Tennis elbow exercise

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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From the American Physical Therapy Association

Lateral epicondylitis or tennis elbow occurs more frequently in non tennis players than in tennis players. It is a form of tendonitis and is considered a repetitive stress injury.

The most common movements leading to tennis elbow are repetitive motion and/or very strong gripping movements, squeezing objects and heavy lifting.

The rehabilitation process can be divided into two major phases.

Immediately after the onset of pain, your focus should be dealing with the damage:

• decreasing inflammation and pain
• promote tissue healing
• minimize muscle atrophy

The period immediately after pain starts is called the acute stage.

Avoid all activity that aggravates the injury. It is important to maintain some degree of activity. Absolute rest should be avoided as it may lead to additional muscle atrophy. It also deconditions the tissue. A higher activity level contributes an increased blood supply to the area; this helps the healing process. Pain will be the best guide as to what is an appropriate level of activity. If it hurts, don't do it.

Icing the affected area is recommended as long as the inflammation is present. You can use ice in a variety of ways. Ice may come in the form of cold packs, Ice in a Ziploc bag, or even ice in frozen paper cups. The cold temperatures help to reduce inflammation in the elbow. Depending on the type of injury, you may want to continue icing the area for as long as inflammation is present. This may mean icing the area during the entire rehabilitation process. It may be particularly beneficial to ice the area as you return to more strenuous activity.

The use of a tennis elbow band to help splint the area is often effective for pain relief in the acute stage.

After the elbow has healed, you want to begin working to increase strength and endurance in the muscles, tendons and ligaments. You will also begin to gradually return to functional activities and return to normal function.


1. Focus on the gentle stretching exercises. You should work on increasing the range of motion during wrist flexion, wrist extension and wrist rotation.
2. Make certain that the elbow is extended and the arm is straight. Keeping the arm straight increase the range of the stretch.
3. Hold each stretch for 20 - 30 seconds
4. Focus on feeling the muscles gradually relax into the stretch.
5. Repeat at least twice a day.
6. Stretch only to the point of comfortable motion.
7. Remember you want to help the area, not re-injure it.

The first exercise is to hold your arm straight out with your palm facing up. Next with the palm still facing up, point the finger tips toward the floor and use the other hand to pull the fingers toward you.

The next exercise starts the same way. Hold the arm straight out but this time with the palm facing the floor. Point the finger tips down towards the floor and use the other hand to pull the fingers towards you.

The next exercise is to hold the arm out with the thumb pointed towards the ceiling. Rotate the hand clockwise so the thumb points towards 3 o’clock and hold it. Next, rotate the hand counterclockwise as far as you can so that the thumb points towards 6 o’clock. And hold it.

After stretching, you can do some strengthening exercises. Perform the following exercises with the wrist supported and the elbow bent.

The first exercise is to strengthen wrist flexors. With the dumbbell in your palm with the palm face up towards the ceiling, grasp the dumbbell and bend the wrist so that the palm brings the dumbbell towards you.

The next exercise is grasp the dumbbell with the palm facing the floor. Bend the wrist upwards so that the dumbbell comes towards you.

The next exercise requires grasping the dumbbell with the palm so that the dumbbell is held in the vertical position. Rotate the dumbbell as far as you can go in one direction. Then rotate the dumbbell as far as you can go in the opposite direction.

The last exercise is to get a thick rubber band and circle all five digits of the hand with it. Then spread your fingers apart so that you are stretching the rubber band.

Gradually increase the amount of work that you are doing. Make sure to begin with a very light weight. Ideally, you should begin with a 1 pound dumbbell. Begin with perform 10 movements in a row. Repeat this sequence 3 times. This is called doing 3 sets of 10 repetitions. With time, this movement will become easier; then you can increase the number of repetitions to 15. Increase the weight when you can easily do 15 repetitions for 3 sets. Remember, you want to work the muscles and ligaments only as long as the movement is comfortable.

For more information about tendonitis, visit our sister site:
Tendonitis provides reliable, accurate, and useful information on tendonitis treatment written by a board-certified rheumatologist. Learn more about how to get tendonitis relief using the most up-to-date methods.

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