Lateral epicondylitis, commonly known as tennis elbow, is a painful condition resulting from the overuse of the tendons connecting the forearm muscles to the bony prominence on the outside of the elbow. This overuse creates micro-tears and degeneration, most often in the extensor carpi radialis brevis (ECRB) tendon, where it attaches to the lateral epicondyle. Pain is typically felt on the outer elbow and can radiate into the forearm, often worsening with gripping or twisting activities.
Understanding the Mechanism of Overload
The ECRB tendon’s main function is to stabilize the wrist during gripping and to help extend the wrist, meaning to bend the hand back toward the ceiling. Forceful or repetitive use of the forearm muscles, especially against resistance, creates a pulling force at the tendon’s attachment site on the elbow.
Forceful wrist extension and repetitive gripping are the two main biomechanical actions that overload the tendon. Forearm rotation (supination and pronation) performed under load also activates the extensor muscles, placing additional strain on the inflamed area. High-velocity or high-force movements with the wrist in an extended or bent position significantly increase the likelihood of further tendon damage, inhibiting the natural healing process.
High-Risk Movements and Exercises to Stop
Structured physical activities requiring sustained or forceful use of the wrist extensors must be stopped immediately to allow the tendon to heal. In weight training, exercises necessitating a tight grip on heavy dumbbells or barbells are particularly irritating. This includes heavy bicep curls, hammer curls, or any rowing movement, as the forearm muscles work overtime just to keep hold of the weight.
Movements specifically designed to work the forearm, such as wrist curls or wrist extensions with weights, should be entirely avoided because they directly stress the injured tendons. Bodyweight exercises demanding a heavy static grip also place immense strain on the wrist extensors and should be paused. Similarly, traditional push-ups and bench presses can aggravate the condition due to the wrist being forced into an extended position under load. High-risk exercises include:
- Wrist curls or wrist extensions with weights
- Pull-ups
- Chin-ups
- Hanging
- Push-ups
- Bench presses
In sports, the repetitive, high-impact nature of racket sports must be addressed; the backhand stroke, especially with a bent wrist, is a known aggravator of the ECRB tendon. Any throwing motion involving a snapping wrist action must be avoided. Activities introducing impact vibration, such as using power tools like jackhammers or chainsaws, transmit shock directly up the arm, further irritating the tendon.
Modifying Daily Activities and Ergonomics
When lifting and carrying objects, avoid a pronated grip (palm facing down), as this heavily recruits the strained extensor muscles. Instead, lifting heavy items with the palm facing up (supinated grip) or using two hands shifts the load to less-affected muscle groups.
Forceful gripping actions in daily life should be minimized. These include:
- Wringing out a wet cloth
- Twisting a tight doorknob
- Opening a stubborn jar
Using a screwdriver or other hand tools requiring a twisting or sustained power grip should be temporarily outsourced or modified. Even tasks like using a computer mouse and keyboard can be problematic if the wrist is held in an extended or non-neutral position for long periods.
Ergonomic adjustments are necessary to maintain a neutral wrist posture while working, potentially by using a vertical mouse or ensuring keyboard placement prevents wrist extension. Carrying heavy items away from the body or with the arm fully extended should be avoided, as this increases leverage and strain on the elbow joint.
Principles of Active Recovery and Safe Movement
The initial response to pain should be relative rest, meaning stopping the specific movements that cause pain rather than complete immobilization. Continuing to push through pain risks worsening the symptoms and can prolong the recovery timeline. Once initial inflammation subsides, total inactivity is discouraged, as the tendon requires controlled movement and loading to regain strength and resilience.
Safe movement alternatives focus on low-impact activities that do not recruit the wrist extensors under load, such as cycling, walking, or lower-body strength training. When the pain is manageable, gentle, pain-free range of motion exercises can be introduced to prevent stiffness and maintain flexibility in the wrist and forearm. These initial movements might include gentle stretching or isometric holds, which load the tendon without significant movement.
If pain persists despite activity modification and rest, a consultation with a physical therapist or doctor is the appropriate next step. A specialist can provide a definitive diagnosis and design a structured rehabilitation plan that includes progressive tendon loading exercises, which are necessary for long-term recovery and prevention of recurrence. Eliminating aggravating movements, both in the gym and in daily life, is the foundation for healing this condition.