The one exercise for tennis elbow that actually works!
For those of you who have ever had tennis elbow you know how frustrating it can be. That intense pain on the outside of your elbow can persist despite your best efforts at trying to stretch and massage the muscles around your elbow. Well, the good news is that there is finally good research to support a specific exercise that has been shown to help this condition. The article can be found here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971639/ However, before we get too far into explaining the results of this study, let’s start by looking at what tennis elbow actually is, and what causes it.
The problem is actually at the wrist!
Believe it or not, tennis elbow is actually caused by repetitive wrist motion. Specifically, repetitive extension of the wrist (ie. when the back of your hand bends backwards towards the back of your forearm). Wrist extension is very common during tennis, and many tennis players end up developing this condition, hence the name… tennis elbow.
The reason you get pain at the elbow can be shown in the photo below. There are three primary muscles that are responsible for extending the wrist and the tendons of these three all join together to form a common tendon that attaches to the outside of your elbow. When you repetitively extend your wrist it can create small microtears in this common tendon, and this can create inflammation and pain. Instead of using the term tennis elbow, you may hear your doctor call it lateral epicondylitis because the bone that the common tendon attaches to is called the lateral epicondyle and the “itis” refers to the fact that it is an inflammatory condition.
Let’s get back to the study that I mentioned at the start of this blog. It focuses on determining if eccentric exercise can be helpful in treating tennis elbow. So, what is eccentric exercise? This is a form of strengthening that occurs when the muscle is lengthening instead of contracting. So, think of it this way… when you do a bicep curl, the concentric part of the exercise occurs when you are contracting the muscle and flexing the elbow. Now, if you were to let the arm slowly straighten back towards the original position, this would be the eccentric phase. Eccentric exercise has been found to be helpful for a variety of tendinopathies (commonly called tendonitis). This study found that tennis elbow is no different! Eccentric exercise was found to be helpful for tennis elbow.
How to eccentrically strengthen the wrist extenors
We mentioned that repetitive wrist extension is the problem in tennis elbow. So, this is the motion that we want to eccentrically strengthen. However, this can be a bit tough by just using a regular dumbbell. The study I mentioned above tested a piece of equipment called a Flex Bar to eccentrically strengthen the elbow. They are actually quite affordable (we sell them for only $30). I could write down a long winded explanation as to how to use this piece of equipment but it’s simpler if I just show you, so check out the two videos below. The affected wrist should be the one that is extended. To eccentrically strengthen it, you want to let is slowly go into full flexion:
How often do you do this exercise?
The exercise was performed for 3 sets of 15 each day. Each repetition took 4 seconds to complete, and there was a 30 second rest between each set of 15 repetitions. The participants in this study did this for 7 weeks.
Can you do these exercise preventatively?
So, the pain has stopped but you want to keep doing the exercise to make sure that it doesn’t come back. Is this advisable? Yes!
One last word on pain on the outside of your elbow…
While pain on the outside of your elbow is often tennis elbow, there are other things that can cause this. If you are in doubt, then you might consider getting it checked out by a physiotherapist or your family doctor. Also, this exercise may not be appropriate for early stage tennis elbow. When the elbow is acutely inflamed, eccentric exercise can often cause the elbow to become more sore. Once again, if in doubt then check with your physiotherapist!
Registered Physiotherapist, Co-Owner of Thrive Now Physiotherapy