Lateral epicondylitis, commonly known as tennis elbow, is an overuse injury affecting the tendons on the outside of the elbow. This condition involves the extensor carpi radialis brevis (ECRB) and other forearm extensor tendons, which become strained from repetitive movements. The resulting pain makes everyday tasks and strength training difficult, but it does not mean all upper body activity must cease. The goal is to modify your exercise routine to allow the irritated tendon to heal while safely maintaining muscle strength and fitness.
Movements That Aggravate Tennis Elbow
The core mechanism that aggravates tennis elbow is any movement combining a forceful, sustained grip with repetitive wrist extension. These actions place excessive tensile load on the stressed forearm extensor tendons. Therefore, movements requiring an aggressive overhand or pronated grip should be avoided, especially when lifting heavier loads.
Traditional barbell bicep curls, particularly those with the palm facing up (supinated grip), can be problematic because the wrist extensors must stabilize the wrist. Similarly, pull-ups and chin-ups using a narrow, overhand grip impose high extensor tendon tension, often causing pain during the lowering (eccentric) phase. Traditional push-ups or bench presses performed with a straight bar can also be painful due to the forced wrist extension angle. Triceps pushdowns using a straight bar or exercises requiring a tight, sustained grip, such as kettlebell swings or heavy deadlifts, can delay recovery.
Safe Strength Training Modifications
To safely continue strengthening the upper body, the primary strategy involves minimizing stress on the lateral epicondyle by adjusting grip and equipment. The use of a neutral grip, where the palms face each other, is often the most effective modification for many movements. This hand position significantly reduces the strain placed on the wrist extensor tendons.
For chest exercises, swapping a barbell for dumbbells allows the hands to rotate into a neutral or “hammer” grip during presses. Performing push-ups on specialized handles or dumbbells helps keep the wrist straight and neutral, which is less painful than pressing directly from the floor. Cable or band chest fly variations are also comfortable, as they allow for controlled resistance and a neutral hand position.
When training the back, movements like lat pulldowns and rows should utilize a neutral grip attachment instead of a wide, overhand bar. If performing heavy pulling exercises, using lifting straps transfers the load to the wrist and hands, reducing the need for the forearm extensors to maintain a crushing grip. For shoulder work, dumbbell lateral raises with light weight or resistance bands are generally well-tolerated, as they limit forearm involvement. Overhead presses should be performed with dumbbells to maintain a neutral grip, ensuring the wrist remains in line with the forearm.
For direct arm work, switch traditional supinated bicep curls to hammer curls, keeping the palms facing inward. This modification still builds strength in the biceps and brachialis muscles while sparing the irritated tendons. Triceps extensions are best performed using a rope attachment on a cable machine, as the flexible grip allows for a more natural, neutral wrist position. Using machines instead of free weights can also offer more stability, minimizing the wrist extensor effort required to balance the weight.
Incorporating Therapeutic Exercises
Beyond modifying strength training, incorporating specific, low-load therapeutic exercises is crucial for promoting tendon healing and remodeling. The gold standard for rehabilitation is slow, controlled eccentric training for the wrist extensor muscles. This technique involves using a very light weight, such as a one- to five-pound dumbbell or even a soup can.
The key is to support the forearm on a table, with the hand holding the weight hanging over the edge and the palm facing down. Use the unaffected hand to lift the weight up (concentric phase), bringing the wrist into extension. The injured arm then slowly lowers the weight back down over five to ten seconds; this eccentric portion facilitates tendon repair. This exercise should be performed for three sets of 10 to 15 repetitions, done once daily or every other day.
Isometric wrist extension holds can also be beneficial, particularly for managing pain. This involves pushing the hand against a fixed object, like a wall, or holding a light weight in a stationary position for five to ten seconds without moving the joint. Gentle stretching of both the forearm flexor and extensor muscles should also be performed to improve tissue mobility and reduce resting tension.