Tennis elbow can make a familiar movement difficult: turning a handle, lifting an object, or gripping a racquet. When pain on the outside of the elbow persists, a search for shockwave treatment may lead to studies that seem to contradict one another. Some report improvements in pain or function. Others find little advantage over a sham procedure. Part of the confusion is that researchers have not always studied the same form of treatment or measured the same outcome.
A 2026 review separated focused and radial shockwave approaches and found different rankings for each. Those rankings do not establish benefit for an individual, and earlier clinical guidance reached a different conclusion.
What Researchers Mean by Tennis Elbow
The medical terms lateral epicondylitis and lateral elbow tendinopathy describe a problem involving the tendons near the outside of the elbow. The clinical features described in the British elbow & shoulder society’s tennis elbow care pathway include gradual pain near the outer elbow, tenderness, and discomfort during grasping or twisting. A person may notice pain when extending the wrist or fingers against resistance.
Despite its name, tennis elbow is not limited to racquet sports. Repeated gripping and wrist or forearm movements can be relevant in work, hobbies, and household tasks. The pathway emphasizes history and examination, with imaging when the diagnosis is uncertain. A new injury, swelling, or neurological symptoms warrant assessment rather than assumptions.
In Carmichael, carmichael recreation and park district reports four tennis courts at Carmichael Park. That provides a local example of an activity in which grip and arm use matter, not evidence that playing there causes elbow problems. Whether symptoms appear on court or while carrying groceries, it helps to describe the movement that brings them on.
Focused and Radial Shockwave Are Not Interchangeable Labels
Extracorporeal shockwave therapy uses externally delivered pressure or acoustic waves. The 2026 research classified focused shockwave therapy, or fESWT, by its convergent pressure field, while radial shockwave therapy, or rESWT, used a divergent wave distributed more superficially. These describe energy delivery, not a hierarchy of strength.
The label “shockwave” can obscure differences in devices, settings, schedules, and enrolled patients. The word focused in a study does not identify an individual clinic’s equipment.
At Baratta Holistic Center, we list tennis elbow among the conditions considered for Shockwave Therapy and describe an evaluation before recommending care.
[FACT NEEDED: Confirm whether the currently used elbow-treatment device provides focused shockwaves, radial pressure waves, or both, and which settings and protocol are used — ask Chantel and the treating clinician.]
Until that is confirmed, results from a focused or radial trial cannot responsibly be presented as results for our equipment.
What the August 2026 Review Found
A systematic review and network meta-analysis published August 28, 2026 included 23 randomized controlled trials with 1,484 participants. Investigators compared focused and radial shockwave treatment with subtypes of platelet-rich plasma treatment and relevant controls. The review ranked treatments across different trials and outcomes.
Those outcomes tell different stories:
• Grip strength: Focused shockwave ranked highest overall, and in the shorter-term analysis covering up to three months.
• Upper-limb disability: Radial shockwave ranked highest overall and at six months or longer on the Disabilities of the Arm, Shoulder and Hand measure.
• Pain at rest: Radial treatment received the highest ranking on the review’s visual pain scale analysis.
• Tennis-elbow-specific function: Focused treatment ranked highest on the Patient-Rated Tennis Elbow Evaluation, or PRTEE.
A ranking is not a patient’s probability of recovery. The review used a statistical method known as SUCRA to order interventions within its evidence network. Rankings depend on available comparisons. They cannot predict an individual’s improvement or establish superiority to supervised exercise.
The authors also found important uncertainty. Comparisons for grip strength and resting pain showed significant inconsistency, and the confidence in many network comparisons was rated low or very low. Trials differed in symptom duration and treatment protocols; harms were not reported consistently enough for a pooled safety analysis.
The authors called for more direct, head-to-head studies of focused and radial treatment. Readers should treat these findings as a reason to ask more precise questions, not as a settled treatment recommendation.
What One Focused-Shockwave Trial Adds
A 2024 randomized trial in Scientific Reports assigned 60 patients with persistent tennis elbow to focused shockwave treatment, therapeutic ultrasound, or placebo ultrasound. Participants in every group also received deep friction massage. The focused-treatment group received three shockwave sessions separated by a week; the ultrasound and placebo-ultrasound groups followed different schedules.
At six and twelve weeks after treatment, all three groups showed improvement from baseline in pain and affected-arm function. Certain between-group comparisons favored focused shockwave over active ultrasound for pain and functional change.
However, the researchers reported no statistically significant between-group difference in percentage changes in affected-arm muscle strength.
Several details limit what can be concluded. Every group received massage, so the trial cannot isolate shockwave from all other care. It compared focused shockwaves with ultrasound-based interventions, not with radial shockwaves or an exercise-only program.
Participants met specific eligibility criteria, including symptoms persisting for at least three months. The findings should not be carried over automatically to newly developed elbow pain or to people with conditions excluded from the trial.
Comparators, accompanying care, and follow-up shape each result.
Why Clinical Guidance Remains Cautious
There is a genuine tension between promising results in selected studies and broader treatment guidance.
The 2023 British Elbow & Shoulder Society patient care pathway made a strong recommendation against extracorporeal shockwave therapy for lateral elbow tendinopathy.
Its assessment found no meaningful advantage on its critical tennis-elbow function outcome through twelve weeks, with low-quality or inconsistent evidence for several other comparisons against sham or control treatment.
That guidance predates the 2024 trial and the August 2026 review. The newer review gives more attention to focused-versus-radial distinctions, but its own uncertainty findings do not automatically overturn an established clinical recommendation.
The studies also ask partly different questions: a ranking among several interventions is not the same as a guideline judgment about whether a treatment provides adequate benefit over control care.
For a patient, this means Shockwave Therapy should not be framed as a proven or necessary first choice for tennis elbow. Ask about the evidence, alternatives, and reasons for changing a plan.
Where Exercise-Based Care Fits
The same 2023 clinical pathway made a strong recommendation to offer physiotherapy for lateral elbow tendinopathy.
The underlying analysis found improvement in overall outcomes in the short term, while evidence for medium- and longer-term differences was less certain. Its practical guidance also discusses activity modification, stretching, and progressive loading of the wrist extensor tendons.
Exercise decisions should account for difficult activities, tolerable movements, and how progress will be reviewed.
Helpful discussion points include:
• What activities currently reproduce the elbow symptoms, and how can those be modified while care is underway?
• Is a supervised strengthening or stretching plan appropriate, and who will guide it?
• Which changes in function should be measured, beyond a pain score alone?
• If additional treatment is considered, what question is it meant to answer that exercise-based care has not addressed?
We approach decisions about complementary treatments through individualized evaluation at our Carmichael chiropractic and wellness practice.
That does not establish that we provide a specific tennis-elbow rehabilitation protocol.
[FACT NEEDED: Confirm whether supervised elbow loading or referral for physiotherapy is part of the clinic’s tennis-elbow pathway — ask the treating clinician.]
Patients should know who is responsible for guiding that part of care.
How to Judge Whether a Proposed Plan Is Helping
Pain, strength, and daily function are different outcomes. The PRTEE asks about pain and difficulties with activities affected by tennis elbow. Grip strength provides a different measurement. General upper-limb disability questionnaires capture limitations beyond a single movement.
Before treatment, describe a few activities that matter in everyday life. Compare those activities at follow-up and note whether changes matter to your goals.
Questions worth bringing to an evaluation are straightforward:
1. What findings support lateral elbow tendinopathy rather than another source of arm pain?
2. Is the proposed Shockwave Treatment focused or radial, and which clinical studies match that approach?
3. How will exercise, activity changes, and any other care be coordinated?
4. What measures and review dates will determine whether to continue, adjust, or stop?
5. What discomforts, uncertainties, or reasons to avoid the procedure should I understand before agreeing?
For people in Fair Oaks, our nearby chiropractic services for Fair Oaks residents are provided from the Carmichael office.
That service information does not substitute for a condition-specific discussion. Patients can use our contact page to ask what type of elbow assessment is available and how care options are reviewed.
The useful conclusion from the research is not a single winner. Focused and radial shockwave studies should be evaluated separately; their rankings vary with the outcome being measured, and uncertainty remains substantial.
Exercise-based management has clearer support in the cited clinical pathway. For persistent elbow symptoms, an accurate diagnosis and a discussion that includes alternatives are more valuable than a promise attached to any one device.
About Baratta Holistic Center
Baratta Holistic Center is a chiropractic and wellness practice in Carmichael, California, serving Carmichael and nearby Fair Oaks. We offer chiropractic care and complementary services that include Shockwave Therapy, and we evaluate patients before discussing whether a particular option fits their concerns.
For questions about an assessment, call (916) 837-0716.Find our Google Business Profile for location information and directions.
