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Background: Lateral elbow pain is a common musculoskeletal condition of the upper extremity. It can lead to marked dysfunction and decreased productivity at work. Persistent lateral elbow pain is often challenging to treat due to numerous treatment options with limited evidence to prove which is more efficacious. Purpose: The purpose of this case study is to outline the clinical decision making associated with treating persistent lateral elbow pain in a patient that displayed variable responses to care. Case Description: This case study examines a 33-year-old male with lateral elbow pain who was initially diagnosed with lateral epicondylalgia. His pain lasted over ten physical therapy visits despite conventional treatment interventions including manual therapy, trigger point dry needling, and various forms of therapeutic exercises including concentrics, eccentrics, and isometrics. Outcome Measures: The Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) was used to assess this patient’s outcome. Discussion: Various treatments were performed with the patient discussed in this study due to changing symptoms and lasting pain. This case study presents the clinical reasoning behind treatment decisions based on patient response. While often therapeutic interventions have gradually positive outcomes, it is important to recognize and evaluate cases which show less clear immediate improvement.