Rehab Library · Shoulder & arm
Tennis Elbow Rehab Guide
A general guide to settling and strengthening pain on the outside of the elbow. Use it alongside the advice from your treating practitioner.
← Back to Rehab LibraryAbout tennis elbow
What is tennis elbow?
Tennis elbow (lateral elbow tendinopathy) is pain on the outside of the elbow, where the tendons that lift your wrist and fingers attach. Despite the name, most people who get it don't play tennis. It often develops with repeated gripping, lifting or computer work, and is most common between the ages of 35 and 55.
It can be slow to settle, sometimes taking several months, but many people improve with a gradual strengthening program and changes to the activities that aggravate it.
What usually helps
• Reducing, rather than completely stopping, activities that aggravate it.
• Gradual, progressive strengthening of the wrist and forearm.
• Changing how you grip, such as lifting with your palm facing up.
• Patience, as tendons respond to loading over weeks to months.
• Your practitioner may also suggest a brace for some activities.
Before you start
This guide is general information. Elbow pain can have other causes, so it's worth having it assessed. Follow the specific program your practitioner gives you, and move slowly and with control.
A simple pain guide
Tendons usually respond well to gradual loading, so some discomfort during exercise is expected. As a general guide, keep pain at or below about 3 out of 10 while you exercise, and it should settle back to your usual level by the next morning.
If pain goes higher or lingers, ease back on the weight or repetitions, and let your practitioner know.
Phase 1
Settle and calm
Early on, the aim is to calm the tendon down with gentle, steady loading, and to ease back on the tasks that aggravate it.
1
Isometric wrist hold
5 holds of 30–45 seconds
Rest your forearm on a table, palm down, with your wrist just over the edge. Use your other hand to press down on the back of your hand while you resist, so nothing moves. Hold at a moderate, comfortable effort.
2
Forearm stretch
3 holds of 20–30 seconds
With your arm straight in front of you and palm facing down, use your other hand to gently bend your wrist downwards until you feel a light stretch along the top of your forearm.
3
Change your grip
Through the day
Practise lifting cups, bags and other objects with your palm facing up, and avoid gripping tightly for long periods. Use tools with thicker handles where you can.
4
Scapular setting
10 holds of 5 seconds
Sit or stand tall. Gently draw your shoulder blades back and slightly down, as if sliding them towards your back pockets. Use light effort, keep breathing, and avoid shrugging.
Phase 2
Build strength
As the elbow settles, gradually strengthening the wrist and forearm helps the tendon tolerate more load. These are often done 3–4 times a week, slowly increasing the weight.
1
Wrist lifts with slow lowering
3 sets of 10–15
Rest your forearm on a table, palm down, holding a light weight or water bottle. Lift your wrist up, then lower it slowly over about 3 seconds. Use your other hand to help with the lift if needed.
2
Palm-up wrist curls
3 sets of 10–15
Same position, but with your palm facing up. Curl your wrist up, then lower slowly with control.
3
Forearm rotation
3 sets of 10 each way
Hold a hammer or light weight at one end, with your elbow bent and resting by your side. Slowly turn your palm up, then slowly turn it down.
4
Grip squeeze
3 sets of 10, holding 3–5 seconds
Squeeze a soft ball or rolled-up towel at a comfortable effort, hold, then relax fully.
Phase 3
Return to everyday activities
The final stage builds strength for the gripping, lifting and carrying you do every day, so you can get back to work, hobbies and sport.
1
Band rows
3 sets of 10–12
Hold a band anchored in front of you at chest height. Pull your elbows back towards your ribs, gently drawing your shoulder blades together. Return slowly.
2
Farmer's carry
3 walks of 20–30 metres
Hold a light bag or weight in each hand and walk tall, keeping a firm but relaxed grip. Increase the weight gradually over time.
3
Progress your wrist lifts
3 sets of 8–12
Progress your wrist lifts with a slightly heavier weight, then try them with your elbow straighter, as your practitioner advises.
4
Practise your own activities
Build up gradually
Gradually reintroduce gripping tasks like gardening, using tools, racquet sports or lifting children, starting light and short.
Everyday tips
• Take regular breaks from gripping and computer work.
• Keep your wrists straight and your mouse close. See our Desk & Posture Checklist.
• Lift with your palm facing up where you can.
• Choose tools and utensils with thicker handles.
• Little and often is usually better than a lot at once.
When to seek prompt medical review
• Elbow pain after a fall or injury, especially with swelling or an odd shape.
• Your elbow is hot, red or swollen, or you feel feverish or unwell.
• Numbness, tingling or weakness in your hand or fingers.
• You can't fully bend or straighten your elbow.
• Pain is severe and getting worse.
This resource is general information only and is not a substitute for individual assessment and advice. Prepared by Dr Emma Cormack (Chiropractor), Vital Chiropractic, Mona Vale.
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