Tennis elbow, medically known as lateral epicondylitis, is a condition affecting the tendons on the outside of the elbow. This injury involves degeneration and microscopic damage, primarily to the Extensor Carpi Radialis Brevis (ECRB) tendon, where it attaches to the arm bone at the lateral epicondyle. The damage is commonly caused by repetitive gripping, twisting, or forceful wrist extension movements that strain the forearm muscles. While the name suggests a link to racquet sports, the condition frequently affects people with jobs requiring vigorous forearm use, such as plumbers or painters. Continuing to work out is generally possible, but it requires strict modification of your training routine.
General Safety Guidelines for Training
The most important guideline for training with a tendon injury is the “Pain Rule”: any exercise causing sharp or shooting pain must be stopped immediately. Attempting to “work through the pain” will worsen the underlying damage and prolong recovery. A slight, tolerable discomfort in the muscle is acceptable, but pain at the tendon attachment site is a clear signal to modify or stop.
A fundamental requirement for continuing exercise is drastically reducing the load on the affected joint. This often means lowering the weight significantly, sometimes by 50% or more, or switching to no weight at all. The goal of training shifts from building strength or size to maintaining muscle mass and promoting blood flow for healing. Adjusting your training frequency is also necessary, incorporating more rest days between upper body workouts to allow damaged tissue time to recover.
Warming up the injured area is required before engaging in any activity. A gentle warm-up increases blood circulation, which is beneficial for tendon health and recovery. This can involve light range-of-motion movements or a gentle massage around the affected elbow before lifting.
High-Risk Exercises and Necessary Modifications
Exercises that demand a strong, sustained grip or involve forceful wrist extension are considered high-risk and should be avoided or heavily modified. Movements such as heavy deadlifts, pull-ups, and rows place tension on the forearm tendons simply through gripping the bar. Barbell curls and overhead triceps extensions with a straight bar also tend to aggravate the ECRB tendon due to the fixed, supinated or extended wrist position they enforce.
To continue training the upper body safely, alter the equipment and the movement pattern. Replace straight barbells with dumbbells to allow for a more natural, independent wrist position. Switching to a neutral grip, where the palms face each other, significantly reduces the strain on the wrist extensor muscles. For example, use hammer curls instead of supinated bicep curls, and neutral-grip pull-ups or rows instead of pronated ones.
For pulling movements, employing lifting straps or hooks effectively offloads the grip requirement from the forearm muscles, allowing you to train the back without stressing the elbow tendons. Using thick grip attachments can also help by forcing the load across the entire hand and reducing localized finger and tendon strain. High-load exercises like push-ups and bench presses should be substituted with machine-based presses or flyes where the wrist remains in a neutral position.
Maintaining Fitness with Safe Alternatives
While the elbow is healing, maintain overall fitness and cardiovascular health by prioritizing activities that do not require an active or forceful grip. Lower body exercises are largely unaffected and should form the foundation of your temporary training program. Squats, lunges, and leg presses can be performed with maximal effort, ensuring strength maintenance in the largest muscle groups.
Cardiovascular fitness can be maintained through activities that minimize arm involvement, such as stationary cycling or using a recumbent bike. Running and brisk walking are excellent options that place no stress on the elbow joint. When performing core work, focus on movements that do not require holding a weight or bracing with the hands, such as planks, crunches, or leg raises.
Targeted Rehabilitation Movements
Active recovery and strengthening are important for tendon healing, but these movements must be performed separately from your main workout using very low resistance. The primary focus of rehabilitation is eccentric loading, which involves slowly lengthening the extensor muscles under tension. This specialized movement encourages the remodeling of damaged collagen fibers within the tendon, which is necessary for long-term recovery.
A common eccentric exercise involves sitting and resting the forearm on a table, with the hand holding a very light dumbbell (one to three pounds) over the edge, palm facing down. Use the unaffected hand to lift the wrist into an extended position, then slowly lower the weight back down using only the injured arm’s extensor muscles over a count of four to five seconds. Only the lowering phase provides the therapeutic eccentric load.
Stretching and Isometrics
Gentle stretching of both the wrist extensors and flexors is an important component of the protocol, performed multiple times throughout the day to improve flexibility and circulation. Isometric exercises, which involve gripping a towel or stress ball and holding the contraction without movement, can be introduced to safely build grip endurance and strength.
Progression
These rehabilitation movements should begin with no pain and progress slowly over several weeks to ensure the damaged tendon is adequately healing without being re-injured.