At a glance

The main loading exercise for tennis elbow: a light weight lifted and lowered slowly, three seconds each way. The tempo is the treatment, not the weight.

What it works

Primary muscles

Wrist extensors (extensor carpi radialis brevis and longus)

Also involved

Extensor digitorum
Grip muscles of the forearm, working to hold the weight

Equipment: A light dumbbell, half a kilogram to start, or a resistance band. A table or your thigh to rest the forearm on.

How to do it

1
Sit with your forearm resting along a table or your thigh, palm facing down, hand and wrist hanging over the edge.
2
Hold a light dumbbell, or the end of a band anchored under your foot. Start with less than you think: half a kilogram is a normal starting point.
3
Lift the back of your hand upward, taking three full seconds to reach the top. Count it out loud if you need to, because the tempo is the exercise.
4
Pause briefly at the top with the wrist lifted, keeping the forearm flat on the support.
5
Lower over three seconds, all the way down, resisting the whole way. The lowering phase gives the tendon its strongest stimulus.
6
Keep the elbow and forearm still throughout. If the forearm starts lifting off the support to help, the weight is too heavy.

How much to do

3 sets of 10 to 15 repetitions, 3 seconds up and 3 seconds down

Once a day, or every other day if the forearm is sore between sessions

Two or three out of ten discomfort during the exercise is acceptable and expected. Being worse the following morning means the dose was too high. Six to twelve weeks of consistent loading is a realistic timeline, and it helps to know that at the start rather than to conclude at week three that it is not working.

Stop and get assessed if

Stop and get assessed if the elbow locks or gives way, if numbness, tingling or weakness appears in the hand, or if the pain followed a fall. Get it looked at too if you have loaded it consistently for three months with no change, since something other than the tendon may be driving it.

Common mistakes

Going too heavy too soon: Tendons respond to controlled, repeated load rather than to maximum effort. A weight you can only move quickly is a weight that has removed the slow tempo, which is the ingredient actually doing the work.
Rushing the way down: The controlled lowering is where the tendon gets the strongest signal to remodel. Dropping the hand takes the most useful three seconds out of every repetition and leaves you doing half an exercise.
Stopping the moment it feels uncomfortable: Two or three out of ten discomfort during the exercise is expected and is not a sign of damage. The measure that matters is the next morning: if the elbow is worse on waking than it usually is, reduce the weight or the repetitions rather than abandoning the exercise.
Lifting the forearm off the table to help the weight up: Once the forearm moves, the elbow and shoulder share the load and the wrist extensors receive less of it, which is exactly the tissue you are trying to load. Pin the forearm so the movement happens only at the wrist.
Stopping the programme as soon as the pain settles: Pain settles well before capacity returns, which is why tennis elbow so often comes back a few months later. Keep loading through the full six to twelve weeks even once the elbow feels fine.

Making it harder

Add weight in small steps, 250 to 500 grams at a time, and only once you can complete all three sets at full tempo without the next morning being worse.
Emphasise the lowering: help the weight up with your other hand, then lower it slowly with the sore side alone. This loads the lowering phase more heavily than you could lift.
Rebuild grip alongside it, since gripping is what provokes the pain and gripping is therefore what has to recover. Start with gentle sustained squeezes on a soft ball.
Reintroduce the tasks that hurt, kettles, jars, tools and shopping bags, one at a time rather than testing them all in the same afternoon.

Making it easier

If movement is too sore to start with, use isometrics: hold the wrist in a lifted position against light resistance for 30 to 45 seconds, five repetitions, once or twice a day. They often reduce pain for a couple of hours afterwards, which makes them a good entry point.
Drop the weight entirely and practise the same slow movement with an empty hand, then add a band before you add a dumbbell.

Wrist Extensions