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Tennis elbow, also known as lateral epicondylitis, is caused by inflammation of the muscles of the forearm that attach to the elbow. It’s usually a result of inflammation of the extensor carpi radialis brevis tendon.

Tennis elbow is an overuse injury caused by a repetitive activity. Although common in racket sports, it can also be seen in workplace injuries, particularly among painters, carpenters, and plumbers.

According to the American Academy of Orthopedic Surgeons, typical symptoms of tennis elbow include pain and burning on the outside of the elbow and weak grip strength (1).

Symptoms develop over time and may gradually worsen over weeks or months. Nonsurgical treatment includes:

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Getty Images/Pekic

The first steps in treating tennis elbow are reducing inflammation and resting the irritated muscles and tendons. Ice and compression may also help reduce inflammation and pain.

Once inflammation subsides, you can begin gentle exercises to strengthen the muscles of your forearm and prevent recurrence.

“To heal a tendon you are going to need to eventually move and load that tendon,” says Kelly Starrett, DPT, Hyperice performance advisor and founder of The Ready State.

This will likely result in some discomfort as you begin to restore movement and function to your elbow’s tissues, and Starrett says that is to be expected.

Starrett explains that tendons need to be able to do three things: eccentrically load (absorb force), isometrically load (stay in one position under tension), and concentrically load (transmit force).

So, the first order of business in tennis elbow, he says, is to begin to apply those forces to the tissue of the elbow. This is the goal of tennis elbow treatment.

Be sure to check with your doctor or physical therapist to determine when you are ready to begin therapy exercises.

Shop for over-the-counter pain relievers.

Fist clench

Poor grip strength is a common symptom of tennis elbow. Improving grip strength by building your forearm muscles can help improve your ability to perform daily activities.

Equipment needed: table and towel

Muscles worked: long flexor tendons of the fingers and thumb

  1. Sit at a table with your forearm resting on the table.
  2. Hold a rolled-up towel or small ball in your hand.
  3. Squeeze the towel in your hand and hold for 10 seconds.
  4. Release and repeat 10 times. Repeat with the other arm.

Supination with a dumbbell

The supinator muscle is a large muscle of your forearm that attaches into your elbow. It’s responsible for turning your palm up and is often involved in movements that can cause tennis elbow.

For all the supination exercises listed below, it’s recommended that you first practice isometric supination without weights: With your elbow fixed, rotate your palm up and hold for about 30 seconds.

Equipment needed: table and 1-pound dumbbell

Muscles worked: supinator muscle

  1. Sit in a chair, holding a 2-pound dumbbell vertically in your hand, with your elbow resting on your knee.
  2. Let the weight of the dumbbell help rotate your arm outward, turning your palm up.
  3. Rotate your hand back in the other direction until your palm is facing down.
  4. Repeat 20 times on each side.
  5. Try to isolate the movement to your lower arm, keeping your upper arm and elbow still.

Wrist extension

The wrist extensors are a group of muscles that are responsible for bending your wrist, as when making the hand signal for “stop.” These small muscles that connect into your elbow are often subject to overuse, especially during racket sports.

Equipment needed: table and 2-pound dumbbell

Muscles worked: wrist extensors

  1. Sit in a chair, holding a 2-pound dumbbell in your hand, with your palm facing down. Rest your elbow comfortably on your knee.
  2. Keeping your palm facing down, extend your wrist by curling it toward your body. If this is too challenging, do the movement with no weight.
  3. Return to the starting position and repeat 10 times on each side.
  4. Try to isolate the movement to your wrist, keeping the rest of your arm still.

Wrist flexion

The wrist flexors are a group of muscles that work opposite the wrist extensors. These small muscles that connect into your elbow are also subject to overuse, which can lead to pain and inflammation.

Equipment needed: table and 2-pound dumbbell

Muscles worked: wrist flexors

  1. Sit in a chair, holding a 2-pound dumbbell in your hand, with your palm facing up. Rest your elbow comfortably on your knee.
  2. Keeping your palm facing up, flex your wrist by curling it toward your body.
  3. Return to the starting position and repeat 10 times on each side.
  4. Try to isolate the movement to your wrist, keeping the rest of your arm still.

Towel twist

Equipment needed: hand towel

Muscles worked: wrist extensors, wrist flexors

  1. Sit in a chair, holding a towel with both hands, shoulders relaxed.
  2. Twist the towel with both hands in opposite directions, as if you are wringing out water.
  3. Repeat 10 times, then repeat another 10 times in the other direction.

Always consult a doctor before starting an exercise program. It’s important to get a full evaluation to rule out a serious injury such as a muscle or tendon tear.

Don’t begin activities until inflammation has subsided, because activity may aggravate the condition. If pain returns after activity, rest and ice your elbow and forearm and consult a physical or occupational therapist to ensure you are doing the exercises correctly.

Often, changing the way you perform a daily activity can help decrease symptoms. Your therapist can help you determine which movements may be causing pain.

“Tennis elbow is common among athletes who participate in racket sports, such as tennis and squash, because of the high and repetitive forces these sports place on the wrist extensor muscles,” says Rami Hashish, PhD, DPT.

Hashish is the founder of the National Biomechanics Institute and the founder and chief technological officer of pareIT. He says the fundamental goal for physical therapy is to help restore function while managing inflammation and pain.

“The approach is to utilize exercise to help improve the strength, flexibility, and endurance of the affected muscles and tendons,” he says. Other techniques, such as ice massage, electrical stimulation, or bracing may also help control pain and inflammation.

According to Hashish, strengthening exercises that help treat tennis elbow include some of the moves listed above, such as the weighted wrist extension, weighted wrist flexion, and weighted wrist rotation, as well as ball squeezes and towel twists.

In addition, stretching the wrist extensors and flexors also improves the flexibility of these muscle groups.

According to Hashish, for weighted wrist flexion and extension, you want to keep your elbow at approximately 90 degrees, hold a weight in your hand, raise your hand, and then slowly lower your hand.

In the case of wrist extension, you rotate your palm down, whereas in wrist flexion, you rotate it up.

The weighted wrist rotation has a similar setup, but rather than raise your hand, Hashish says, you now rotate your wrist from a position where the palm is facing down to a position to where the palm is facing up.

If you’ve had tennis elbow in the past or are recovering from it now, try these exercises to help strengthen your forearm muscles and improve function. Strengthening the muscles and avoiding repetitive motions can go a long way in helping you avoid this issue in the future.