Tennis Elbow Exercises: Three Key Principles
Are you looking for which exercises you should do when you have Tennis Elbow? You’re in the right place! – But are you sure it’s the right time?
Because there’s a right time and a wrong time to begin those Tennis Elbow exercises, and it can make a huge difference in your rehab – giving you a faster, easier recovery! (Or a slow, painful slog.)
So, let’s explore, not only what exercises to do, but when to do them – And a couple other key principles I’ll share with you that you won’t likely find anywhere else.
The Three Key Principles Of Tennis Elbow Rehab:
- Tennis Elbow Rehab Exercises are NOT the top priority in the beginning – (And should be deferred until the later stages of healing and recovery) – What’s The Top Priority?
- Starting Tennis Elbow Rehab Exercises right away often aggravates the injury – (For many, beginning right away is often too soon and turns out to be a mistake) – Starting Too Soon
- The Best Exercise to begin your Tennis Elbow rehab with – Is NOT the standard ‘Wrist Extension Exercise’ that directly targets your “Tennis Elbow Muscles” – The Best Exercise
Runner Up Principle: Eccentric Exercise Probably Doesn’t Matter – Why it shouldn’t matter which type of exercise you do IF you do it at the right time – Eccentric Exercise
Of course, there’s more to treating Tennis Elbow than just exercises! – Get a complete program of therapies, stretches AND exercises here: Start breaking your vicious cycle of pain today with this video-based self-help treatment program!
Getting these three major principles wrong, are the biggest mistakes far too many Tennis Elbow sufferers make when it comes to their rehab – with or without formal Physical Therapy.
And I hope to help you avoid these mistakes which, along with all the other far-too-common Tennis Elbow treatment mistakes, can aggravate your symptoms, worsen your injury and delay your recovery.
Now, chances are, this is going to “butt heads” with much of you’ve been told or read up to this point…
But, I’m here to encourage you, as a therapist who has specialized in treating Tennis and Golfer’s Elbow for 15+ years in person – and as a virtual teacher of these principles and techniques online for at least a decade…
That following these strategies should give you a much better chance at a better, shorter and less frustrating recovery!
Let’s begin with WHY exercise isn’t the priority…
I don’t know if you had the same experience, but it seems that for many sufferers the minute you get diagnosed or realize that you have Golfer’s or Tennis Elbow, rehab exercises are immediately foisted on you by well-intentioned “experts” and “authorities.”
Most well-meaning Physical Therapists, trainers and online personalities will tell you to get started with those Tennis Elbow rehab exercises right away…
Although, sometimes with the caveat that you should rest for a certain amount of time and/or ice the area to supposedly “get the inflammation down” first before beginning those exercises.
Which is a complete myth – See this article on The Inflammation / Tendonitis Fallacy
After all, it is a well-known, common-sense principle of rehab and recovery that you normally want to allow your injury to heal to some extent…
BEFORE you start challenging and strengthening it with exercises, right?
So, why then, does this principle often seem to either get thrown out the window entirely when it comes to Tennis Elbow?…
OR, if it is applied, and you go through a period of several weeks or months of Resting, Hoping And Waiting – Along with the requisite inflammation-chasing “witch hunt” of pills, shots and ice…
WHY doesn’t that help your tendons heal and prepare them for exercise?
Probably because Tennis Elbow is a different kind of injury, altogether.
Unlike a torn muscle, fractured bone or ligament sprain, Tennis Elbow USUALLY involves no torn tissues (at least in the early to middle stages the vast majority of the time)
It’s not an Acute type of injury that you have to wait a certain length of time – moving it as little as possible – to allow for healing to progress before you start exercising the area.
For example, a fracture is usually immobilized with a cast for 6-8 weeks to allow the healing process to “knit” the bone back together.
Then the cast comes off and you begin your rehab exercises.
Tennis Elbow is different. It’s a sneaky, gradual, degenerative injury process.
The tendon usually isn’t torn – It’s gradually breaking down on a microscopic level (like some kind of “dry rot”)
This is known as Tendinosis (forget Tendonitis – Tennis Elbow is NOT Tendonitis. It’s not inflammatory – It’s degenerative.)
And, as it progresses, it slowly weakens the tendon – Possibly setting it up for a tear later on – If this degenerative state is not reversed.
What we need to do is “flip the switch” and change course from this state of degenerative breakdown – To a state of REgeneration, repair and healing.
But time ALONE doesn’t necessarily lead to this…
These tendon injuries often remain stalled and stagnant for months or even years!
That’s the essence of the degeneration problem. Time alone often doesn’t help…
What matters is what you’re proactively DOING over that time – as opposed to passively ‘Resting, Hoping And Waiting’
Now, many schools of thought encourage exercises as a way to reverse this process…
But I’m convinced that the #1 priority is to physically disrupt the state of stagnation in the tendon with hands-on manipulation / advanced massage techniques
As well as, by using heat instead of ice to encourage circulation in and around the tendon – which is typically sorely lacking!
And to be clear, it’s not that exercise doesn’t help – There is plenty of evidence that it does…
It’s just that it doesn’t seem to be very efficient at stimulating healing, and it seems to be risky for many Tennis Elbow sufferers who start it too soon…
Yes, there are a wide range of injury severity levels, of course: Mild, moderate and severe – And everything in between.
Not everyone is in the same boat.
If you are in the early stages and have a milder Tennis Elbow injury it may be perfectly safe for you to begin your rehab exercises right away.
(You can find countless stories from people who recovered by only doing exercises and they had a fairly easy time of it. Chances are they had the mildest of injuries.)
In the early stages, there is little to no degenerative change to the tendons and just strengthening the muscles and tendons involved can arrest the process and prevent that downward slide.
But if you already have a moderate to severe injury, there’s a significant risk you face by starting those exercises right away.
Chances are, you do already have some degeneration – and although exercises might be enough to turn it around…
There’s also a very good chance that the increased load might be too much for your weakened tendons and might aggravate or worsen your injury.
I can’t tell you how many times I’ve heard this story – Even in a controlled, “expert” setting.
Susan is diagnosed with Tennis Elbow, she ices it, wears a brace and takes anti-inflammatories for several weeks, and then reports to Physical Therapy, as prescribed…
Only to find that the exercises they have her doing in Physical Therapy and/or at home only seem to aggravate her Tennis Elbow.
(She diligently keeps trying for a few weeks, but eventually gives up when her elbow doesn’t improve or actually gets worse.)
So, when IS the right time to begin rehab exercises?
From my perspective, the best time is after you’ve made significant progress with hands-on techniques (and heat) and some stretching…
AND your symptoms are significantly diminished – Not necessarily gone, but at least 75% better.
75% – 90% seems to be the sweet spot.
(But, by that, I’m talking about a 75% – 90% reduction in pain and other symptoms that comes about by supporting the healing process – NOT by suppressing the symptoms with pills, shots and ice.)
So, heat, gentle stretching and movement and especially advanced massage techniques are the priority in the beginning.
Then, once your symptoms have subsided considerably, and you’re feeling a lot more confident in your elbow (every little thing you do no longer “tweaks” it!) you gradually begin introducing the exercises.
And, later on, when your Tennis Elbow pain is nearly or completely gone, continuing to strengthen your muscles and tendons with the exercises becomes the top priority.
Again, I want to be clear that exercises are important and serve an essential role…
However, I’m convinced that role becomes paramount toward the END of the painful part of the recovery process – And NOT at the beginning!
(If you skip this last, essential part and don’t build the strength of your muscles and tendons with the exercises, you have a much greater chance that your Tennis Elbow will recur at some point down the road.)
Here’s my separate article and video on The Timing Of Exercise
Okay, so, which exercises should you start out with when it IS time to begin?
Almost every professional you ask and nearly every guide or resource you refer to on Tennis Elbow will suggest that Wrist Extension is the #1 exercise you need.
After all, it is the exercise that most specifically targets and strengthens the muscles most directly involved in Tennis Elbow.
And, yes, I do recommend including Wrist Extension – I just don’t recommend starting with it!
- I believe in starting with what I call the “indirect” approach.
- Rather than pure Wrist Extension, which loads the “Tennis Elbow” muscles and tendons with all of the weight or resistance…
- I recommend beginning with one or two other exercises – ‘Radial Deviation’ especially.
This Radial Deviation exercise requires some of your Wrist Extensors (Tennis Elbow muscles) to work in tandem with some of your Wrist Flexors (Golfer’s Elbow muscles.)
(It’s also a good idea to do the opposite exercise, which is Ulnar Deviation.)
After that’s been going well for awhile, you could add Wrist Supination, (probably along with Wrist Pronation)
And, finally, when you’re feeling pretty strong and a lot more confident, you could THEN begin adding pure Wrist Extension and perhaps Finger Extension to your rehab program.
But, again, if you’re going to pick just one exercise to start out with, I would strongly recommend Radial Deviation.
Here’s a slightly more detailed look at The Three Best Exercises For Tennis Elbow
And then there’s a debate we could get into on ‘Eccentric Exercise’
Suggesting that focusing on a certain type of exercise – at the exclusion of the other types – is the best and safest way to rehab Tennis Elbow.
This is known as the ‘Eccentric’ or ‘Eccentric-Only’ Exercise Approach.
There are three types of muscle contraction that can be involved in an exercise:
- ‘Concentric Contraction’ which simply means your muscle is contracting and shortening against resistance. (The raising of the dumbbell weight in a Biceps curl, for example.)
- ‘Isometric Contraction’ which is when your muscle neither shortens nor lengthens against resistance, (Holding a dumbbell weight without raising or lowering it, for example.) And,
- ‘Eccentric Contraction’ which is the controlled lengthening of a muscle against resistance. (The Lowering of a dumbbell weight in a Biceps curl.)
The strategy involves setting up an exercise in such a way as to emphasize the Eccentric Contraction and avoid the other two – Especially the Concentric Contraction.
One way to do this is by using the FlexBar device.
I’m basically neutral on this.
See this article and video on Eccentric Exercise And The FlexBar Here for the details on the pros and cons as I see them.
But the bottom line is that I just don’t think it’s necessary to isolate the Eccentric Contraction…
IF you have your priorities set in the right order!
By that, I mean if you prioritize working on your muscles and tendons by hand with advanced massage techniques and encouraging circulation (with heat – not ice!)
And you hold off on the exercises until your symptoms have significantly subsided…
Then it shouldn’t make much difference which type of muscle contractions you do, once you begin exercising!
OK, so what about P.T / Physio?
Physical Therapy For Tennis Elbow
If you’ve been prescribed Physical Therapy or Physiotherapy, you may be wondering how much of that therapy will involve rehab exercise.Usually, rehab exercises are one of, if not THE central component of PT or Physiotherapy…
Typically, along with Therapeutic Ultrasound, Cryotherapy (icing) Electrical Stimulation and a couple other possible ‘Modalities.’
OR, if you’ve already been through a series of Physical Therapy treatments that didn’t end up helping you, you may be wondering why.
I suspect some of the primary reasons PT doesn’t consistently help more Tennis Elbow sufferers, include the failure to apply the 3 principles outlined in this article.
As well as, an attachment to an outdated medical model that still often views inflammation as an enemy to be treated and defeated – rather than allowed – If not encouraged, in some cases.
For a deeper look at P.T. for Tennis and Golfer’s Elbow, see my article and video on the question of:
The bottom line is, once your Tennis or Golfer’s Elbow injury has progressed past a certain point, it usually becomes very difficult to impossible to “strengthen your way out of it!”
Again, the exercises need to be part of a complete program with the right therapies and stretches – that can:
- “Kick-start” your stuck, stalled healing process,
- Break up those nasty adhesions and Scar Tissue in your muscles and tendons…
- And release that stubborn, painful muscle tension.
(NONE of which exercise alone is efficient at accomplishing!)
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I’ll be your personal tutor guiding you through easy-to-follow video lessons, where you’ll learn all the therapy techniques, key stretches AND essential exercises you need to treat and recover from your injury at home. (No special equipment or gimmick devices needed!)
Just watch the videos, follow along and start putting an end to your elbow pain today.
A Complete Self-Treatment Program For Tennis Elbow
Learn more about the Tennis Elbow self-help treatment program – Including the video lessons, bonuses and success stories: Tennis Elbow Self-Help Program
A Comprehensive Golfer’s Elbow Self-Help Program
Learn more about the self-help home treatment program for Golfer’s Elbow – About the video lessons, bonuses and more: Golfer’s Elbow self-help home program
Podcast Playlist: Tennis Elbow Exercises
Featured Articles & Videos On Tennis Elbow Exercise
Here are some other exercise-related articles – One about whether to keep playing tennis or stop and rest, and the second about which exercises to avoid. (Followed by several more.)
Can You Keep Playing Tennis Or Golf If You Have Tennis Elbow?
Is it absolutely necessary to stop playing tennis or golf when you have an elbow injury – Or is it sometimes safe to “play through it” – IF you’re cautious enough?
And if you really DO need to take time off to focus on healing, when will it be safe to start playing again? – Two questions I’m often asked: Can You Keep Playing Tennis Or Golf – Or Must You Rest?
Which Exercises Should You Avoid When You Have Tennis Elbow?
Which upper-body strength-training exercises should you avoid, stop or modify – while you’re injured, anyway?
Does it matter whether you use dumbbells or barbells? What about muscle isolation?
This viedo, post and podcast covers general “classes” of exercises as well as the Specific Exercises You’ll Probably Want To Avoid
Can You Still Work Out When You Have Tennis Elbow?
Can you continue to lift weights or do upper-body strengthening exercises while you’re injured? (It usually depends on several factors.)
What if your injury was caused by weight training in the first place?… Does it matter whether it was from playing tennis or golf – Or computer use OR heavy physical work? Article, Podcast and Video
Eccentric Exercise And Rubber Bars
What form of exercise is the best for Tennis Elbow rehab? Eccentric Exercise has been getting a lot of attention for some time now – (especially when performed with a rubber bar tool called the FlexBar)
But is it really the latest, greatest thing in rehab? Or is this “rubber bar” method just another over-hyped fad? Read the full article here
Exercise Myths, Mistakes And Timing: When Should You Begin?
Many “Lateral Epicondylitis” sufferers make the mistake of starting rehab too soon – before their healing process has progressed enough. Have you already tried Physical Therapy, and it only made your pain worse?
This post and video covers exercise myths and mistakes and the question of the “right timing” for exercise: Article, Video + Podcast
What Exactly Are The Goals Of Rehab? (Besides Becoming Pain Free!)
It might also be a good idea to review what exactly the goals of exercise are when recovering from Tennis Elbow.
This might seem like too obvious a question, at first glance – but there are three key muscle and tendon-healing goals you’re trying to accomplish. Article, Video, and Podcast
What Are The Best Exercises For Tennis Elbow Rehabilitation?
In other words, which specific exercises (wrist extension, reverse curls, supination) are best for strengthening the muscles involved in Tennis Elbow?
(Discover why it’s safer to ease into strengthening with just one or two of them and avoid the third at first.) Article, Video and Podcast