Tennis elbow can be more than just an annoying ache – it can linger, limit your grip strength, and make everyday activities surprisingly difficult. For years, patients were told to rest, ice, or try steroid injections, even though those options rarely solved the underlying issue.
But what if there was a better way? A new 2025 clinical trial put four popular treatment approaches to the test – physiotherapy, shockwave therapy, prolotherapy, and platelet-rich plasma (PRP) – to see which ones actually deliver lasting relief.
At Regenexx Cayman, we keep a close eye on the latest research, so our patients know what really works…and why. Let’s dive into this study – and what it means for anyone struggling with chronic tennis elbow.
Understanding Tennis Elbow: More Than Just Inflammation
Chronic tennis elbow (lateral epicondylosis) affects up to 3% of adults every year. While long believed to stem from inflammation, scientists now agree it reflects tendon degeneration that fails to heal – resulting in chronic pain and reduced grip strength. For years, the main treatments were NSAIDs, bracing, or steroid injections: all offering short-term help, but failing to address the real problem. In fact, repeated steroid use can raise the risk of tendon rupture and may make things worse long-term.
A Groundbreaking Study Sheds Light on Treatment Options
A 2025 clinical trial led by Lhee et al. evaluated 231 adults with stubborn tennis elbow who hadn’t improved after months of standard care[1]. Patients were randomly placed in one of four groups: physiotherapy (home eccentrics/exercise), shockwave therapy, prolotherapy (dextrose injections), or PRP (platelet-rich plasma) injections. All patients were tracked for 24 months using rigorous scoring of arm function and patient satisfaction.
Specific Treatment Protocols Used in the Study
Physiotherapy Protocol
Shockwave Therapy (ESWT) Protocol
Prolotherapy Details
Platelet-Rich Plasma (PRP) Protocol
What Did the Results Show?
Key Findings:
DASH Score Improvement at 24 Months
Chart Reference:
| Treatment | DASH Improvement | Clinical Significance |
|---|---|---|
| PRP | 31.18 points | Excellent improvement |
| Prolotherapy | 20.70 points | Very good improvement |
| Physiotherapy | 18.70 points | Good improvement |
| ESWT | 17.62 points | Good improvement |
Patient Satisfaction at 24 Months
Chart Reference:
| Treatment | Satisfaction Score | Patient Rating |
|---|---|---|
| PRP | 4.6/5 | Highly satisfied |
| Prolotherapy | 4.2/5 | Very satisfied |
| ESWT | 3.43/5 | Moderately satisfied |
| Physiotherapy | 3.0/5 | Moderately satisfied |
Decoding the Science of Regeneration – How Does PRP Work?
PRP harnesses your body’s natural healing power by concentrating growth factors from your blood. The biological process includes:
Multiple studies have shown PRP helps remodel tendon fibers, promotes blood flow, and recruits the cells needed for long-term healing[2][4].
Understanding Prolotherapy
Prolotherapy uses controlled irritation to trigger healing through a dextrose injection that:
While lower-cost and requiring more sessions than PRP, evidence shows it offers real and lasting benefit[5].
What about Physiotherapy?
Physiotherapy focuses on strengthening and retraining the tendon through targeted exercises:
The 2025 study showed that physiotherapy provided improvement in pain and function, though results and patient satisfaction were lower than with PRP or prolotherapy.
Where Does Shockwave Fit In?
Shockwave therapy delivers acoustic energy to injured tissue:
While helpful, the 2025 trial found it was not as effective as the regenerative injection options for chronic cases.
Why Regenexx Cayman Leads in Regenerative Medicine
At Regenexx Cayman, PRP and cell therapies are processed using the industry’s most advanced lab protocols, resulting in higher concentration PRP than typical machines. Regenexx Cayman also pioneered stem cell culture in orthopedics (Regenexx-C) offering up to 1,000 times more stem cells than many US procedures. All sample processing takes place in a highly controlled laboratory, which meets ISO Class 7 criteria, and is certified by the International Cellular Medicine Society (ICMS), and licensed by the Health Practice Commission (HPC).
What Sets Regenexx Cayman Apart:
At Regenexx Cayman, every patient receives a personalized, evidence-based treatment plan for joints, tendons, and the spine – always delivered with precise, image-guided injections (never blind).
Our rigorous safety and lab testing protocols, combined with world-class research, ensure the highest standards of care – giving patients confidence in both expertise and results. In fact, Regenexx physicians have published the world’s largest safety study on orthopedic stem cell procedures and have completed nearly 44% of all research in the field.
Patients travel from around the globe not only for access to Regenexx-C – available exclusively at our Cayman clinic – but also for the option to bank their stem cells for future orthopedic health and longevity. With unmatched expertise and a tranquil setting that blends best-in-class treatment with a relaxing recovery, Regenexx Cayman offers a truly unique path to orthopedic healing.
Evidence-Based and Safe
Multiple studies support regenerative therapies:
With strong evidence for regenerative approaches, should PRP and prolotherapy become the new gold standard for treating chronic stubborn injuries?
From Everyday Pain to the CrossFit Games – A Patient Success Story
“My elbow just started hurting – just everyday use. Getting in my husband’s Jeep… Any sort of gripping movement would really hurt my elbow. Face cloth underwater and just gripping it to wring it out, it hurt my elbow. Anything where I had to squeeze or pinch my fingers in toward my thumb and have a good grip, it would just automatically hurt my elbow.
They’d done an MRI and some ultrasounds on both my shoulder and elbow. Turns out my problem was I had partial tearing in my biceps tendon, the supraspinatus and labrum, as well as the UCL and common flexor tendon in my elbow.
I went to the local Regenexx office where they did SCP [PRP injections]. They withdrew my blood and then re-injected it later in the afternoon. Since having the treatment, I was able to go to the CrossFit Games twice. For any athlete, well, CrossFit in particular, the CrossFit Games is the pinnacle of everything. It’s like going to the Olympics. So, for three years after having the [PRP injections] done, I’m still pain-free and everything feels great. It’s pretty incredible.”
– Wanda Brenton, 2014 CROSSFIT GAMES WINNER, LATIN AMERICA
Watch Wanda’s story: how PRP therapy at Regenexx Cayman helped her overcome tennis elbow and return to peak performance.
Final Thoughts
The takeaway is simple: tennis elbow doesn’t have to linger forever. This 2025 study shows that treatments like PRP and prolotherapy can deliver superior, long-term outcomes, helping the tendon repair itself (rather than simply masking the pain). The outcome can lead to a better grip, better function, and getting back to the things you love without the constant ache holding you back.
If your own cells have the power to restore function and relieve pain, why wait until everything else has failed before making them your first choice?
Can PRP, prolotherapy, or another regenerative option help you?
Contact Regenexx Cayman to find out at info@regenexxcayman.ky or by phone: 345-943-5900 (Cayman) or 1-877-211-3834 (US toll-free).
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