This blog post offers effective exercises and strategies to help treat your own Tennis Elbow at home.

What is Tennis Elbow?

“Tennis Elbow” is a condition which involves an injury to the tendons in the elbow.

It is associated with pain on the outer side of the elbow/forearm.

(It is also referred to as “Lateral Epicondylitis”.)

Table Of Contents

• Tendons Involved
• Causes
• Tests
• Exercises To Fix Tennis Elbow
• Common Questions

Tendons Involved

The following muscles/tendons are involved with a Tennis Elbow injury,

The function of these muscles is to EXTEND the wrist/fingers

They share a common attachment site called the Common Extensor Origin.

(Note: I would advise you to check out the location of these muscles on Google.)

causes

Essentially – it is due to overuse, misuse and/or abuse of the elbow.

Any repetitive or prolonged use of weak elbow structures can increase the risk of an injury.

This may be associated with:

The above mentioned factors may also lead to pain in the inner elbow region (called Golfer’s Elbow).

How to tell if you have Tennis Elbow

Here a few methods to determine if you have Tennis Elbow.

Get A Scan

An ultrasound or a MRI scan of the elbow is the best way to determine if you have any injury to the elbow.

Location Of Pain

Pain is usually experienced on the outside of the elbow and/or forearm.

Test For Tennis Elbow

Instructions:

• Place your arm in front of you.
• Have your palm facing downwards and fingers extended.
• Using your other hand, apply a firm downward force on top of your finger tips.
• Resist this motion.

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Exercises for Tennis Elbow

When performing the following exercises at home, please be gentle so that you do not make your pain worse.

STEP 1: Reduce Aggravation
STEP 2: Reduce Inflammation
STEP 3: Symptomatic Relief
STEP 4: Releases
STEP 5: Stretches
STEP 6: Nerve Sensitivity
STEP 7: Isometric Exercises
STEP 8: Strengthening Exercises
STEP 9: Reduce Demand On Elbow
STEP 10: Neutral Wrist
STEP 11: Know Your Limits
STEP 12: Address Rounded Shoulders
STEP 13: Taping And Braces

STEP 1: Address any activity that causes pain

Stop, Modify and/or Reduce exposure to any activity that makes your symptoms worse.

How can you expect the following exercises to help if you continue to aggravate your symptoms?

I can’t stress this enough: Failure to comply with Step 1 will make it very difficult for you to fix your elbow.

STEP 2: Reduce Inflammation

Before starting the exercises at home, it is important to reduce the amount of inflammation in the elbow.

(If the inflammation is not under control, the elbow may be too painful or sensitive to tolerate the exercises mentioned on this blog post.)

Use a Cold Pack

This will help to:

Recommendation: 10-15 minutes, 3-5 times a day

I generally recommend cold therapy for 2-3 days following any recent aggravation.

Anti-Inflammatory Gel

Apply an anti-inflammatory gel to the areas of pain to help manage excessive inflammation.

Recommendation: 2-3/day

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

This oral medication reduces inflammation in the whole body.

It is recommended that you take it strictly for 10-14 days, at the same time of day, regardless of pain levels.

(Consult your doctor to determine the appropriate medication and respective dosage.)

Steroid Injection

This injection consists of a strong steroid (Cortisone) which helps reduces local inflammation.

My recommendation: Try the following exercises before you even consider getting the cortisone injection.

STEP 3: Symptomatic relief

Consider the following options to reduce pain levels.

Heat Pack

Applying heat to the painful area can help to:

Recommendation: 10-15 minutes, 3-5 times a day

(Note: Following a recent injury to the elbow, I recommend applying a cold pack for 24-72 hours. After this period, switch to heat application.

Pain Medication

In the initial stages, pain medication can help reduce the amount of pain being experienced.

However, as the pain levels improve, I would strongly encourage you to wean off as soon as you can.

(Note: If you are considering taking any medication, consult your doctor to determine what medication will be the most appropriate.)

STEP 4: Releases

Releasing the tight muscles in the elbow can help reduce tension in the painful region.

Outer Elbow Release

Instructions:

• Place a massage ball on top of a table.
• Place the painful region on top of the massage ball.
• Lean an appropriate amount of pressure down on the massage ball.
• Be careful not to press directly onto any bony surfaces.
• Continue for 2 minutes.

(Note: If the area of pain is too sensitive, do not continue performing this technique as it may lead to more aggravation. You may need to consider revisiting Step 2: Reduce Inflammation and Step 3: Pain Relief.)

STEP 5: Stretches

Stretching is a great way to reduce tension in the tight structures in the elbow.

Stretching is all about a game of angles. You may need to adjust the position of your hand/wrist until you achieve the specific stretch in the right location.

(Note: DO NOT stretch into sharp pain!)

Stretch to Extensors

Instructions:

• Straighten your arm in front of you. (palm facing downwards)
• Make a gentle fist with your hand.
• Bend your wrist downwards.
• Twist your wrist outwards.
• Using your other hand, apply a downward pressure onto back of the hand.
  • Make sure that there is no tingling/numbness in your fingers as you do this!
• Whilst locking your wrist into position, twist your arm so that the elbow crease is facing more upwards.
• Aim to feel a stretch on the top side of the elbow.
• Hold for 30 seconds.
• Repeat 3 times.

Warning: If you develop tingling and/or numbness in the palm or fingers whilst performing this stretch, you may have Carpal Tunnel Syndrome. If this is the case – cease this stretch immediately.

Stretch to Flexors

Instructions:

• Straighten your arm in front of you. (palm facing upwards)
• Keep your hand and fingers opened.
• Bend your hand towards the floor.
• Using your other hand, bend the fingers/wrist further backwards.
• Aim to feel a stretch along the front of the fingers, wrist and forearm.
• Hold for 30 seconds.
• Repeat 3 times.

STEP 6: Reduce nerve sensitivity

There are several nerves in the elbow that may amplify the amount of pain being experienced.

Nerve glides/stretches are great ways to reduce the sensitivity of the nerves.

(READ THIS: Do not over stretch the nerves as this can cause more irritation! Go slow! Avoid any tingling/numbness in the arms.)

Nerve Stretch

This stretch/glide targets the Radial Nerve which passes through the outer elbow region.

Instructions:

• Pull your shoulders back and down.
• Keep your elbow completely straight throughout this exercise.
• Lift your arm out towards the side towards shoulder height
• Make a gentle fist with your hand.
• Twist your entire arm inwards (internal rotation) so that the palm is facing behind you.
• Bend your wrist backwards.
• Slowly tilt your neck towards the opposite side.
• Aim to feel a stretch anywhere along the side of the neck/upper arm/outside elbow and back of wrist.
• Hold for 1-2 seconds.
• Repeat 20 times.

sTEP 7: Isometric Contractions

Isometric contractions of the elbow is when you activate the muscle without moving the elbow/wrist/fingers.

The aim of the following Tennis Elbow exercises is to reduce pain and to commence gentle strengthening exercises.

Isometric Exercise

Instructions:

• Bend your elbow to 90 degrees whilst keeping your elbow by your side.
• Make a gentle fist with the palm facing downwards.
• Maintain this position as you push down on the fist with your other hand.
• The aim is to push as hard as possible without causing a significant amount of pain.
  • A slight discomfort and/or small amount of pain is acceptable.
• Feel the contraction of the muscle at the site of pain.
• Hold for 45 seconds.
• Repeat 3 times.
• Progression:
  • Perform the same exercises with an open hand. (resistance applied at finger tips).
  • You can perform this exercise at different wrist angles as well.
  • Repeat exercise with a straight arm.

STEP 8: Strengthening exercises

These exercises are designed to improve tendon strength, endurance and load tolerance in the elbow.

Grip Strength

Instructions:

• Grip onto a stress ball.
• Squeeze as hard as you can without feeling any pain.
• Hold for 5-10 seconds.
• Repeat 10 times.
• Progression:
  • Move your hand in different directions as you squeeze. (eg. Up/down, circles, side to side, twisting)

Eccentric Strengthening

Instructions:

• Support your forearm onto a table with your hand hanging over the edge.
  • The palm should be facing downwards.
• Place a suitable amount of weight in your hand.
  • (Challenging, but able to control)
• Using your unaffected hand, lift both the weight and hand together upwards.
• Let go of the hand, and allow the hand holding onto the weight to control the weight as it is slowly lowered.
• Perform 20 repetitions.
• Repeat 3 times.

Resisted Extension

Instructions:

• Support your forearm onto a table with your hand hanging over the edge.
  • The palm should be facing downwards.
• Place a suitable amount of weight in your hand.
  • (Challenging, but able to control)
• Whilst holding onto the weight, proceed to lift and lower the weight in a slow and controlled manner.
  • 3 seconds up/3 seconds down
• Perform 20 repetitions.
• Repeat 3 times.
• Progression:
  • Change to hook grip.

Resisted Supination/Pronation

Instructions:

• Support your forearm onto a table with your hand hanging over the edge.
• Hold onto a hammer.
• Proceed to twist your forearm (palms up/down).
• Perform 20 repetitions.
• Repeat 3 times.
• Progression:
  • Tie a resistance band to the hammer.

Finger Strength

Instructions:

• Apply the finger resistance band as shown above.
• Proceed to open and close your hand.
• Perform 20 repetitions.
• Repeat 3 times.

sTEP 9: Reduce demand on the elbow

The elbow muscles will tend to compensate for any weakness in other areas of the body.

Strengthening these weak areas may reduce the demand on the elbow muscles which can help prevent this issue from returning.

Scapula Retraction + Posterior Shoulder Strengthening

Instructions:

• Tie a resistance band onto a stationary object at waist height.
• Stand sideways to where the resistance band is anchored.
• Hold onto the band and keep your elbows by your side throughout the exercise.
• Make sure to keep your palms facing towards the anchor point.
• Keep your shoulders wide/long and gently retract the shoulder blades.
• Pull the resistance band out towards the side.
• Aim to feel a contraction in between the shoulder blade and behind the shoulder joint.
• If you feel your elbow is over working, reduce the amount of resistance on the band.
• Hold for 3-5 seconds.
• Repeat 10 times.

Shoulder Flexion

Instructions:

• Hold onto a suitable amount of weight.
  • (Challenging, but able to control)
• Raise your arm up to shoulder height.
• Keep your palm facing downwards.
• Aim to feel a contraction in the front of your shoulder.
• Make sure to keep your wrist and elbow locked into position.
  • The movement should be from the shoulder only.
• Repeat 10 times.

Thumb Opposition

This exercise will help with your grip strength.

Instructions:

• Place the tips of your pinky finger and thumb together.
• Squeeze is hard as you can.
• Keep your fingers curved as you squeeze. (see above)
• Hold for 10 seconds.
• Repeat 5 times.

STEP 10: Use Wrist in a neutral position

It is important to use the wrist in a neutral position as it encourages the most optimal use of the muscles.

(Keep in mind – depending on what you’re doing with your hand, this will not always be possible!)

Neutral position of wrist

1. Middle finger aligned with line of forearm

2. Wrist bend backwards slightly

Any deviation away from the neutral wrist position may increase the risk of aggravating your symptoms.

To complete a thorough rehabilitation of your elbow injury, it is highly recommended that you eventually challenge yourself with exercises where the arm, elbow, wrist and/or hand are in an awkward (non-neutral) position.

STEP 11: Know your limits

Although I have highlighted in Step 1 to avoid all aggravating activities, you still need to keep your elbow as mobile as possible.

Enter what I call Threshold Movements: This refers to the maximum amount of stress the elbow can tolerate before re-aggravating.

(It is important to monitor the pain levels during and 24 hours later.)

The trick is keeping your elbow activity as close to the threshold level without going over.

In this situation, you should aim to type for ~1 hour and follow up by a rest period before resuming the activity.

STEP 12: Address Rounded Shoulders

A forward position of your shoulder will place your elbow in a position where it may be forced to work inefficiently.

This means that the tendons in the elbow will have to work harder than they should!

Here are some exercises to help you address rounded shoulders:

Chest Stretch

Instructions:

• Place both hands on the door frame.
• Pull your shoulders back.
  • “Open up your chest”
• Lunge forwards.
• Do not arch your lower back.
• Aim to feel a stretch in the chest region.
• Hold for 30 seconds.

Scapula Retraction

Instructions:

• Maintain wide and long shoulders.
• Perform Scapular Retraction: (see above)
  • “Pull your shoulder blades together”
• FEEL the contraction between the shoulder blades.
• Hold for 30 seconds.
• Repeat 3 times.

For a complete guide on how to address this issue:

See Post: Rounded Shoulders

STEP 13: Taping And Braces

Elbow taping and braces can help provide support and warmth to your muscles.

Just remember – DO NOT become dependent on them!

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Common Questions

Have a question? Please let me know in the comment section and I will get back to you.

How often should I do these exercises?

• Start with 1/week for the first 2 weeks.
• Progress to 2/week for 4 weeks.
• Aim for 3/week if tolerated.

How long does Tennis Elbow take to heal?

For a minor presentation, it is likely going to take 2-6 weeks to recover.

If you have a chronic case, it may take 3-6 months.

(Keep in mind – there are several factors which can influence the healing time.)

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Conclusion

Tennis Elbow is a painful condition where there is injury to the tendons in the elbow.

It is usually caused by loading the elbow above what the tendons/muscles can tolerate.

Follow the suggested exercises and tips on this blog post to completely fix your Tennis Elbow.

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Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. Seek guidance from a healthcare professional before starting any exercise and/or implementing any recommendation. For more information: Medical Disclaimer.