TENNIS ELBOW PROGRAM
PROGRAM OVERVIEW
PROGRAM OVERVIEW: Welcome to the tennis elbow rehab program. This program consists of 8 phases and you will be given criteria to help you determine when to progress onto the next phase. There are some differences in how this condition should be handled based on how long you have been dealing with tennis elbow. Please take the time to read the following education piece.
EDUCATION: For this program, we will define tennis elbow, also called lateral epicondilitis, as pain in the outer part of the elbow that sometimes extends in the back of the forearm and may be accompanied by a weak and/or painful grip.
We will distinguish chronic vs. acute injuries. When the injury is acute, meaning it is a relatively new injury, it is called lateral epicondylitis and usually does not involve much tissue change or degradation. Think of it as a tendon strain and the area is inflamed. This should heal faster and you should experience significant improvement in 6 to 8 weeks.
On the other hand, if you have dealt with that pain for over 3 months or maybe even longer than a year, it is now a chronic injury. Inflammation is no longer a major factor hence why ibuprofen and other anti-inflammatory medications provide little relief. At this point the pain is due to tissue degradation. The collagen fibers that make up the tendon have degenerated and are now less adept at handling the load you place upon them. We call this lateral epidondylosis. What that means in practical terms is that this will take a much longer time for this to heal properly. You are most likely looking at a 6 months or longer recovery time and your tendon will continue to heal long after you become pain free.
Now that you understand the difference between acute and chronic and you will be getting different recommendations based on which category you fall in.
PROGRAM STRUCTURE: 8 Phases - You will perform the exercise routine from each phase for atleast 1 week prior to moving on to the next phase. Follow our guidelines in each phase to know when you are ready to progress on to the next phase.
SESSION STRUCTURE: Each phase contains a soft tissue work, mobility, and therapeutic exercise section. The soft tissue and mobility portion are to be done daily and the therapeutic exercise one is to be done 3-4x weekly unless stated otherwise. One full session should take you approximately 30 min.
EQUIPMENT: Lacrosse ball, Kinesiology tape, Elastic bands, Suspension trainer
FOCUS: This program is designed to help you overcome tennis elbow so that you can eventually return to your activities pain free. The program initially focuses on pain reduction and restoring mobility. As you progress, you will be taken through an extensive loading program to help your tendon heal and become able to handle the strains of daily life and sports. It finishes with performance training to help you return to full performance in your sport.
This program is for educational purposes only. You should consult your physician prior to engaging in this program.
MOVEMENT VIDEO LIBRARY
PHASE 1
Welcome to phase 1. In phase 1, the main focus is to reduce pain through soft tissue but also activity modifications to help you begin the healing progress. Be patient and make sure you meet the progression criteria before moving onto phase 2.
Before your sessions, check out the instruction videos for your exercises.
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1 ROUND:
1) wrist extensor LAX ball roll and hold + pin stretch x 2 minutes
2) Tennis Elbow Kinesiotaping -
3 ROUNDS:
1) Wrist extensor stretch (30s) -
5 ROUNDS:
1) Wrist extensor isometrics x 40 sec, to pain threshold
2) 20-30 sec rest between rounds
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Activity Modification (Acute)
Limit all painful activities as much as possible
Activity Modification (Chronic)
Reduce painful activities if possible
Avoid a big increase in activity that requires loading your outer elbow - gripping, pulling, etc. -
You are ready to progress when you’re able to perform a total of 200 sec of isometric work without lasting increase in pain
PHASE 2
Welcome to phase 2. In this phase, we will focus on reducing your pain/inflammation in the ankle and begin to regain unloaded movement. Remember to be very light with these movements and do not force any range of motion that is painful.
Before your sessions, check out the instruction videos for your movements.
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1 ROUND DAILY:
1) Wrist extensor roll and hold + pin stretch (2min)
2) Wrist flexor LAX ball roll and hold + pin stretch* (2min)
3) Kinesiotaping -
3 ROUNDS DAILY
1) Wrist extensor stretch 30 sec
2) Wrist flexor stretch 30s
3) 10-15 sec rest/shake out in between rounds -
3 ROUNDS
1) Tempo wrist extensor eccentrics with DB x 10 reps with a 3 sec tempo
2) Rest 30-45 sec between rounds
1 ROUND
1) Side to side wrist isometrics x 10 reps with 10 hold sec each direction
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Activity Modification (Acute)
Continue to limit all painful activities as much as possible.
All exercises should be performed pain free. Load and intensity of stretch should be dictated by pain.
Activity Modification (Chronic)
Continue to reduce painful activities and especially avoid big jumps in activities that tend to flare you up.
Experiencing pain during the rehab exercise is okay but it should not be higher than 3/10 and there should not be any worsening in pain beyond 24 hours. Once the pain subsides below 3/10 during the exercises, it is okay to increase weight. -
Tendon injuries don’t do well with prolonged rest. While it might help reduce pain initially, it will make your tendon weaker in the long run before it is not getting loaded. In response to being unloaded, your body responds by getting rid of any unnecessary tendon material. This is similar to your muscle getting smaller if you don’t exercise them (i.e. load them). Consequently, when you resume your activities, your tendon is even less capable of handling the load you put it under and you soon begin to experience pain again. This can create a vicious cycle which makes for a lengthy rehab to the extensive weakness of your tendon.
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Progression Criteria
1) You are experiencing less pain with daily activities.
2) You have performed phase 2 for at least 2 weeks.
3) You have no increase in elbow pain beyond 24hrs after the exercise program.
PHASE 3
In phase 3, we continue to gradually increase the load placed on the injured tissue/tendon. You will notice that we are performing more reps, lengthening the tempo duration and hopefully using more weight.
Before your sessions, check out the instruction videos for your exercises.
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1 ROUND DAILY:
1) Wrist extensor roll and hold + pin stretch (2min)
2) Wrist flexor LAX ball roll, hold and pin stretch (2min)
3) Tennis Elbow Kinesiotaping -
3 ROUNDS DAILY:
1) Wrist extensor stretch 30 sec
2) Wrist flexor stretch 30 sec
3) Biceps stretch 30 sec
4) Triceps stretch 30 sec -
3 ROUNDS:
1) Tempo wrist extensor eccentrics x 12 reps with 5 sec tempo
2) Banded radial/ulnar deviations x 10 reps
3) Dumbbell pronation/ supination x 10 reps
4) Rest 30-45 sec
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Activity Modification (Acute)
Continue to limit all painful activities, especially the one requiring forceful movements.
All rehab exercises should be done pain free.
Activity Modification (Chronic)
Continue to reduce painful activities and avoid big jumps in activities that tend to flare you up.
Pain with exercise is okay but it should not be higher than 3/10 and there should not be any worsening in pain beyond 24 hours. Once the pain subsides below 3/10 during the exercises, it is okay to increase weight. -
You will want to spend sufficient time in phase 3 to create adaptation, especially if you fall in the chronic category. It takes time for your tendons to adapt to the load placed on them. It is one of the slowest tissues to heal in the human body.
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1) You are experiencing further reduction in pain with daily activities.
2) You have performed phase 3 for at least two weeks.
3) You have no increase in elbow pain beyond 24 hrs after the exercises.
PHASE 4
In phase 4, tissue loading continues to ramp up and we are beginning to work on pulling activities.
Before your sessions, check out the instruction videos for your exercises.
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1 ROUND DAILY:
1) Wrist extensor roll and hold + pin stretch (2 min)
2) Wrist flexor LAX ball roll, hold and pin stretch (2 min) -
3 ROUNDS DAILY
1) Wrist extensor stretch 30 sec
2) Wrist flexor stretch 30 sec
3) Biceps stretch 30 sec
4) Triceps stretch 30 sec -
3 ROUNDS
1) Tempo wrist extensor eccentrics x 15 reps with 5 sec tempo
2) Banded pronation/supination x 10 reps
3) BW rows 8 reps
4) Prone W holds x 10 sec hold
5) Plank shoulder taps x 12 reps total
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Activity Modification (Acute)
1) Continue to limit highly repetitive or forceful activities especially the ones that involve gripping and twisting.
2) All rehab exercises should be done pain free.
Activity Modification (Chronic)
1) Continue to reduce painful activities and avoid big jumps in activities that flare you up
2) Pain during the rehab exercises is okay but it should not be higher than 3/10 and there should not be any worsening in pain beyond 24 hours.
3) Once the pain subsides below 3/10, it is okay to increase weight. -
Notice how we have gradually upped the load but in a progressive manner. That is so your tendons have time to adapt and become stronger. If we do so too rapidly we usually end up flaring them up. You should have the same approach with activities.
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Progression Criteria
1) You are experiencing further reduction in pain with daily activities.
2) You have performed phase 4 for at least two weeks.
3) You have no increase in elbow pain beyond 24 hrs after the exercises.
PHASE 5
In phase 5, tissue loading continues to ramp up and we are integrating more advances loading for the elbow.
Before your sessions, check out the instruction videos for your exercises.
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PERFORM AS NEEDED
1 ROUND DAILY (OPTIONAL):
1) wrist extensor LAX ball roll and hold + pin stretch x 2 minutes
2) Tennis Elbow Kinesiotaping -
3 ROUNDS DAILY:
1) Wrist extensor stretch 30 sec
2) Wrist flexor stretch 30 sec
3) Biceps stretch 30 sec -
3 ROUNDS:
1) Tempo wrist curls flexion/extension x 10 reps with tempo 3:1:3
2) Single arm bodyweight row x 8 each
3) Plank DB drag x 8 each side
4) Prone scaption x 8 reps
5) Farmers carry x 50 sec
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Activity Modification (Acute)
1) Continue to limit highly repetitive or forceful activities especially the ones that involve gripping and twisting.
2) All rehab exercises should be done pain free.
Activity Modification (Chronic)
1) Continue to reduce painful activities and avoid big jumps in activities that flare you up
2) Pain during the rehab exercises is okay but it should not be higher than 3/10 and there should not be any worsening in pain beyond 24 hours.
3) Once the pain subsides below 3/10, it is okay to increase weight. -
1) Most of your activities should be pain free by now.
2) You have performed this phase for at least 2 weeks.
PHASE 6
Phase 6 is the last phase with the not so fun but necessary slow tempo work. The exercises working on the supportive muscles of the elbow also become more challenging.
Before your sessions, check out the instruction videos for your exercises.
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PERFORM AS NEEDED
1 ROUND DAILY (OPTIONAL):
1) wrist extensor LAX ball roll and hold + pin stretch x 2 minutes
2) Tennis Elbow Kinesiotaping -
3 ROUNDS DAILY:
1) Wrist extensor stretch 30 sec
2) Wrist flexor stretch 30 sec
3) Biceps stretch 30 sec -
3 ROUNDS
1) Tempo wrist curls flexion/extension x 15 reps with 3:1:3 tempo
2) Single arm bodyweight row + rotation x 8 each side
3) DB plank to flag x 8 each side
4) Prone swimmer x 8 reps
5) Heavy farmers carry x 60 sec
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Activity Modification (Acute)
Proceed with caution with highly repetitive or forceful activities that involve gripping and twisting.
All exercises should be done pain free.
Activity Modification (Chronic)
Be careful when resuming previously painful activities and avoid big jumps in activities that tend to flare you up.
Pain with exercise is okay but it should not be higher than 3/10 and there should not be any worsening in pain beyond 24 hours. Once the pain subsides below 3/10, it is okay to increase weight. -
Spend enough time on this phase especially if you fall in the chronic category. This is the last phase containing focused tissue loading, therefore your last chance to create the last bit of adaptation necessary to have a strong and resilient tendon. You should also have achieved pain free status before moving on to phase 7 and 8.
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Progression Criteria
1) You are pain free with all activities and exercises.
2) You have done phase 6 for at least 2 weeks
PHASE 7
Phase 7, which means no more tempo and you are probably happy about that. Let’s now work on more advanced pulling and pushing activities as this is often how we tend to use our upper extremities.
Before your sessions, check out the instruction videos for your exercises.
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PERFORM AS NEEDED
1 ROUND DAILY (OPTIONAL):
1) wrist extensor LAX ball roll and hold + pin stretch x 2 minutes
2) Tennis Elbow Kinesiotaping -
PERFORM AS NEEDED
3 ROUNDS DAILY:
1) Wrist extensor stretch 30 sec
2) Wrist flexor stretch 30 sec
3) Biceps stretch 30 sec -
3 ROUNDS:
1) Hollow hang with scapular depression x 30 sec
2) Push up to toe taps x 5 each side
3) Supported bent over rows x 8 each side
4) Plank with banded clock (12 o’clock to 6 o’clock) x 1 each side
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Activity Modification (Acute & Chronic)
All exercises should be done pain free. -
Working on pushing and pulling stability and strength is crucial to function well in your activities and sports which is why we are now doing those. The tendon rehab is technically over and now we are optimizing movements at a higher level. All exercises should be done pain free. If that is not the case, it means your tissue is not able to fully withstand the loads placed upon them and you should go back to Phase 6 to continue working on building up more tendon tissue and making it stronger.
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1) You spent at least one week on phase 7.
2) You are pain free with all exercises.
PHASE 8
In phase 8, we build on the movement patterns we introduced in phase 7. This last phase is a little spicier but you will be more than equipped to get back to your normal exercise routine in and out of the gym.
Before your sessions, check out the instruction videos for your exercises.
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PERFORM AS NEEDED
1 ROUND DAILY (OPTIONAL):
1) wrist extensor LAX ball roll and hold + pin stretch x 2 minutes
2) Tennis Elbow Kinesiotaping -
PERFORM AS NEEDED
3 ROUNDS DAILY:
1) Wrist extensor stretch 30 sec
2) Wrist flexor stretch 30 sec3) Biceps stretch 30 sec -
3 ROUNDS
1) Pull ups (with or without assistance) x 5 reps
2) Banded push ups x 8 reps
3) Hi/Lo farmers carry x 30 sec each side
4) 1-handed DB or KB swing x 8 reach
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Activity Modification (Acute & Chronic)
All exercises should be done pain free. -
Consistent stability and strength work is one of the most effective ways to reduce injuries and perform well. Consider checking out our strength programs or complete our training questionnaire for recommendation on which program is best for you.
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Progression Criteria
1) You spent at least one week on phase 8.
2) You are pain free.