If you have already spent several weeks or months doing physiotherapy for elbow pain but still struggle with:

• Gripping
• Lifting
• Carrying bags
• Opening jars
• Using tools
• Gym exercises
• Racquet sports
• Computer or mouse work

it is reasonable to ask:

Why am I not getting better?

Physiotherapy is commonly used for conditions such as tennis elbow and golfer’s elbow.

But tendon problems can be slow to recover, and lack of improvement does not always mean that you simply need more of the same treatment.

Sometimes:

• The rehabilitation load needs to change
• The diagnosis needs to be reconsidered
• A nerve may be contributing
• There may be a more significant tendon injury
• Imaging may provide useful additional information
• Another non-surgical treatment may be considered

Mayo Clinic notes that tennis elbow often improves with conservative treatment, but persistent cases may require additional procedures or, rarely, surgery. (mayoclinic.org)

How Long Should Tennis Elbow Take to Improve?

Tendon problems can take longer than many patients expect.

The NHS notes that tennis elbow may persist for months and sometimes longer, with physiotherapy often considered when symptoms have not improved after several weeks of simpler treatment. (nhs.uk)

Mayo Clinic also notes that surgery is usually considered only when symptoms remain significant after approximately 6 to 12 months of other treatment. (mayoclinic.org)

That does not mean you should simply wait for a year without reassessment.

The more useful question is:

Is there a meaningful trend toward improvement?

For example:

• Is grip strength improving?
• Can you lift heavier objects?
• Is pain less frequent?
• Can you work for longer?
• Can you return gradually to sport?
• Is tenderness decreasing?

If progress has completely stalled, the treatment plan may need to change.

Why Might Physiotherapy Not Be Working?

There are several possible reasons.

1. The Diagnosis May Need to Be Reconsidered

Not all elbow pain is tennis elbow.

Possible causes include:

• Tennis elbow
• Golfer’s elbow
• Tendon tear
• Bursitis
• Arthritis
• Ligament injury
• Ulnar nerve irritation
• Radial nerve irritation
• Pain referred from the neck

If treatment is aimed at the wrong structure, progress may be limited.

2. The Tendon May Be Getting Too Much Load

Tendons need load to recover, but too much too quickly can repeatedly aggravate symptoms.

If every exercise session causes:

• Significant pain
• Several days of worsening
• Reduced grip strength
• Difficulty working

the programme may need to be adjusted.

Possible changes include:

• Lower resistance
• Fewer repetitions
• More recovery time
• Different exercises
• Gradual progression

The goal is progressive tendon adaptation rather than repeated flare-ups.

3. The Tendon May Not Be Getting Enough Load

The opposite can also happen.

If rehabilitation consists only of:

• Massage
• Stretching
• Rest
• Passive treatments

without gradually rebuilding tendon capacity, the elbow may remain sensitive when normal gripping or lifting resumes.

Mayo Clinic notes that forearm strengthening is an important part of tennis-elbow rehabilitation and recovery. (mayoclinic.org)

4. The Aggravating Activity Has Not Changed

If the elbow is repeatedly overloaded during:

• Work
• Gym training
• Racquet sports
• Manual labour
• Repetitive gripping

then therapy may struggle to keep up with the daily irritation.

Sometimes technique, equipment or workload needs to be modified.

Mayo Clinic specifically recommends examining work or sporting movements when they are contributing to tennis-elbow symptoms. (mayoclinic.org)

5. There May Be a More Significant Tendon Injury

A more substantial tendon injury becomes more important to consider when symptoms:

• Began suddenly
• Followed heavy lifting
• Followed a sports injury
• Include significant weakness
• Have not improved despite appropriate rehabilitation

In these situations, imaging may help determine whether there is:

• Tendon degeneration
• Partial tearing
• Another structural problem

6. A Nerve May Be Involved

Persistent tingling or numbness is not typical of a simple tendon problem.

For example, pain around the inside of the elbow with tingling into the:

• Ring finger
• Little finger

may involve the ulnar nerve.

Pain around the outer elbow can also occasionally overlap with radial nerve problems.

If neurological symptoms are present, repeatedly treating the tendon alone may not solve the problem.

7. The Pain May Be Coming From the Neck

A cervical nerve problem can sometimes cause pain around the:

• Shoulder
• Upper arm
• Elbow
• Forearm

Clues include:

• Neck pain
• Tingling
• Numbness
• Burning pain
• Arm weakness

If these symptoms are present, the cervical spine should also be considered.

What if I Have Been Diagnosed With Tennis Elbow but I Am Not Improving?

The diagnosis may still be correct.

Tennis elbow can be stubborn.

However, persistent symptoms should prompt questions such as:

• Is the pain really located at the outer tendon attachment?
• Is there substantial weakness?
• Is nerve irritation present?
• Is the exercise load appropriate?
• Is work or sport repeatedly aggravating the tendon?
• Would imaging change treatment?

Mayo Clinic notes that medical history and examination are often enough to diagnose tennis elbow, but imaging may be used when another cause is suspected. (mayoclinic.org)

What if Golfer’s Elbow Is Not Improving?

Golfer’s elbow can also take months to settle.

Mayo Clinic states that strengthening should be gradually progressed and that ultrasound or MRI may be considered when symptoms are severe or are not improving. (mayoclinic.org)

Persistent inner elbow pain may justify asking whether:

• The flexor tendons remain irritated
• The ulnar nerve is involved
• There is another structural problem

Should I Stop Physiotherapy?

Not necessarily.

A better next step may be to:

• Reassess the diagnosis
• Modify exercise loading
• Change exercise selection
• Adjust aggravating activities
• Add another treatment
• Obtain imaging where appropriate

Physiotherapy may remain useful even if the original programme was not producing enough progress.

Is Shockwave Therapy an Option?

Shockwave therapy is sometimes used for persistent tendon problems.

Mayo Clinic lists extracorporeal shockwave therapy among treatment options that may be considered for tennis elbow that is not settling with simpler treatment. (mayoclinic.org)

It works by delivering acoustic pressure waves to the affected tissue.

It is not automatically suitable for every painful elbow.

The diagnosis should first be reasonably clear.

Does Shockwave Replace Exercise?

Usually not.

Even when shockwave is used, strengthening and gradual return to activity remain important.

Mayo Clinic specifically notes that exercises to rebuild strength and restore elbow function remain important regardless of the treatment selected. (mayoclinic.org)

What About Steroid Injections?

Steroid injections may provide temporary pain relief in selected patients, but they are not always the preferred long-term solution for chronic tendon problems.

Mayo Clinic Sports Medicine notes that corticosteroid injections are not routinely recommended for tennis elbow because they have not demonstrated significant long-term benefit. (sportsmedicine.mayoclinic.org)

Whether any injection is appropriate should be decided individually.

What About PRP?

Platelet-rich plasma injections are sometimes used for persistent tendon problems.

Mayo Clinic lists PRP among procedures that may be considered for tennis elbow. (mayoclinic.org)

However, PRP is not automatically necessary and should not replace proper diagnosis and rehabilitation.

Should I Have an X-Ray?

X-ray can help rule out other causes such as:

• Arthritis
• Fracture
• Bone abnormalities

Mayo Clinic notes that X-rays may be used when another cause of elbow pain is suspected. (mayoclinic.org)

X-rays do not show tendon structure in the same detail as ultrasound or MRI.

When Is Ultrasound Useful?

Ultrasound can be particularly useful when persistent pain is suspected to involve:

• Tennis-elbow tendons
• Golfer’s-elbow tendons
• Partial tendon tears
• Bursa
• Superficial nerves

Musculoskeletal ultrasound provides real-time imaging of tendons, muscles, ligaments and nerves without ionising radiation.

It can also be used to guide certain procedures.

When Is MRI Useful?

MRI may be useful when:

• Symptoms remain persistent despite appropriate treatment
• Significant weakness is present
• A deeper or more extensive tendon injury is suspected
• The diagnosis remains uncertain
• There may be ligament or joint involvement
• Surgery or another procedure is being considered

RadiologyInfo states that musculoskeletal MRI provides detailed images of joints, soft tissues and bones and is particularly useful for injuries and degenerative disorders. (radiologyinfo.org)

Ultrasound vs MRI: Which Is Better?

Neither is always better.

Ultrasound May Be Particularly Useful For:

• Superficial tendons
• Tennis elbow
• Golfer’s elbow
• Dynamic assessment
• Selected nerve problems
• Image-guided procedures

MRI May Be Particularly Useful For:

• More extensive tendon injury
• Ligament problems
• Joint abnormalities
• Deeper structures
• Multiple possible causes
• Persistent unexplained symptoms

The correct scan depends on the clinical question.

Does MRI Use Radiation?

No.

MRI uses a strong magnetic field and radiofrequency energy rather than ionising radiation. (radiologyinfo.org)

Does Every Persistent Elbow Problem Need MRI?

No.

Many cases can still be diagnosed clinically.

Imaging becomes more valuable when:

• The diagnosis is uncertain
• Symptoms are atypical
• Treatment is not working
• A structural tear is suspected
• Imaging would change the next step

What if My Grip Is Getting Weaker?

Persistent or progressive weakness deserves reassessment.

Weakness can occur because pain limits effort, but it can also suggest:

• More significant tendon injury
• Nerve involvement
• Another musculoskeletal problem

Do not simply continue increasing exercise resistance if strength is clearly deteriorating.

What if I Have Tingling or Numbness?

Tingling or numbness suggests that a nerve may be involved.

That changes the clinical question.

Persistent neurological symptoms may require:

• Nerve examination
• Assessment of the neck
• Imaging or other testing where appropriate

What if My Elbow Pain Is Actually Worse With Neck Movement?

That makes a cervical source more important to consider.

The elbow may not be the primary problem at all.

A medical assessment can help determine whether symptoms originate from:

• Elbow tendons
• Peripheral nerves
• Cervical spine

When Does Surgery Become Relevant?

Surgery is rarely the first treatment for tennis or golfer’s elbow.

Mayo Clinic notes that surgery may be considered for tennis elbow after approximately 6 to 12 months of other treatments without adequate improvement. (mayoclinic.org)

Similar timing is described for persistent golfer’s elbow. (mayoclinic.org)

Most patients do not require surgery.

How Much Does an Elbow MRI Cost in Singapore?

For many patients arranging an elbow MRI through The Pain Relief Clinic, the current price is approximately:

S$1,000

This generally includes:

• MRI examination
• MRI images
• Formal radiologist’s report

Eligible outpatient diagnostic scans may qualify for up to:

S$600 per patient per year from MediSave

subject to prevailing requirements and the patient’s remaining annual withdrawal limit.

Singapore’s Ministry of Health confirms that the annual MediSave withdrawal limit for outpatient diagnostic scans increased from S$300 to S$600 from 1 January 2026. (moh.gov.sg)

How Quickly Can I Get an Elbow MRI?

When MRI is medically appropriate, The Pain Relief Clinic can often arrange elbow imaging:

Within one working day

subject to:

• MRI safety screening
• Appropriate imaging protocol
• Appointment availability

Frequently Asked Questions About Elbow Pain Not Improving After Physiotherapy

How long should tennis elbow take to improve?

Recovery can take months. Surgery is generally considered only in selected cases after approximately 6 to 12 months of conservative treatment. (mayoclinic.org)

Why is physiotherapy not helping my elbow?

Possible reasons include incorrect diagnosis, excessive or insufficient tendon loading, ongoing aggravating activity, significant tendon injury, nerve involvement or referred pain from the neck.

Should I get an ultrasound?

Ultrasound can be useful when persistent pain is suspected to involve a superficial tendon or nerve.

Should I get an MRI?

Not automatically. MRI may be useful if symptoms remain unexplained, significant structural injury is suspected or imaging would change the treatment plan. (radiologyinfo.org)

Is shockwave therapy an option?

Yes, it is one non-surgical option sometimes used for persistent tennis elbow. (mayoclinic.org)

Should I have a steroid injection?

Not automatically. Mayo Clinic Sports Medicine notes that steroid injections are not routinely recommended for tennis elbow because of limited long-term benefit. (sportsmedicine.mayoclinic.org)

Does failed physiotherapy mean I need surgery?

No. Surgery is rarely required and is generally considered only after a prolonged period of unsuccessful non-surgical treatment.

How much does an elbow MRI cost?

An elbow MRI arranged through The Pain Relief Clinic is currently approximately S$1,000, including the scan images and formal radiologist’s report.

Elbow Pain Still Not Improving Despite Physiotherapy?

If you have already completed weeks or months of physiotherapy but elbow pain still affects gripping, lifting, work or exercise, it may be useful to reassess why progress has stalled.

At The Pain Relief Clinic, we can assess:

• Whether the original diagnosis still fits
• Whether the problem is tendon-related
• Whether nerve involvement is present
• Whether the neck may be contributing
• Whether the rehabilitation load should change
• Whether ultrasound, X-ray, MRI or no imaging is most appropriate
• Whether shockwave therapy or another non-surgical treatment may be suitable

When MRI is medically indicated, elbow imaging can often be arranged within one working day.

Elbow reassessment through The Pain Relief Clinic

• Medical assessment by a licensed medical doctor
• In-house physiotherapy
• Review of previous rehabilitation
• Assessment of tendon and nerve-related causes
• Shockwave therapy where clinically appropriate
• Fast access to imaging when indicated
• Elbow MRI often available within one working day
• Approximately S$1,000 for many elbow MRI examinations
• Up to S$600 MediSave for eligible outpatient diagnostic scans
• Formal radiologist’s report
• Non-surgical treatment options where appropriate

Arrange an Elbow Pain Reassessment

The Pain Relief Clinic

Call / WhatsApp: +65 9068 9605

If your elbow pain has not improved despite physiotherapy, contact us for an assessment of whether the diagnosis, rehabilitation programme or investigation plan should be reconsidered.

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References

1. Mayo Clinic — Tennis Elbow: Diagnosis and Treatment.
2. Mayo Clinic Sports Medicine — Tennis Elbow: Treatments.
3. Mayo Clinic — Golfer’s Elbow: Diagnosis and Treatment, updated 2026.
4. NHS — Tennis Elbow.
5. RadiologyInfo.org — Musculoskeletal MRI, reviewed 15 June 2026.
6. Singapore Ministry of Health — Outpatient Care, updated 1 June 2026.
7. Singapore Ministry of Health — Adequacy of S$600 Annual MediSave Withdrawal Limit for Outpatient CT and MRI Scans, 6 August 2026.

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Important Medical Information

This article provides general educational information and does not replace an individual medical consultation.

Persistent elbow pain after physiotherapy can result from ongoing tendon overload, an incomplete diagnosis, nerve irritation, structural tendon injury, joint problems or referred pain from the neck.

Imaging is not required for every persistent elbow problem. The appropriate investigation depends on symptoms, examination findings, neurological symptoms, trauma history, duration, treatment response and whether imaging would change management.

Seek prompt medical attention for significant trauma, visible deformity, inability to move the elbow after an injury, major sudden weakness, or a hot swollen elbow with fever.

Reviewed by Dr Terence Tan, Founder of The Pain Relief Clinic — 18 September 2026