Tennis Elbow Rehab: What It Is, Why It Happens, and the Best Exercises

At Modern Movement Physical Therapy & Performance in Santa Monica, we work with tennis players of all levels dealing with elbow pain, grip weakness, and overuse injuries. Tennis elbow—also known as lateral epicondylalgia—is one of the most common conditions we see in recreational and competitive players. This guide explains what tennis elbow is, why it happens, and the most effective rehab exercises we use to reduce pain, restore strength, and help athletes return to tennis safely.

What Is Tennis Elbow?

Tennis elbow, or lateral epicondylalgia, is a condition involving the tendons on the outside of the elbow, most commonly the extensor carpi radialis brevis (ECRB). While it was once thought to be an inflammatory condition, research shows it is more often related to tendon degeneration and failed healing, rather than classic inflammation.

Over time, repetitive loading without adequate recovery can lead to changes in tendon structure, reduced load tolerance, and persistent pain.

Common Symptoms of Tennis Elbow

• Pain or tenderness on the outside of the elbow

• Pain with gripping objects or shaking hands

• Discomfort during wrist extension activities

• Increased pain during or after tennis, especially backhand strokes

  
  

How Common Is Tennis Elbow in Tennis Players?

Injury rates for tennis elbow have been reported as high as 37–57% among recreational and competitive tennis players, making it one of the most common overuse injuries in the sport.

What Causes Tennis Elbow?

Overuse and Load Management

Tennis elbow often develops when the tendon is exposed to repetitive stress without sufficient recovery. Playing frequently, increasing volume too quickly, or returning from time off without proper conditioning can overload the tendon’s capacity to heal.

Stroke Technique and Biomechanics

Certain technical factors can increase strain on the wrist extensor tendons:

• Contacting the ball with the wrist in a flexed position

• Consistently missing the racket’s sweet spot

• Leading the backhand with the elbow or rotating the trunk too early

These mechanics increase eccentric demand and vibration through the forearm.

Wrist Extensor Muscle Function

Some athletes with tennis elbow demonstrate reduced activation and endurance of the wrist extensor muscles, limiting their ability to absorb force efficiently during play.

Shoulder and Scapular Strength

The elbow does not function in isolation. Reduced strength or control of the shoulder blade—particularly the lower trapezius—can lead to compensations that increase stress on the forearm during tennis strokes.

The Rehab Approach That Works Best

Research supports a progressive strengthening approach that includes:

• Isometric exercises for early pain control

• Eccentric loading to improve tendon capacity

• Proximal strengthening of the shoulder and scapula

  
  

The goal is to restore load tolerance while addressing contributing movement and strength deficits.

Tennis Elbow Rehab Exercises

Mild discomfort during rehab is expected. Pain levels up to 4/10 are generally acceptable as long as symptoms do not significantly worsen the following day.

Exercise 1: Wrist Extension Eccentrics (ECRB)

Purpose: Improve tendon load tolerance and reduce pain.

How to perform:Begin with the wrist in extension. Slowly lower into wrist flexion over 4 seconds, then use the opposite hand to assist the wrist back to the starting position.

Sets & Reps:3 sets of 20 repetitions

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Exercise 2: Wrist Extension Isometrics (Elbow Straight)

Purpose: Reduce pain and build early strength.

How to perform:With the elbow straight, press into wrist extension and hold the contraction steadily.

Sets & Reps:3 sets of 15 repetitions 8-second holds

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Exercise 3: Side Lying External Rotation

Purpose: Improve scapular stability and reduce excessive load at the elbow.

How to perform:Maintain controlled shoulder blade movement without shrugging or excessive arching.

Sets & Reps:3 sets of 15–20 repetitions

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Exercise 4: Side Lying Flexion

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Exercise 5: Prone Extension

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Exercise 6: Prone Abduction with External Rotation

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How Often Should These Exercises Be Done?

• Isometrics: daily, especially during painful phases

• Eccentrics: 4–6 days per week

• Scapular strengthening: 3–5 days per week

  
  

Tennis participation may need temporary modification depending on symptom severity and irritability.

When to Seek Professional Help

If symptoms persist longer than 6 weeks, worsen over time, or significantly limit grip strength or play, a comprehensive assessment is recommended. For athletes in Santa Monica and the Westside of Los Angeles, a sports-focused physical therapy evaluation can help identify contributing strength, technique, and workload factors.

Frequently Asked Questions

How long does tennis elbow take to heal?Many cases improve within 6–12 weeks with proper load management and strengthening, though timelines vary.

Should I stop playing tennis completely?Not always. Many players can continue with modified volume and intensity while rehabbing.

Are strengthening exercises better than stretching?Progressive strengthening tends to be more effective than stretching alone for improving tendon health.

Why does shoulder strength matter for elbow pain?Efficient force transfer through the shoulder and scapula reduces compensatory stress on the wrist extensors.