Tennis Elbow Part 2 – Exercises for Rehab

In part 2 of our tennis elbow series, we will cover specific rehab exercises that we commonly prescribe to our patients.

If you are still in an acute stage or a flareup of pain then rest and ice may be your best starting treatments.  Modifying how much you use your arm may also help.  Counter-force braces and forearm sleeves can also help.  These treatments will help reduce your pain if inflammation is the cause.

For chronic pain the problem is degenerative tissue.  Progressive loading and soft tissue techniques increase the quality of the tissue.  Here are some of the best exercises to help get you stronger.

Exercise Guidelines

If an exercise causes more than Phase 3 pain (see pain phases below) or more, modify by:

a. Decreasing the amount of weight you are lifting and/or

b. Decreasing the number of repetitions you are performing and/or

c. Moving through a lesser range of motion (“pain free” range of motion).

If still painful check with your therapist or doctor.

Pain Phases

Phase 0: No pain or soreness.

Phase 1: Soreness after activity, usually gone in twenty-four hours

Phase 2: Mild stiffness and soreness before activity which disappears with warm-up. No

pain during activity, but mild soreness after activity that disappears within 24 hours.

Phase 3: Mild/moderate stiffness and soreness plus mild pain during activity which

does not alter activity.

**Phase 4: Pain during activity which alters activity.

**Phase 5: Constant pain even at rest.

**These pain phases should be avoided. It is not beneficial to work through this type of pain.

Wrist Extension:

Arm Bent:

Sit in a chair with your forearm resting on your leg or the tabletop, elbow bent to 90°. Your wrist and hand should extend past the edge of your leg with your palm facing down as shown in the photo.

• Lift your hand/wrist as high as possible. Hold for 2 seconds and slowly return.

Arm Straight:

Same as previous exercise but no bend in elbow, almost straight but not fully locked.

• Sit in a chair with your forearm resting on your leg or a table top, elbow straight but not locked. Your wrist and hand should extend past the edge of your leg, with your palm facing down.

• Lift your hand/wrist as high as possible. Hold for 2 seconds and slowly return

Pronation/Supination:

• Sit in a chair with your forearm resting on your leg or the tabletop, elbow bent to 90°. Your wrist and hand should extend past the edge of your leg.

• Hold the hammer at one end rather than in the middle, with your palm facing up.

• Slowly roll your forearm so that your palm faces down. Hold for 2 seconds and rotate back to the palm up position.

One of the keys is to progress the loading to your needs. Most people only progress to a 2-3 pound weight when in reality they should progress to 10-15 pounds. Slow and steady wins the race.

In the clinic we would also clear you neck and make sure your shoulder blade and shoulder muscles also function as they are much bigger than your arm muscles.  Total arm strength matters.

If your symptoms don’t resolve at home with these exercises give us a call!

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About the author: David Potucek, PT, MSPT, CFMT

David is an orthopedic physical therapist with over 20 years of experience. As manual therapist, a lifter, and a climber, he is no stranger to elbow and forearm discomfort. He has treated hundreds of folks with forearm and elbow pain that didn't make improvements with traditional care.

Disclaimer: This blog post is for informational purposes only and does not substitute for professional medical advice. Please consult with a qualified healthcare professional for personalized guidance.