Tennis elbow exercises

Tennis elbow exercises 1

Tennis elbow exercises and stretching the wrist extensor muscles are the key.

An ice massage is the best painkiller; anti inflammatory drugs have no place in the treatment of lateral epicondylitis, as it's known in orthopaedic jargon. Give it a mysterious name and you can charge twice as much.

These exercises are for the right arm. Here is the first.

Stretch out your right arm so the elbow is straight. With your left hand, grasp the middle finger, and perhaps the ring also on the other.

Test it to get maximum flexibility in the forearm. Now pull on them, not so they pop out of their sockets, but if you have lateral epicondylitis you will almost certainly feel a good stretch in the extensor muscles on the outside of the elbow.

Repeat several times a day.

Don't jerk, just a nice slow gentle stretch of the muscles in the elbow.

This page was last updated by Dr Barrie Lewis on 19th December, 2018.

The second one's a bit more tricky.

Pronate your right arm, turn it inwards, as far as you can, with the elbow straight. Now reach over with your left hand, and interlace the fingers.

Now extend the left wrist, using the muscles in your left limb, to stretch the muscles in the right forearm.

Get it? Clear as mud? I'll try and do a video of these in the next couple weeks.

Tennis elbow exercise 2

Tennis elbow exercises are an essential part of the chiropractic regimen.

Tennis elbow exercise 2, arms outstretched.

It's not a bad idea to do this to both arms, but if your right arm hurts, it might give pain when using it to stretch the left wrist extensors. Gently does it.

Tennis elbow exercise 3

Place your right hand behind your back, elbow straight as you can for tennis elbow exercise 3. Make a fist.

Now grasp your right fist with your left hand and flex the right wrist using your left hand. You should feel a stretch in the right elbow muscles.

Tennis elbow exercise 3, arms behind back.

Tennis elbow exercise 4

This exercise is quite different. The first three are stretch exercises for the extensor tendons in the right arm.

This exercise is not to stretch them, but to exercise them. You are going to use them...

As in exercise 2, pronate your LEFT arm, elbow straight, and cross over with the right hand. Interlace the fingers.

Now extend the RIGHT wrist, using the right extensor muscles. You will probably feel a little pain in the right elbow area. Not too hard... or you'll strain the muscles in your right arm.

A nice little benefit of this exercise, is that you are stretching the tennis elbow muscles in the LEFT arm at the same time.

Apologies for the quality of the photograph.

Lateral epicondylitis

Lateral epicondylitis does respond to ice treatment even though there are questions as to whether it's an inflammatory condition; it's the tennis elbow exercises that really help.

Ice cold therapy.

If you are a sports person, or regularly have acute pains of one sort or another, keep an ice cup in the freezer. Here you can see a patient icing his knee.

Do the same on the elbow, ice massaging the muscles and their origin on the lateral epicondyle until it's very cold. Now warm, say in the bath or shower. Repeat several times, alternating cold and hot.

Then when it's warm again do your stretches.


64 people suffering from Tennis Elbow (Lateral Epicondylosis) were divided into two groups, one of which was given a cortisone injection, the other a placebo treatment.

The researchers tested for

  1. Disability using the Arm pain Quick DASH (Disability Arm Shoulder Hand) test)
  2. Pain (using a Visual Analog scale)
  3. Grip strength
  4. and Ineffective Coping Skills (using Pain Catastrophizing Scale: PCS) 

They repeated these tests one and six months after the injections.

The research was conducted using the "gold-standard" double-blind RCT (Randomized Clinical Trial). Neither the researchers nor the patients knew whether they were receiving the real treatment or the placebo; hence "double-blind".

That arm pain quick DASH test is easy to do at home to see how badly you are in need of exercises.

Their hypothesis was...

There would be no difference in disability, pain, and grip strength one and six months after steroid and lidocaine shot combined,  compared with lidocaine shot alone (the placebo).

The result

  • One month after injection DASH scores averaged 24 versus 27 points (cortisone vs placebo), pain 3.7 versus 4.3 cm, and grip strength 83% versus 87%.
  • Six months, DASH scores averaged 18 versus 13 points, pain 2.4 versus 1.7 cm, and grip strength 98% versus 97%.

Their conclusion

  1. Steroid injections did not affect the apparently self-limiting course of tennis elbow.
  2. The disability associated with tennis elbow correlated with depression and ineffective coping skills.
  3. At one month, the cortisone group had significantly less pain, but after six months, the cortisone group lagged significantly behind the untreated group.
  4. DASH scores were higher for the cortisone group (they were more disabled)
  5. The cortisone group had more pain (4.3 -vs- 3.7) than the placebo group.

Chiropractic help

Chiropractic help is a frequent business in any sports oriented practice; and tennis elbow exercises are often in demand.

The technical name for tennis elbow used to be Lateral EpicondylITIS; tennis elbow exercises, ice and adjustments of the radial head are what help; and of course a thorough assessment of the lower neck. Lower cervical facet anatomy will give you a clearer understanding.

'ITIS' means inflammation. However even current medical thinking is that it is really Lateral EpicondylOSIS. A condition of, rather than an inflammation of the elbow.

So it comes as no surprise that in the long term there was no scientific benefit from corticosteriod injections for tennis elbow. In fact, the steroid injection group was significantly worse off than the placebo group in the long term; the drug weakens the tendon and it may even rupture completely.

Chiropractic help tennis elbow treatment is based rather on ice, stretching, active tennis elbow exercises, various techniques such as Active Release Therapy, and of course seeking out any subluxations in the lower neck, or of the first rib.

The "brachial plexus" of nerves to the arm pass through the inter scalene triangle, bounded by two scalene muscles and the first rib, sometimes accompanied by cervical ribs. An irritation of the nerves or artery in the triangle may cause what is known as a THORACIC OUTLET SYNDROME frequently with shoulder or elbow pain, or carpal tunnel syndrome, or tingling in the arms and hands.

The correction of the first rib fixation needs to be done by your chiropractor, but you can help yourself by doing these exercises.

Inter scalene triangle

Adson's test is used to determine if the artery is affected; the pulse in the wrist is reduced.

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  2. Head neck pain
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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

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