PRP vs Cortisone Injection for Tennis Elbow: What the Research Shows
- 2 days ago
- 4 min read
By Dr. Jeffrey Peng, MD · Published March 6, 2026 · 5 min read
Watch the Full Video
Tennis elbow — clinically known as lateral epicondylitis or lateral elbow tendinopathy — is one of the most common causes of elbow pain. It develops when the common extensor tendon in the forearm is subjected to repetitive overuse or overloading, leading to microtears that weaken the tendon over time. The result is chronic pain, reduced grip strength, and difficulty performing everyday tasks.
For decades, cortisone injections have been the go-to treatment when first-line therapies like rest and exercise fail to provide relief. But a growing body of high-quality research now suggests that cortisone may do more harm than good in the long run — and that platelet-rich plasma (PRP) injections may offer a far superior alternative.
Why Are Cortisone Shots Still Used for Tennis Elbow?
The appeal of cortisone is straightforward. Cortisone is a potent anti-inflammatory medication that can rapidly reduce pain and swelling. For patients with severe tennis elbow who are struggling to participate in an exercise and rehabilitation program, a cortisone injection can provide enough short-term relief to get started with physical therapy.
However, the critical question is not whether cortisone helps in the short term — it does — but whether that short-term benefit comes at the cost of long-term tendon health. The latest evidence strongly suggests that it does.
Does Cortisone Actually Harm the Tendon Long Term?
A randomized controlled trial by Couppé et al. (2022) examined whether combining heavy slow resistance training with a cortisone injection or a placebo injection changed outcomes for patients with lateral elbow tendinopathy. Sixty patients were followed for one year with assessments at 12 weeks, 26 weeks, and 52 weeks.
At 12 weeks, all groups showed equivalent improvement. But at long-term follow-up, the results told a very different story. The researchers concluded that heavy slow resistance training improved symptoms in both the short and long term, but adding a cortisone injection did not amplify this effect. In fact, the cortisone group showed impaired patient-reported outcomes compared with exercise therapy alone at long-term follow-up.
This finding is consistent with a landmark systematic review published in The Lancet by Coombes et al. (2010), which analyzed 41 randomized controlled trials involving 2,672 participants. The review demonstrated consistent findings across multiple high-quality studies: corticosteroid injections reduced pain in the short term compared with other interventions, but this effect was reversed at intermediate and long-term follow-up.
In other words, we have known for well over a decade that cortisone injections may provide temporary pain relief but ultimately cause more harm than good for tennis elbow. Despite this evidence, cortisone injections remain widely covered by insurance companies and continue to be offered as a standard treatment — a practice that is increasingly difficult to justify.
Is PRP a Better Treatment for Tennis Elbow?
Unlike cortisone, which merely suppresses inflammation temporarily, PRP therapy works by harnessing your body's own healing capacity. PRP delivers a concentrated dose of growth factors directly into the damaged tendon, stimulating tissue repair and regeneration at a cellular level.
A systematic review and meta-analysis by Niemiec et al. (2022) evaluated 26 studies examining PRP for the treatment of lateral epicondylitis. Using minimal clinically important difference (MCID) values as a benchmark, the researchers found that after a PRP injection, patient outcome scores improved significantly from baseline and exceeded the MCID threshold at follow-up time points out to 52 weeks.
This is a critical distinction. With cortisone, patients get short-term relief that reverses over time. With PRP, patients experience progressive and sustained improvement because the treatment addresses the underlying tendon pathology rather than just masking pain. Both leukocyte-rich and leukocyte-poor PRP formulations were found to be effective in this analysis.
When Should You Consider PRP Over Cortisone for Tennis Elbow?
In my practice, the first-line treatment for tennis elbow is always a structured exercise and stretching program. Tennis elbow is fundamentally a chronic overuse problem, and the goal of rehabilitation is to strengthen the weakened tendon and restore normal mechanics. Many patients will see meaningful improvement with a consistent exercise program alone.
However, when pain is severe enough to prevent participation in a rehabilitation program — or when symptoms persist despite consistent exercise — that is where PRP becomes especially valuable. Rather than reaching for a cortisone injection that provides temporary relief at the expense of long-term tendon health, a PRP injection can reduce pain while simultaneously promoting the biological healing process the tendon needs.
If you are dealing with persistent tennis elbow that has not responded to conservative treatment, a consultation with a sports medicine physician who specializes in ultrasound-guided PRP injections can help determine whether this treatment is right for you. You can also schedule a consultation to discuss your options.
References
1. Couppé C, Døssing S, Bülow PM, et al. Effects of Heavy Slow Resistance Training Combined With Corticosteroid Injections or Tendon Needling in Patients With Lateral Elbow Tendinopathy. Am J Sports Med. 2022;50(10):2787-2796. doi:10.1177/03635465221110214
2. 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
3. Niemiec P, Szyluk K, Jarosz A, Iwanicki T, Balcerzyk A. Effectiveness of Platelet-Rich Plasma for Lateral Epicondylitis: A Systematic Review and Meta-analysis Based on Achievement of Minimal Clinically Important Difference. Orthop J Sports Med. 2022;10(4):23259671221086920. doi:10.1177/23259671221086920
Medical Disclaimer: This content is for educational purposes only and does not substitute for the medical advice of a physician. Always consult your healthcare provider before beginning any new treatment program. The information presented reflects the opinion of Dr. Jeffrey Peng and does not represent the views of his employers or affiliated hospital systems.
Comments