What is Tennis Elbow

Pain at the lateral (outside) aspect of the elbow is a commonly know as Tennis Elbow. But you say, “I don’t play Tennis!”. Well these days, this problem is more often associated with desk work than with playing Tennis. Fortunately the fix is the same in both situations.

– insert photo of lateral elbow

Tennis elbow occurs due to changes that occur in the tendon of your wrist extensor muscles. This tendon attaches at the lateral (outside) elbow. In order to reverse these changes and return the tendon back to normal, we need to load it via strengthening exercises. Stretching or massaging the muscle can be useful to provide pain relief and manage symptoms (insert link for tennis elbow symptom management), however these methods are not a long term fix. With that being said, there is no quick fix for any tendon problem including Tennis elbow. It will likely take from several weeks up to months to fully resolve. 

Below we will discuss various loading options, starting with the gentle/easiest ones, then move on to heavier loading options. The decision as to where you should start is based on your pain level and pain response. If you elbow is very painful, then you’ll need to start with the first exercise. Pain response (what you feel during/after the exercise) will also inform you if the exercise you’re doing is appropriate or not. In order for this to work, you’ll need to pay attention to how your elbow feels before, during and after the exercises.

Appropriate pain response

1) There is a mild production or increase in pain on each repetitions (no more than 3-4/10) that does not increase as you do more repetitions


2) The pain does not last after you’re finished – it returns to how your elbow felt before you started the exercise

Inappropriate pain response

1) Pain gets progressively worse with each repetition 


2) Pain remains worse for longer than 5-10 minutes after you’re finished the exercise

If you are experiencing either or both of the inappropriate pain responses, the exercise is too aggressive for you at the moment and you need to select and gentler option.

Gentle Loading Option: Isometric Wrist extension

  1. Support affected arm on a table, arm of a chair or your lap, with palm facing down
  2. Place your unaffected hand on top of the hand of your affected arm
  3. Gently press your affected hand up into the unaffected hand
  4. Your unaffected hand should resist this movement so that your affected hand does not move/change position
  5. Push as strongly as you can while eliciting the appropriate pain response – this could be 1% or 100% effort or anything in between
  6. Hold 5-10 seconds
  7. Repeat for prescribed number of repetitions/sets (see below)

It is important to stress that if you are experiencing an inappropriate pain response, you need to push more gently! Continually working into increasing or lasting pain will not help things get better more quickly.

Programming for Isometric Wrist Extension:

Early phase (for those with more intense pain):

Sets: 1

Repetitions: 10-15

Hold: 5-10 seconds on each repetition

Frequency: 3 different times per day (morning, afternoon, evening)

Later phase (for those with less intense pain):

Sets: 3
Repetitions: 10-15

Hold: 5 seconds on reach repetition

Rest: 30-90 seconds between sets

Frequency: Once per day

Once you are able to do the later phase option for these exercises with maximal or near maximal effort level and have no pain at all, you are ready to progress to the next level of loading.

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