Exercise With Tennis Elbow: Stay Active While Your Tendon Heals

That nagging pain on the outside of your elbow makes gripping anything—including weights—uncomfortable. Tennis elbow (lateral epicondylitis) is frustrating, but it doesn't have to stop your fitness routine. With the right modifications and specific exercises, you can stay active while your tendon heals.

Understanding Tennis Elbow

What It Is: Tennis elbow is tendinopathy (tendon damage) of the forearm extensor muscles where they attach to the outside of the elbow. Despite the name, most cases aren't caused by tennis.

Common Causes:

• Repetitive gripping motions
• Computer/mouse use
• Manual labor
• Weightlifting with poor technique
• Racquet sports
• Any repetitive wrist extension

Symptoms:

• Pain on outer elbow
• Weak grip
• Pain with gripping, lifting, or twisting
• Worsens with repetitive forearm use

Exercises to Avoid (Temporarily)

High-Risk Movements:

• Pull-ups and chin-ups
• Barbell rows
• Bicep curls (especially with heavy weight)
• Reverse curls
• Any exercise requiring tight gripping
• Racquet sports
• Heavy deadlifts
• Exercises causing pain

The Problem: These all stress the forearm extensors and the damaged tendon attachment.

Safe Exercises During Recovery

Lower Body Training

Your legs are unaffected—train them fully:

• Squats (all variations)
• Leg press
• Lunges
• Leg curls and extensions
• Calf raises
• Hip exercises

Tip: Use straps for deadlifts if grip causes pain, or skip until healed.

Core Training

Mostly unaffected:

• Planks
• Dead bugs
• Bird dogs
• Crunches (no holding weights)
• Russian twists (light or no weight)
• Leg raises

Cardio

Full range available:

• Running, walking, hiking
• Cycling
• Elliptical
• Swimming (may need to modify stroke)
• Stair climbing
• Rowing (may aggravate—test carefully)

Upper Body (Modified)

Some upper body work is possible:

• Machine exercises (easier grip than free weights)
• Chest press machine
• Pec deck
• Shoulder press machine
• Lat pulldown with open grip or handles
• Cable exercises with careful grip

Exercises That Help Tennis Elbow Heal

Eccentric Wrist Extension (The Key Exercise)

Research strongly supports eccentric exercise for tennis elbow:

1. Hold light weight (1-3 lbs initially)
2. Rest forearm on table, palm down, wrist over edge
3. Use other hand to lift weight up
4. Slowly lower weight down (3-5 seconds)
5. That's one rep—the lowering is the exercise
6. 15 repetitions, 3 sets, twice daily

Tyler Twist (With FlexBar)

Another evidence-based exercise:

1. Hold FlexBar vertically with affected hand
2. Grab top with unaffected hand
3. Twist the bar with both hands (wringing motion)
4. Keeping wrists locked, slowly untwist by extending affected wrist
5. 15 repetitions, 3 sets

Wrist Extensor Stretch

1. Extend affected arm straight
2. Use other hand to bend wrist down (fingers toward floor)
3. Keep elbow straight
4. Hold 30 seconds
5. Repeat 3-5 times, multiple times daily

Wrist Flexor Stretch

1. Extend affected arm straight
2. Use other hand to bend wrist up (fingers toward ceiling)
3. Keep elbow straight
4. Hold 30 seconds
5. Repeat 3-5 times

Grip Strengthening (When Ready)

Once acute pain subsides:

• Squeeze tennis ball or therapy putty
• Progress gradually
• Stop if pain increases

Modifying Your Workout

Gripping Strategies:

Reduce Grip Intensity:

• Use open grip (thumbless) where safe
• Lighter weights requiring less grip
• Wrist straps for pulling exercises
• Thicker grip handles (reduces stress on extensors)

Machine Alternatives:

• Machines require less grip than free weights
• Cable machines with D-handles
• Pad handles if possible

Exercise Substitutions:

| Instead Of | Try | |------------|-----| | Barbell rows | Chest-supported machine row | | Pull-ups | Lat pulldown (open grip) | | Bicep curls | Preacher curl machine | | Deadlifts | Leg press + back extensions | | Dumbbell press | Machine chest press |

Building Your Recovery Program

Acute Phase (First 1-2 Weeks):

• Rest from aggravating activities
• Ice (15-20 minutes, several times daily)
• Anti-inflammatory measures
• Gentle stretching
• Lower body and cardio only
• Begin eccentric exercises if not too painful

Subacute Phase (Weeks 2-6):

• Continue eccentric exercises twice daily
• Stretch multiple times daily
• Gradually reintroduce upper body with modifications
• Avoid exercises that cause pain

Remodeling Phase (Weeks 6-12):

• Progress eccentric exercise weight
• Gradually increase grip demands
• Return to normal exercises slowly
• Continue stretching and eccentrics for maintenance

Return to Full Activity:

• When pain-free with daily activities
• Gradual return to full exercise
• Maintain preventive exercises
• Address any form issues that contributed

Preventing Recurrence

Once Healed:

Warm-Up:

• Forearm stretches before upper body work
• Light wrist movements
• Gradual load increase

Form Check:

• Avoid excessive wrist extension during exercises
• Neutral wrist position when possible
• Don't grip tighter than necessary

Program Balance:

• Include wrist flexor strengthening
• Balance extensors and flexors
• Don't overtrain gripping muscles

Equipment:

• Proper grip size on tools and equipment
• Ergonomic workplace setup
• Appropriate racquet grip size if playing tennis

When to See a Doctor

Seek Medical Evaluation If:

• No improvement after 2-4 weeks of conservative treatment
• Severe pain limiting daily activities
• Weakness or numbness
• Locking or catching
• Pain following trauma

Treatment Options May Include:

• Physical therapy
• Bracing
• Corticosteroid injection (controversial, short-term)
• PRP injections
• Shockwave therapy
• Surgery (rare, for chronic cases)

Sample Weekly Routine

Monday:

• Eccentric wrist exercises (morning and evening)
• Lower body strength training
• Stretching

Tuesday:

• Cardio (30 min)
• Core work
• Eccentric exercises
• Stretching

Wednesday:

• Modified upper body (machines, light grip)
• Eccentric exercises
• Stretching

Thursday:

• Lower body strength training
• Cardio
• Eccentric exercises
• Stretching

Friday:

• Full rest or light cardio
• Eccentric exercises
• Extra stretching

Saturday:

• Active recovery
• Walking, swimming, or cycling
• Eccentric exercises
• Stretching

Sunday:

• Rest
• Stretching only

The Bottom Line

Tennis elbow is frustrating but manageable. You don't have to stop exercising—you have to exercise smarter. Train your lower body and core fully. Modify upper body work to reduce grip stress. Do your eccentric exercises consistently—they're the most evidence-based treatment available.

Most cases resolve in 6-12 weeks with proper management. Rushing back to full training extends recovery. Patience and consistency with rehabilitation exercises pay off.

Your elbow will heal. Keep the rest of your body strong while it does, and you'll return to full training with a resilient, healthy tendon.