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Tennis elbow exercises
Tennis elbow is a tendinopathy of the muscles that straighten the wrist and fingers, at the point where their shared tendon attaches to the bony bump on the outside of the elbow. Every time you grip, that tendon takes the strain, which is why a problem at the elbow shows up most clearly in the hand.
Despite the name, most cases have nothing to do with tennis. It usually follows a spell of repetitive gripping, lifting, twisting or wrist work that the tendon was not conditioned for - a new job or a new tool, a DIY project, a lot of typing and mousing, the start of gardening season, or carrying a baby around. It is most common between the ages of 35 and 55.
The main symptoms are pain and tenderness over the outer elbow, sometimes spreading into the forearm, brought on by gripping. Lifting a kettle or a full mug, shaking hands, turning a door handle, wringing out a cloth and using a screwdriver are the usual offenders. The arm can feel weak, largely because gripping hurts. Sleep is usually undisturbed and the elbow itself looks completely normal.
It can be stubborn and it often lasts longer than people expect, but it is not harmful and it does respond to the right kind of loading. Many people improve over 6 to 12 weeks and keep building for several months. This programme reduces the irritation first, then progressively loads the tendon along with the forearm, wrist and shoulder, so gripping and lifting become comfortable again and stay that way.
Who this programme is for
Adults with pain over the outer elbow that is brought on by gripping and wrist use, with no history of a fall onto the elbow. It suits both a recent flare and one that has grumbled on for months. If the elbow locks, gives way, or swells markedly, get it assessed first.
Get checked by a clinician first if
- The elbow locks, catches or gives way
- Marked swelling, redness or warmth around the joint, especially with a fever
- Pins and needles or weakness in the hand, or pain that is mainly on the inner side or into the forearm
- Elbow pain after a fall onto the arm that has not been checked
- The pain followed a significant accident, fall or direct blow and you have not been checked over
- You feel unwell with the pain - a fever, night sweats, or losing weight without trying
- The area is hot, very swollen and red, especially if you also feel feverish
- Pain that is severe, steadily getting worse, or keeps you awake every night and does not ease with a change of position
Not sure it's this? Try a self-check
Quick movement tests you can try at home to see what your symptoms might point towards. A guide, not a diagnosis.
- Resisted Wrist Extension TestThe wrist and finger extensor tendons that attach on the outer elbow
The staged programme
Stage 1
Settle the pain
Start here while everyday gripping is painful. Reduce aggravating tasks where you can, use gentle stretching and light isometric holds, and consider a strap or brace for painful activities.
Stage 2
Build strength
Once light gripping is tolerable, load the wrist extensor tendon progressively, with an emphasis on the slow lowering phase, and add strengthening for the shoulder and shoulder blade.
Stage 3
Return to activity
The final stage rebuilds tolerance for heavier gripping, lifting and sport. Increase load and speed gradually, and reintroduce the specific tasks that used to hurt.
How long recovery takes
Tennis elbow often takes 3 to 6 months to settle, and sometimes up to a year. It usually gets better whatever you do, but a structured loading programme reduces pain faster and lowers the chance of recurrence. Most cases never need an injection or surgery.
Knowing when to progress
Use a 24-hour rule: an exercise level is right if the elbow is no more than mildly sore the next morning and settles quickly. Keep loading through some discomfort - waiting for it to be completely pain-free before you start usually means it never improves.
Common questions
Should I rest it completely?
No. Complete rest gives short-term relief but the pain returns as soon as you use the arm. The tendon needs graded load to recover. Modify the heaviest tasks rather than stopping using the arm.
Do cortisone injections work?
They can ease pain for a few weeks, but studies show worse outcomes at 6 to 12 months compared with exercise or even doing nothing. Most guidelines advise against them as a first choice.
Are elbow straps and braces useful?
A counterforce strap or a wrist brace can reduce pain during aggravating activities in the early stages. They are a short-term aid, not a substitute for the strengthening programme.
Why is it taking so long?
Tendons remodel slowly and the outer elbow tendon has a limited blood supply. Consistency over months, rather than intensity in any one session, is what gets results.
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