Why Elbow Tendonitis Rehab Isn’t Always a Straight Line to Recovery
By: Kelsie Mazur, DPT
If you’re dealing with elbow tendonitis, whether tennis elbow (lateral epicondylitis) or golfer’s elbow (medial epicondylitis), you may have noticed something frustrating: progress doesn't always move in one direction. One week things feel better; the next your elbow flares up again. This back-and-forth is common. I get SO many patients who make progress with their tennis/golfer’s elbow and then BOOM it seems like one day they regress. In this week’s blog post, we are talking out why this is completely normal and expected. For clarity in this blog, I am going to use the term: elbow tendinopathy, this means any injury occurring laterally or medially at the elbow joint.
Tendons Don’t Heal Like Muscles
Tendon rehab doesn’t follow a predictable pattern. Tendons respond to load: the right amount, at the right time, with the right frequency. Too much load, too soon, can aggravate symptoms. Not enough, and improvement stalls. Managing this balance is one of the most challenging aspects of treating tendon-related pain.
This explains the peaks and valleys people experience during recovery. Feeling better for a few days, then noticing symptoms after a more active day, is not unusual. It doesn’t mean you’re starting over. It simply reflects the natural progression of tendon healing.
Why Does Elbow Tendinopathy Happen?
Your elbow tendons are involved in many daily tasks: lifting, gripping, working, and playing sports. When the intensity, volume, or frequency of these activities exceeds your body’s current capacity to recover, tendinopathy can develop.
Often, the issue is doing too much, too quickly. Here are a few real-life scenarios:
You start a new workout routine, lifting weights every day without prior experience.
You pick up tennis and begin playing daily after work to improve rapidly.
You spend a vacation doing home projects that involve repetitive arm movements.
In each case, the tendon was exposed to more load than it was prepared to handle. Rehab, at its core, aims to reduce that load to a tolerable level, then progressively build your tendon’s capacity to meet or exceed the demands of your life and activities.
Monitoring Pain During Rehab
Understanding how to monitor pain is another key part of the process. Many people worry that exercising with pain is harmful. However, pain alone doesn't necessarily mean you're causing damage.
Elbow tendinopathy (tennis or golfer’s elbow) isn’t purely inflammatory. The goal is to build strength and resilience in the tendon by restoring its ability to tolerate load. Mild discomfort during exercise is often acceptable and even expected.
This doesn’t mean pushing through severe pain. Instead, it’s about working within a tolerable range. Most current research supports this approach. What's tolerable varies person to person, which is why paying attention to your individual response is so important.
Use these three questions to guide your progress:
Is my pain tolerable during exercise?
You can use a 0–10 scale. Some clinicians recommend staying under 2–3/10, while others allow up to 4–5/10, as long as it's manageable and not worsening.How do I feel after exercise?
Some people notice a warm-up effect and feel better immediately after movement.How do I feel the next day?
This is the most important checkpoint. If your pain increases significantly the following day, the load may have been too much. Adjustments to volume or intensity are likely needed.
A simple way to check this is with a repeatable movement, like squeezing a ball. If you rate the pain as 2/10 before your routine and 5/10 the next day, the dose was probably too high. It doesn't mean you caused harm, it means the tendon needs a slightly lower challenge while it builds strength.
Key Takeaways
Healing from elbow tendonitis takes time and patience. It’s normal to experience fluctuations in symptoms. What matters most is consistency, listening to your body, and adjusting your program based on how you respond.
Tendons need load to heal, but only the right amount.
Pain during exercise can be acceptable if it’s mild and doesn’t spike the next day.
Use your symptoms to guide progression, not fear them.
Stay committed to the process. With smart, progressive loading and appropriate monitoring, you'll get back to the activities you enjoy.
Let’s chat. Book an assessment and let’s get you back to feeling good in your body.
No referrals, no waiting, just answers. Did you know that we offer free 1-on-1 injury screens? Wattage Physical Therapy will take an in depth look at your ergonomics, posture, muscle tone, muscle weaknesses, and movement patterns to create a plan for YOU. If this article intrigues you, you can directly email me, Kelsie at Kelsie@wattagept.com. I would be happy to help you start the process of living a life free from pain.