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Injury2026-03-06•7 min read

Tennis Elbow: Causes, Exercises, and How to Finally Get Rid of It

What Is Tennis Elbow?

Tennis elbow (lateral epicondylitis) is pain on the outside of your elbow where your forearm muscles attach. Despite the name, most people who get it have never picked up a racket.

It's an overuse injury—repetitive gripping, twisting, and lifting gradually damages the tendons that attach to the lateral epicondyle (the bony bump on the outside of your elbow).

Who Gets Tennis Elbow?

Common Culprits

  • **Office workers** - mouse use, typing
  • **Tradespeople** - plumbers, painters, carpenters
  • **Tennis/racquet sports** - especially backhand-heavy players
  • **Weightlifters** - heavy pulling movements
  • **Musicians** - guitar, violin
  • **Anyone 35-55** - peak age range

    • The Pattern

    Usually starts gradually. You notice it gripping things—coffee cups, doorknobs, handshakes. Gets worse with any twisting motion (turning keys, opening jars).

    Why It's So Stubborn

    Tennis elbow is notoriously slow to heal. Here's why:

    Poor Blood Supply

    The tendon attachment point has limited blood flow. Less blood = fewer healing nutrients.

    Ongoing Stress

    Unlike an acute injury you can rest, tennis elbow is triggered by activities you do all day—typing, gripping, carrying.

    Degenerative, Not Inflammatory

    Despite the "-itis" suffix (meaning inflammation), tennis elbow is actually a degenerative tendinopathy. The tendon breaks down faster than it rebuilds.

    What Actually Works

    Load Management (Not Complete Rest)

    Rest feels intuitive but isn't ideal. Tendons need load to heal—just the right amount.

    The goal: Stay under the threshold that aggravates symptoms while providing enough stimulus to remodel the tendon.

    Eccentric Exercise (The Gold Standard)

    Eccentric exercises—where the muscle lengthens under load—have the strongest evidence for tendinopathy.

    Tyler twist with FlexBar:

    The classic evidence-based exercise:

  • Hold FlexBar vertically
  • Grip with affected hand, wrist extended
  • Grip with other hand, twist the bar by flexing wrist
  • Slowly untwist by letting affected wrist flex
  • 3 sets of 15, twice daily

    • Wrist extension eccentric:

  • Hold light dumbbell (1-3 lbs), palm down
  • Support forearm on table, wrist hanging off edge
  • Use other hand to lift weight up
  • Slowly lower over 3-5 seconds
  • 3 sets of 15

    • Wrist Strengthening

    Beyond eccentrics, build overall forearm strength:

    Wrist curls:

  • Palm up, curl weight
  • 3 sets of 15

    • Reverse wrist curls:

  • Palm down, lift weight
  • 3 sets of 15

    • Grip strengthening:

  • Squeeze stress ball or hand gripper
  • Focus on slow, controlled squeezes

    • Stretching

    Wrist extensor stretch:

  • Straighten arm, palm facing down
  • Use other hand to gently flex wrist down
  • Keep elbow straight
  • Hold 30 seconds, 3x daily

    • What to Avoid

    Activities That Spike Pain

  • Heavy gripping or twisting when inflamed
  • Backhand tennis (until healed)
  • Heavy pulling exercises (rows, deadlifts, pull-ups)

    • Treatments Without Strong Evidence

  • **Cortisone injections:** Provide short-term relief but may worsen long-term outcomes
  • **Shockwave therapy:** Mixed evidence, may help some cases
  • **PRP injections:** Research is inconclusive
  • **Braces alone:** May reduce strain but don't address underlying problem

    • The Rehab Timeline

    Weeks 1-2: Relative Rest

  • Avoid aggravating activities
  • Ice for pain relief
  • Gentle stretching
  • Consider a counterforce brace

    • Weeks 2-6: Loading Phase

  • Begin eccentric exercises
  • Start light, progress gradually
  • Expect some discomfort (not sharp pain)

    • Weeks 6-12: Strengthening

  • Continue eccentrics
  • Add general wrist/grip strengthening
  • Gradually return to aggravating activities

    • 3-6 Months: Full Recovery

    Most cases resolve with consistent rehab. Some take up to a year.

    Workplace Modifications

    Computer Work

  • Use ergonomic mouse/keyboard
  • Keep wrist neutral (not bent up or down)
  • Take micro-breaks every 20-30 minutes
  • Consider vertical mouse

    • Manual Labor

  • Use tools with larger, padded grips
  • Alternate hands when possible
  • Take breaks before fatigue sets in
  • Strengthen opposing muscles

    • When to See a Professional

  • No improvement after 6-8 weeks of consistent exercise
  • Significant weakness in grip
  • Pain at rest or at night
  • Numbness or tingling in hand
  • Sudden onset after trauma

    • Prevention

    Build Forearm Strength

    Strong muscles protect tendons. Consistent training beats reactive treatment.

    Warm Up Before Activity

    Whether tennis or typing marathon, prepare the tissue.

    Progress Gradually

    Sudden increases in activity volume are the most common trigger.

    Address Root Causes

    If it's your workstation, fix your workstation. If it's your backhand technique, get a lesson.

    Tennis elbow is frustrating because it happens from activities you can't avoid. But with consistent eccentric exercise, load management, and patience, most people recover completely. The key is sticking with rehab even when improvement is slow.

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