There is no such thing as one-size-fits-all exercises for tennis elbow. In this article, we demonstrate the most commonly used exercises for tennis elbow and discuss their benefits, common pitfalls, and how to decide whether they are right for you. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.
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Important! Exercises must match healing stage
It’s natural to want to “do something” to heal more quickly when you get injured. But, depending on the stage of healing of your injury, “not doing anything” might actually be the correct treatment.
Yes, we know – the Internet is swarming with people telling you to strengthen your elbow muscles and tendons to get it to heal. And yes, that is the correct advice … for the later stages of recovery.
If you jump in and start doing strength exercises or strong stretches during the early stages of healing (the reactive stage), when the injury is still trying to settle down, you usually just irritate it further and delay your recovery.
You can find a detailed explanation of the stages of healing for tennis elbow and how you can tell which you are in here. As a quick reference, you are likely in the:
Reactive stage – if your elbow pain only started a few weeks ago.
Tendon dysrepair stage – if your elbow pain has been going on for more than 6 weeks.
Tendon degeneration stage – if your elbow pain has been dragging on for more than 6 months.
👉I will refer to these stages when I discuss the exercises below. You can read more about what treatments other than exercise work best during each stage of tennis elbow here.
Should tennis elbow exercises cause pain?
When you have tennis elbow, you can expect to feel a certain amount of pain or discomfort during everyday activities.
Research suggests that tennis elbow treatments are most effective when they don’t cause a significant increase in pain during and in the hours after the treatment.
With this in mind, we tend to find best results when our patients:
Experience only slight discomfort while doing their exercises (you’re aware of the injured area but it’s not really painful),
and no or only slight discomfort after completing the exercises,
and any increased discomfort caused by the exercises settles back to its previous level within 24 hours.
💡If the exercises we prescribe cause a significant increase in the patient’s symptoms, it is usually a sign that they need to be adjusted (resistance reduced, done in a different position, or less force applied), swopped out for a different type of exercise, or that the patient is actually not ready yet for exercises.
Types of exercise for tennis elbow
You can divide the exercises used for tennis elbow into three categories:
Stretches – For the muscles that attach to the outer elbow but also the shoulder girdle and neck.
Neural mobilization – These exercises ensure that the nerves that run across your elbow are free to slide.
Strengthening exercises – These exercises restore the strength in the tendon.
Let’s look at each type of exercise and whom they benefit.
Tennis elbow stretches
When to use them
You can usually start with gentle stretches while you’re in the reactive stage.
Elbow-specific stretches
With tennis elbow, your wrist extensor muscles can feel very tight and painful. Gentle stretches can help to relax these muscles and reduce your pain.
⚠️ You should feel a gentle stretch in your wrist extensor muscles – it should not cause a strong stretch in the painful area on the outside of the elbow.
1. Gentle wrist extensor stretch
Instructions
Sit with your elbow bent about 90 degrees and your palm facing down.
Make a gentle fist (keep your palm facing down).
Use your opposite hand to bend your wrist down into flexion and slightly out to the side (direction of little finger).
You should be feeling a comfortable stretch in the top of your forearm.
Hold the position for 10 to 30 seconds – it is often best to test shorter durations first.
Relax for about 10 seconds.
Repeat up to 3 times in one session.
You can usually do this 2 to 3 times a day.
If you don’t feel much of a stretch, try the stronger version below.
2. Stronger wrist extensor stretch
Instructions
Sit with your elbow bent to about 90 degrees and your palm facing down.
Make a gentle fist (keep your palm facing down).
Use your opposite hand to bend your wrist down into flexion and slightly out to the side (direction of little finger).
Slowly straighten your elbow until you feel a gentle stretch in your wrist extensor muscles.
Hold the position for 10 to 30 seconds – it is often best to test shorter durations first.
Relax for about 10 seconds.
Repeat up to 3 times in one session.
You can usually do this 2 to 3 times a day.
👉 If these stretches make your pain worse:
You may be pushing or pulling too hard or for too long – test whether adjusting your technique helps.
Or your injury may simply not be ready for stretches – leave them for now.
Stretches for the shoulder and neck
Your radial nerve runs very close to the area in the wrist extensor tendons that typically gets injured when you have tennis elbow. This nerve originates in the neck, runs over the front of your chest, past the shoulder and then down your arm.
The radial nerve is meant to slide freely as we move. Sometimes, stiffness or an injury in the neck or shoulder girdle can stop it from sliding freely, which then contributes to tennis elbow pain. Other times, the ongoing tennis elbow injury can irritate the nerve, causing your shoulder and neck to become stiff and uncomfortable.
This is why stretches for the neck and shoulder can help for some cases of tennis elbow.
⚠️ These stretches are not appropriate if you have a serious injury in your neck or shoulder, e.g. a disc or joint injury. Ask your physiotherapist for tailored exercises.
1. Neck flexion stretch
Relaxes the muscles at the back of your neck.
Instructions
Sit up straight
Pull your chin into a “double chin”.
Drop your head forward, moving your nose closer to your chest, until you feel a gentle stretch in the back of your neck.
Hold the position for 10 to 30 seconds (shorter holds are often better for the neck).
Then come back upright and rest for 10 seconds.
Repeat 3 times.
2. Side flexion stretch
Relaxes the muscles at the side of your neck.
Instructions
Drop your left ear towards your left shoulder.
Place your left hand on your head and gently pull it to the left until you feel a gentle stretch in your right neck and upper traps.
Check that your right shoulder stays down and doesn't pull up towards your ear.
Hold the position for 10 to 30 seconds (shorter holds are often better for the neck).
Repeat on the other side.
Do 3 times each side.
3. “Double chin” stretch
Brings the vertebrae (neck bones) into good alignment, increasing the space for the radial nerve to slide.
Instructions
Stand with your lower back against a wall and your feet about 40 cm away from the wall.
Place the back of your head against the wall.
Pull your chin in, as if you want to get the back of your neck to touch the wall. Take care not to tilt your head forwards as you do this – you’re aiming for the maximum “double chin” look.
Do not push as hard as you can. Only pull your chin back to where you can feel a gentle stretch in the back of your neck.
Hold the position for 10 seconds and relax. Repeat up to 10 times.
💡 Tip: You may not be able to get the back of your head against the wall if your upper back is very stiff. If this is the case, place a small rolled-up towel between the back of your head and the wall.
4. Pec stretch
Relaxes the muscles at the front of the shoulder girdle.
Instructions
Stand with your arm straight out to the side and hook your hand against a door frame or other solid object.
Have your hand at shoulder height or slightly higher.
Slowly turn your body away from your hand until you feel a gentle stretch over the front of your chest or shoulder. You may also feel a stretch in your biceps.
Hold the position for up to 30 seconds.
Switch arms and repeat.
Do 3 times on each side.
Top tip: If your hand is lower than shoulder height, you will likely not feel a stretch. If your hand is in line with your shoulder, the stretch targets the pec minor more. If you hand is higher than shoulder height, it targets the pectoralis major more.
5. Triceps/lat dorsi stretch
Relaxes the muscles at the back of the shoulder and upper arm.
Instructions
Place your right hand behind your head (it doesn't matter if you can't reach very far back).
Use your left hand to gently pull our elbow back.
Hold the position for up to 30 seconds.
Switch arms and repeat.
Do 3 times on each side.
Neural mobilization for tennis elbow
When to use them
These exercises can usually be used in any stage of healing but may irritate your elbow if it is very sensitive to stretch. So, it can be useful to let your injury calm down a bit before trying them.
💡If your elbow tolerates the stretches we listed above that target the wrist extensor muscles, it is likely to also tolerate the neural glide discussed below.
Radial nerve glides
Neural mobilization exercises help your nerves to slide more freely. In this case, we want to target the radial nerve.
⚠️ For best results, loosen the muscles and joints in your neck and shoulder girdle by doing the stretches in the previous section BEFORE doing neural mobilization exercises. The radial nerve won’t be able to slide if the muscles are holding on to it.
Instructions
Stand with your feet shoulder width apart.
Have your arm straight down by your side, palm facing forward, and open your hand so your fingers form a straight line with your arm.
Rotate your hand inward and away from your body so your thumb faces backward.
Bend your wrist so your palm faces up and flex your fingers as far as they can comfortably go (your hand won’t close all the way).
Lift your arm out to the side until you feel a mild-to-moderate stretch in your forearm or rest of the arm.
Hold that position.
Now tilt your head to the hand-opposite-side and relax your wrist. Then bring your head back as you bend your wrist again.
Alternate between these two head/wrist positions 10 times.
Strength training exercises for tennis elbow
When to use them
It’s best to avoid strength training exercises during the reactive stage of tendinopathy, as these usually make the injury feel worse during this time – rest and techniques aimed at allowing the injury to settle are more effective during this stage.
If you acted quickly and managed to calm your elbow pain down before it entered the dysrepair or degeneration stage, you might not have to bother with strength training exercises.
However, if you’ve had your tendon pain for quite a few months, the injured part of the tendon and the wrist extensor muscles might have lost some strength, which can be part of the reason why even regular daily tasks make it hurt.
Strength training exercises can help to restore your tendon and muscle strength and function.
What type of strength training works best?
Research shows that any of the following types of strength training can work:
Eccentric exercises – these train only the lengthening (eccentric) muscle action, e.g. you slowly release a resistance band, moving your wrist from a fully extended position to a fully flexed position.
Isotonic exercises – these train both the shortening (concentric) and lengthening (eccentric) muscle actions, e.g. you first bend your wrist back into extension against the resistance of the band (concentric) and then release it slowly so your wrist moves back into flexion (eccentric).
Isometric – these strengthen the muscles without actually changing their length, e.g. you contract the muscles against resistance but without moving your wrist.
In our experience, exercises that isolate the wrist extensor muscles often cause tennis elbow pain to flare up. We often get better results with exercises that work the wrist extensors isometrically (so, holding the wrist still against resistance) while performing functional movements with the arm.
That’s not to say that we’ll never use isolated wrist extensor strengthening – patients are all different, and for some cases that is the best choice.
💡Tips to avoid flare-ups
Start with super light resistance and very few repetitions.
Check how your elbow pain reacts in the 24 hours after the exercise session, then adapt the exercises accordingly.
Leave at least one recovery day between training days – your body needs time to adapt and recover after strength training exercises.
Examples of isometric strength training for tennis elbow
1. Shoulder external rotation
This exercise mimics how the wrist extensor muscles work when we move our arm out to the side while holding something.
Instructions
Tie a light resistance band to something solid that won’t move if you pull on it.
Position yourself so the the band is fastened on the opposite side to the side you want to exercise.
Stand with your elbow bent 90 degrees and tucked into your side.
Hold the loose end of the resistance band and make a first with your palm side facing the resistance band. The back of your fist should form a straight line with your forearm.
Slowly turn your arm out to the side (about 60 degrees), keeping your elbow bent and tucked into your side. Your wrist must remain in line with your forearm, not bending back or forward.
Pause for a moment and then slowly rotate your arm back so your first is pointing straight forward again.
Repeat this up to 10 times.
Rest for 1 to 2 minutes.
Do 3 sets.
⚠️ If this exercise causes pain, you may be gripping too hard, using too strong a resistance band, doing too many repetitions, or turning your arm too far out. See whether adjusting the exercise helps. If not, it might not be the right exercise for you.
2. Forward punch
This exercise mimics how our wrist extensor muscles work when we lift an object or reach for something, e.g. lifting a kettle.
Instructions
Tie a light resistance band to something solid that won’t move if you pull on it.
Position yourself so the the band is fastened directly behind you.
Grip the loose end of the band and make a fist.
Start with your elbow bent to 90 degrees next to your body and the palm side of your fist facing in (thumb is pointing up).
Now slowly punch forward and upward, lifting your arm and extending your elbow, but keeping your thumb pointing up.
Pause for a moment, then lower back down to the starting position.
Repeat this up to 10 times.
Rest for 1 to 2 minutes.
Do 3 sets.
👉 As you get stronger, you can start to turn your fist as you punch out, so that the back of your first points to the ceiling. This will cause the wrist extensor muscles to work harder. Only do this once you can easily do the first version with heavier resistance bands.
⚠️ If this exercise causes pain, you may be gripping too hard, using a too strong resistance band, or doing too many repetitions. See whether adjusting the exercise helps. If not, it might not be the right exercise for you.
Final thoughts on exercises for tennis elbow
There are many stretches, mobilizations, and strength exercises you can use for tennis elbow. So, just because your physio has given you something different to what we demonstrated above does not necessarily mean that their plan is wrong.
It is not always possible to accurately predict how an exercise will affect your elbow pain. Rehab plans often have to be adjusted and fine tuned. This is why it’s important to have your exercises reviewed by your physiotherapist, so they can listen to your feedback and adjust your programme accordingly.
One of the most common causes of lateral elbow pain not calming down is patients overdoing their rehab. If you are able to lift heavy weights or do a lot of strength training (showing us your tendon and muscles are actually strong), but your pain persists, you might just need to give it a break and allow the sensitivity to calm down. My colleague Steph has written a brilliant article where she shares tips for tennis elbow that doesn’t want to stop hurting.
How we can help
Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.
