PRP Injection vs Physical Therapy for Tennis Elbow: What a New 2-Year Study Shows
- 6 days ago
- 4 min read
Written by Dr. Jeffrey Peng, MD — Board-Certified Sports Medicine Physician
Published: March 1, 2026 | Last Updated: March 1, 2026
Tennis elbow — medically known as lateral epicondylosis — can be one of the most frustrating conditions to deal with. It often drags on for months, sometimes even years, and many patients find that physical therapy alone does not provide lasting relief. But what if there is a treatment that goes beyond managing symptoms and actually helps repair the damaged tendon? A brand new randomized controlled trial with two-year follow-up sheds important light on this question, and the results strongly favor platelet-rich plasma (PRP) injections.
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What Does the Latest Research Say About Tennis Elbow Treatments?
A prospective randomized controlled trial published in The American Journal of Sports Medicine followed over 200 patients with chronic lateral epicondylosis for two full years (Lhee et al., 2025). The study compared four widely used treatments: physical therapy (daily stretching and eccentric wrist extensor strengthening), platelet-rich plasma (PRP) injections, prolotherapy (dextrose injections to trigger a healing response), and extracorporeal shockwave therapy. All enrolled patients were adults over 35 years old with elbow pain lasting more than six months that had not improved with at least three months of prior conservative care.
The PRP group received a single ultrasound-guided injection of concentrated platelets, prepared from approximately 30 cc of the patient's own blood (yielding around 5 billion platelets). This is a well-established preparation protocol that delivers a high concentration of growth factors directly into the diseased tendon.
How Did PRP Compare to Physical Therapy, Prolotherapy, and Shockwave?
The results at the 24-month mark were striking. While all four groups showed improvement, PRP and prolotherapy clearly stood out. Patients who received PRP demonstrated an average improvement of 31 points on the DASH (Disabilities of the Arm, Shoulder and Hand) score, compared with just 19 points in the physiotherapy group and 18 points in the shockwave group. For clinical context, a 10-point change on the DASH score is generally considered the minimum clinically important difference — meaning PRP delivered roughly three times the threshold for a meaningful improvement.
Patient satisfaction scores followed the same pattern. PRP patients rated their outcomes an average of 4.6 out of 5, while the physiotherapy group averaged only 3.0 and shockwave therapy averaged 3.4. Prolotherapy also performed well, with satisfaction scores of 4.2 out of 5. These are not marginal differences — PRP nearly doubled the functional gains achieved by physical therapy alone.
These findings are consistent with broader evidence in the literature. A systematic review and meta-analysis by Chen et al. (2018) in The American Journal of Sports Medicine evaluated 21 randomized controlled trials involving over 1,000 participants and found that PRP significantly reduced long-term pain in patients with lateral epicondylitis. Additionally, a landmark Lancet systematic review by Coombes et al. (2010) demonstrated that while corticosteroid injections can provide short-term relief for tendinopathy, their effects reverse at intermediate and long-term follow-up — further highlighting the need for regenerative approaches like PRP that address the underlying tissue damage rather than simply masking symptoms.
Why Does PRP Work Better Than Other Tennis Elbow Treatments?
The answer lies in how PRP works at a biological level. Platelet-rich plasma delivers a concentrated dose of your body's own growth factors — including platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-β), and vascular endothelial growth factor (VEGF) — directly into the damaged tendon. These growth factors signal tendon cells to produce new collagen, restore blood supply, and remodel tissue that has been stuck in a chronic degenerative state.
This is fundamentally different from what physical therapy, shockwave, or even prolotherapy can accomplish. Exercise-based rehabilitation strengthens the muscles around the elbow and can improve load tolerance, but it does not directly supply the biological building blocks needed for tendon repair. Shockwave therapy creates mechanical stimulation that may promote healing in some patients, but this study showed no significant advantage over exercise at two years. Prolotherapy, which uses dextrose to provoke an inflammatory and healing response, showed better results than physical therapy — but still fell short of PRP's outcomes.
PRP is addressing the root cause of the problem: a tendon that has failed to heal on its own. By delivering the exact biological ingredients needed for tissue repair, PRP jumpstarts the regenerative process in a way that other treatments cannot match.
When Should You Consider PRP for Tennis Elbow?
In my clinical practice, I typically recommend starting with a structured exercise program for at least four to six weeks. The reality is that many patients with tennis elbow will see meaningful improvement once they begin consistent eccentric strengthening and stretching — and the research supports this approach as a first-line therapy (Landesa-Piñeiro & Leirós-Rodríguez, 2022).
However, if symptoms persist despite consistent rehabilitation — or if the pain is severe from the outset — I often take a more aggressive approach and recommend PRP as the next step. Tennis elbow is notorious for lingering and becoming chronic, and that is precisely why PRP can be so valuable. By addressing the underlying tendon degeneration and stimulating true biological healing, PRP offers a powerful option to restore function and help patients get back to their daily activities and the sports they love.
If you are dealing with persistent tennis elbow that has not responded to rest, bracing, or physical therapy, a consultation with a sports medicine physician who specializes in ultrasound-guided PRP injections can help determine whether this treatment is right for you.
References
Lhee SH, Ryeol Lee K, Young Lee D. Comparing the Use of Physiotherapy, Shockwave Therapy, Prolotherapy, and Platelet-Rich Plasma for Chronic Lateral Epicondylosis: A Prospective, Randomized Controlled Trial With 2-Year Follow-up. Am J Sports Med. 2025;53(11):2707-2714. doi:10.1177/03635465251361515
Chen X, Jones IA, Park C, Vangsness CT. The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment. Am J Sports Med. 2018;46(8):2020-2032. doi:10.1177/0363546517743746
Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376(9754):1751-1767. doi:10.1016/S0140-6736(10)61160-9
Landesa-Piñeiro L, Leirós-Rodríguez R. Physiotherapy treatment of lateral epicondylitis: A systematic review. J Back Musculoskelet Rehabil. 2022;35(3):463-477. doi:10.3233/BMR-210053
Disclaimer: This content is for educational purposes only and does not substitute for the medical advice of a physician. Always consult with your healthcare provider before starting any new treatment. Individual results may vary. Dr. Peng is a board-certified sports medicine physician practicing in Campbell, California.
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