Tennis Elbow Exercises: Where to Start and How to Progress

What tennis elbow exercises should you start with?

At Origin Health, tennis elbow exercises start at a point the tendon can tolerate. For me, the programme needs to be individualised. This is variable with tennis elbow, because some people come in and are unable to lift a mug, whereas others only feel it after long spells of typing or lifting heavy weights.

So really, I focus on the irritability of that tendon, meaning how easily it flares up, and start at a point that the tendon can tolerate. That might be simple isometric holds (the muscle works but the joint stays still) and some light stretching.

Or it could be that we start with gentle band resistance or very light dumbbells.

Across a programme, the exercises I use include:

• Isometric holds and light stretching
• Gentle band resistance or very light dumbbells
• More functional exercises, meaning movements that match what your work, sport or daily life asks of the arm

From there the load goes up in manageable amounts. Each time the elbow copes with its level, the weight steps up.

Most people I treat for tennis elbow play no racket sports

Despite its name, tennis elbow isn’t just a problem for tennis players. In fact, around 80% of the people I see with tennis elbow in clinic don’t play racket sports at all.

Research suggests that tennis and other racket sports account for only 5 to 10% of cases, with many people developing symptoms through everyday activities instead.

I regularly see weightlifters, office workers and people whose jobs involve repetitive manual tasks. Sometimes, the trigger is less obvious: carrying heavy shopping bags, spending long hours typing or using a mouse, or increasing gym weights too quickly.

The common factor isn’t necessarily the activity itself, but the amount of load being placed through the wrist extensor tendons in relation to their current capacity to tolerate it. These are the tendons on the back of the forearm that lift the wrist.

For example, my most recent patient with tennis elbow was a 43-year-old right-handed office worker who spent long hours at a desk, with plenty of typing and mouse use.

They were also a regular gym-goer and had recently increased the weights they were lifting. It was this sudden increase in training load, combined with the demands of their working day, that appeared to trigger their symptoms.

Tennis elbow can affect anyone, regardless of whether they play sport. Understanding what has overloaded the tendon is an important first step in developing a treatment plan that addresses the underlying problem, rather than simply managing the pain.

Why rest alone will not fix tennis elbow

Rest can help settle the pain associated with tennis elbow, but it doesn’t necessarily restore the tendon’s ability to tolerate load. One of the most common misconceptions I see is that, if your elbow hurts, the best solution is to stop using it altogether.

Taking a few days or weeks away from aggravating activities might ease your symptoms. However, when you return to your usual routine, the pain often returns too. That’s because, although the symptoms may have settled, the tendon’s capacity to cope with the demands being placed on it hasn’t necessarily improved.

This doesn’t mean you should push through significant pain or continue with activities that make your symptoms worse. Instead, the key is to modify your activity rather than stop completely.

Tendons need the right amount of loading to adapt and become more resilient. Through a gradual, progressive rehabilitation programme, we can rebuild the tendon’s capacity to tolerate the demands of everyday life, work and exercise, helping you return to the activities you enjoy with greater confidence.

What six to twelve weeks looks like

Generally, a tennis elbow loading programme is going to take six to twelve weeks. We should be seeing really good progress between weeks two and six, and then getting back to full function between six and twelve.

So for a gym-goer, the programme might mean from six weeks progressively reintroducing rows, carries, pulling exercises and heavier gripping tasks.

Towards the end stages, I look at the shoulder and the whole arm as well.

When tennis elbow needs more than exercises

Generally, tennis elbow does settle with treatment, and it has a good prognosis with physio.

If six to twelve weeks go by with no progress, I’d consider a scan under an upper limb consultant, a specialist in the arm. That is generally the first step, just to check that the diagnosis is accurate.

I’d also reassess everything, to make sure the neck isn’t involved and it’s not the radial nerve, which runs down the arm past the elbow.

Surgery is still very unlikely, but we do just need to have a clearer picture of why it’s not responding.

So where should you start with a sore elbow?

Find the level your elbow copes with, add load in small steps, and give it six to twelve weeks. Rest can settle the pain, but it often returns when you go back to normal.

If your elbow keeps flaring up, book an initial consultation at Origin Health.

You can read how Origin Health treats elbow, wrist and hand pain, or more about physiotherapy and exercise rehabilitation.

Frequently asked questions

What exercises should I start with for tennis elbow?

The first stage depends on how sore the tendon is. At Origin Health it is either isometric holds, where the muscle works but the joint stays still, plus light stretching, or gentle band resistance or very light dumbbells. From there the load rises a step each time the elbow copes.

How long does tennis elbow take to get better?

Most tennis elbow loading programmes at Origin Health take six to twelve weeks. Amanda Yardley aims for clear progress between weeks two and six, and a return to full function between weeks six and twelve. If there is no progress by then, she'd consider a scan under an upper limb consultant, an arm specialist.

Should I rest my elbow completely?

No. A break from aggravating activities can ease the pain, but it often comes back when your routine does, because the tendon's capacity to cope hasn't necessarily improved. Keep moving with modified activity, avoid pushing through significant pain, and rebuild that capacity with a gradual loading programme.

Can you get tennis elbow without playing tennis?

Yes. Around 80% of the people Amanda Yardley sees with tennis elbow in her clinic don't play racket sports. She regularly sees weightlifters, desk workers and people doing repetitive manual work. What usually matters most is how much load goes through the forearm tendons compared with what they can currently tolerate.

Is my elbow pain worth getting assessed?

Yes, if the pain keeps coming back. Private physiotherapy needs no GP referral, so you can book an initial consultation at Origin Health directly, in Liverpool Street, Canary Wharf or Marylebone. The first appointment runs for 60 minutes and costs £120.