PRP for Tennis Elbow: The Long Term Solution

Samuel G Oltman, ND, RMSK

Evidence for Platelet-Rich Plasma (PRP) in treating tennis elbow (lateral epicondylitis) is generally strong, particularly for long-term recovery compared to other treatments. However, the data reveals a distinct "tortoise and the hare" pattern when compared to traditional steroid shots.

The scientific consensus as of 2026 can be summarized into four key findings:

1. PRP vs. Corticosteroids (The Trade-off)

The most significant evidence compares PRP to corticosteroid (steroid) injections.

• Short-term (0–4 weeks): Steroids are consistently superior in terms of pain relief. They provide rapid pain relief by shutting down inflammation in the short term.

• Long-term (6–24 months): The trend reverses. Multiple meta-analyses show that PRP provides significantly better pain relief and functional improvement at the one-year and two-year marks, whereas steroid benefits often "wear off" or lead to recurrence (1).

2. PRP Efficacy as a "Second-Line" Tennis Elbow Treatment

PRP shows its strongest scientific support in patients who have failed conservative therapy (physical therapy, bracing, and rest) for at least 3 to 6 months.

• A major multicenter trial of 230 patients found that while there was no difference at 12 weeks, by 24 weeks, 84% of PRP patients reported significant improvement compared to 68% in the control group.

• Recent 2025 research indicates that for chronic cases (symptoms >12 months), PRP outperforms even prolotherapy and shockwave therapy in long-term functional scores (2).

3. "Leukocyte-Rich" vs. "Leukocyte-Poor"

There is an ongoing scientific debate about whether the presence of white blood cells (leukocytes) helps or hurts.

• Leukocyte-Rich (LR-PRP): Some evidence suggests the initial "pro-inflammatory" hit from white blood cells helps restart the healing process in chronic, stagnant tendon injuries.

• Leukocyte-Poor (LP-PRP): This version is generally associated with less post-injection pain and is gaining favor for being more "anabolic" (tissue-building) without the harsh inflammatory spike.

• My Theory: The prior evidence supporting LR-PRP may be due to the fact that the way it is processed generally increases platelet count/dose. So it may not be that the leukocytes are what are helping, but rather that there’s a higher platelet dose. As PRP processing methods have improved, LP-PRP can be made with equally high platelet counts without the pain associated with higher leukocytes (3). 

• Conclusion: Current meta-analyses suggest both are effective, with no definitive winner for tennis elbow specifically, though LR-PRP is more historically studied for this condition.

4. Structural vs. Symptomatic Healing

Interestingly, while patients report feeling much better, radiological evidence (MRI and Ultrasound) doesn't always show a total "repair" of the tendon.

• Conclusion: PRP's primary success appears to be "biological recalibration"—it reduces the pathological pain signaling and improves the quality of the existing tendon tissue, even if a small tear remains visible on a scan (4).

Tennis elbow is a classic example of a condition where people often fall into the gap between surgery and PT. Surgery is

rarely useful or appropriate in tennis elbow. PT works well but not 100% of the time. For those people, PRP has strong evidence and is the choice for long term resolution. PRP quality and platelet dose matter deeply to get a good outcome, and we do it right. Schedule with us today and put your pain behind you. 

References:

1. Huang K, Giddins G, Wu L dong. Platelet-rich plasma versus corticosteroid injections in the management of elbow epicondylitis and plantar fasciitis: an updated systematic review and meta-analysis. Am J Sports Med. 2020;48(10):2572-2585. doi:10.1177/0363546519888450

2. Le ADK, Enweze L, DeBaun MR, Dragoo JL. Current clinical recommendations for use of platelet-rich plasma. Current Reviews in Musculoskeletal Medicine. 2018;11(4):624. doi:10.1007/s12178-018-9527-7

3. Oeding JF, Varady NH, Messer CJ, Dines JS, Williams RJ, Rodeo SA. Platelet concentration explains variability in outcomes of platelet-rich plasma for lateral epicondylitis: a high dose is critical for a positive response: a systematic review and meta-analysis with meta-regression. Am J Sports Med. 2025;53(10):2489-2496. doi:10.1177/03635465241303716

4. Maffulli N, Nilsson Helander K, Migliorini F. Tendon appearance at imaging may be altered, but it may not indicate pathology. Knee Surg Sports Traumatol Arthrosc. 2023;31(5):1625-1628. doi:10.1007/s00167-023-07339-6