Tennis Elbow: Exercises and Activities to Avoid

Why the Wrong Exercise Makes Tennis Elbow Worse

Tennis elbow is tendinosis — the ECRB tendon is in a fragile state of attempted healing. Exercises that load the tendon incorrectly cause micro-tearing that undoes whatever healing has occurred. The key is understanding the difference between compressive load (which damages tendons) and controlled tensile load (which remodels them).

Exercises and Movements to Avoid

1. Wrist Curls and Reverse Wrist Curls (with weight)

Both load the wrist extensors and flexors in a way that directly stresses the lateral epicondyle. Avoid any dumbbell wrist curling movement, particularly reverse wrist curls (wrist extension against resistance), which directly load the ECRB.

2. Barbell Rows and Dumbbell Rows

Rowing movements require sustained grip and wrist extension against load — two things that directly stress the lateral epicondyle. Heavy rows are one of the fastest ways to worsen tennis elbow in the gym.

3. Pull-Ups and Chin-Ups

The grip required loads the forearm extensors through the full range of elbow flexion. Even with good grip strength, the load at the lateral epicondyle during pull-ups is significant. Avoid during active healing.

4. Forearm Pronation/Supination with Resistance

Exercises using a resistance band or weight to pronate or supinate the forearm create rotational stress at the elbow that worsens both lateral and medial epicondylitis.

5. Any Exercise Causing Pain Above 4/10

The general rule during tennis elbow rehabilitation: if an exercise causes lateral elbow pain greater than 4 out of 10 during or after, it is loading the tendon beyond its current healing capacity. Reduce load or skip the exercise.

What to Do Instead

Eccentric Wrist Extension Exercises (The Gold Standard)

Slowly lower a light weight from wrist extension to wrist flexion, using the other hand to return to the start position. Start with no weight and build gradually. This is the core of every well-designed tennis elbow PT program.

Tyler Twist (Rubber Bar Exercise)

A specific eccentric exercise using a flexible rubber bar (such as the TheraBand FlexBar). Research has shown significant improvement in pain and function in patients who completed a 6-week Tyler Twist program.

Isometric Wrist Extension

Holding a static wrist extension position against light resistance. Isometric exercise produces less tendon stress than dynamic loading and is a good starting point when pain is significant.

Sport-Specific Modifications

• Pickleball: Avoid hard drives and overhead smashes; continue dinking with a light grip and counterforce brace
• Tennis: Reduce pace and spin; avoid the one-handed backhand drive temporarily
• Golf: Reduce swing power; focus on tempo and smooth impact
• Weightlifting: Substitute machine exercises for free weights where possible; reduce load on all pulling movements