no tissue repair, risk of tendon weakening with repeated use, relief fades within weeks to months
• Shockwave: Gradual pain relief (weeks), stimulates actual tissue regeneration, no risk of tendon weakening, results tend to last long-term

This does not mean cortisone is always the wrong choice. For acute flare-ups where you need to function quickly, a single cortisone injection can buy you time. But for long-term resolution of chronic golfer's elbow, shockwave therapy has a stronger track record. Your provider can help you weigh both options based on your specific situation.

What Can You Do Between Sessions to Speed Recovery?

Shockwave therapy does the heavy lifting, but what you do between sessions matters. Managing stress and supporting your body's healing process can shorten your recovery timeline. Here are practical steps to take:

• Eccentric exercises: Your provider may prescribe specific wrist flexor eccentric exercises. These controlled movements load the tendon in a way that promotes proper collagen alignment during healing.
• Avoid anti-inflammatories: This sounds counterintuitive, but NSAIDs like ibuprofen can slow the healing response that shockwave therapy is trying to trigger. Stick with ice for pain management unless your doctor advises otherwise.
• Modify your grip: Use a larger grip on tools, golf clubs, or rackets. A thicker grip reduces the strain on your flexor tendons. Ergonomic keyboard and mouse setups can also help if your elbow pain is desk-related.
• Stay active: You do not need to stop all exercise. Avoid activities that load the elbow, but keep moving. Walking, lower body exercises, and gentle cardio all support blood flow and healing.

Ready to Get Rid of Golfer's Elbow for Good?

If you have been dealing with inner elbow pain that will not quit, shockwave therapy may be the answer. At City of Palms Chiropractic in Fort Myers, Dr. Austin Elkin evaluates each patient individually to determine if ESWT is the right fit for your condition. We combine shockwave therapy with a full assessment of your spine, posture, and movement patterns to make sure we are treating the root cause, not just the symptom. Call (239) 690-7794 or book your appointment online to find out if shockwave therapy is right for you.