What exercises are recommended for managing lateral epicondylitis (tennis elbow)?

Recommended Exercises for Tennis Elbow (Lateral Epicondylitis)

Eccentric strengthening exercises are the most effective intervention for managing lateral epicondylitis (tennis elbow), reducing symptoms, increasing strength, and promoting tendon healing. 1

Understanding Tennis Elbow

Tennis elbow (lateral epicondylitis) is a common musculotendinous degenerative disorder affecting the extensor origin at the lateral humeral epicondyle. It:

• Is 7-10 times more common than medial epicondylitis
• Affects the dominant arm 75% of the time
• Occurs equally in men and women
• Is most common after age 40
• Results from activities requiring repetitive wrist extension 1

Evidence-Based Exercise Protocol

1. Eccentric Strengthening Exercises

Eccentric exercises have proven beneficial in tendinopathies and should form the core of your rehabilitation program:

• Wrist Extension Eccentric Exercise:

  • Hold a light weight (start with 1-2 lbs)
  • Use the unaffected hand to assist in raising the wrist to extension
  • Slowly lower the weight with the affected wrist (3-5 second count)
  • Perform 3 sets of 10-15 repetitions 1, 2

• Forearm Pronation/Supination:

  • Hold a light weight or hammer
  • Rotate forearm slowly from palm up to palm down position
  • Perform 3 sets of 10-15 repetitions 3

2. Progressive Resistance Training

• Grip Strengthening:

  • Use a soft squeeze ball or hand gripper
  • Start with 8-12 repetitions
  • Progress to 15-20 repetitions for muscular endurance
  • Rest 2-3 minutes between sets 1

• Wrist Flexion/Extension:

  • Start with very light weights (40-50% of maximum capacity)
  • Progress gradually as strength improves
  • Perform 2-4 sets of 8-12 repetitions 1

3. Stretching Exercises

• Wrist Extensor Stretch:

  • Extend arm with palm facing down
  • Use opposite hand to gently pull hand downward
  • Hold for 15-30 seconds
  • Repeat 3-4 times 1, 4

• Forearm Stretches:

  • Perform daily
  • Hold each stretch for 10-30 seconds (30-60 seconds for older adults)
  • Stretch to the point of mild discomfort, not pain 1

Complementary Treatments

Ice Therapy

• Apply ice through a wet towel for 10-minute periods
• Effective for short-term pain relief
• Use after exercise sessions 1

Bracing

• Consider using a counterforce brace (tennis elbow band)
• Wear during activities that provoke symptoms
• May help unload the affected tendon 1, 5

Exercise Progression

1. Initial Phase (Weeks 1-2):

   • Focus on stretching and very light resistance
   • Emphasize proper technique
   • Use ice after exercises

2. Progressive Phase (Weeks 3-6):

   • Gradually increase resistance
   • Add more repetitions before adding weight
   • Continue stretching program

3. Functional Phase (Weeks 7+):

   • Incorporate sport or occupation-specific movements
   • Progress to more challenging exercises as tolerated

Important Considerations

• Avoid Pain Triggers: Modify activities that worsen symptoms during rehabilitation
• Proper Form: Ensure exercises are performed with correct technique
• Consistency: Exercise 2-3 times per week minimum for best results 1
• Gradual Progression: Increase resistance gradually to avoid symptom exacerbation
• Patience: Tendon healing takes time; improvements may be gradual

Common Pitfalls to Avoid

• Rushing progression of exercises
• Ignoring pain during exercises (mild discomfort is acceptable, but sharp pain is not)
• Focusing only on the elbow while neglecting shoulder stability
• Returning to aggravating activities too quickly
• Relying solely on passive treatments without active exercises

By following this structured exercise program with emphasis on eccentric strengthening, most patients with tennis elbow can expect significant improvement in pain and function without requiring more invasive interventions.