- Loading is the treatment. Tennis elbow (lateral epicondylalgia) is a tendon-overload problem, and slow, progressive strengthening of the wrist extensors is the core of recovery — not rest.
- The eccentric wrist extension is the key move: a 6-week eccentric program significantly improved pain-free grip strength (Söderberg et al., 2012).
- Be careful with cortisone. A large systematic review found steroid injections help in the short term but leave you worse at 6–12 months than doing nothing (Coombes et al., Lancet 2010). Loading is the long game.
- Progress by feel, not by the calendar: a little discomfort during exercise is fine; sharp pain that lingers overnight means ease the load.
- Price: ₪400 per private 1:1 session · ★5.0 · 187 Google reviews · Recovery TLV, Tel Aviv.
Despite the name, most people with "tennis elbow" never play tennis — it usually comes from gripping and lifting at work, the gym, or the computer. The pain sits on the bony bump on the outside of the elbow and flares when you grip, lift a kettle, or shake hands. The good news: the right exercises, loaded gradually, are the single most effective treatment — and they are simple to do at home.
What is tennis elbow, really?
Tennis elbow (lateral epicondylalgia) is an overload problem of the wrist-extensor tendons where they attach to the outer elbow — not a simple "inflammation." The tendon has lost some of its capacity to handle gripping loads. That is why the fix is to gradually rebuild that capacity with loading, not to rest and wait.
The common forearm tendon involved is the extensor carpi radialis brevis (one of the muscles that cocks your wrist back). Repeated gripping creates small areas of disorganized tissue that are sensitive to load. Because it is a capacity problem, complete rest tends to backfire: the tendon gets weaker and flares again the moment you return to normal use.
The exercise routine, step by step
Three moves cover it: a slow eccentric wrist extension (the key one), a wrist-extensor stretch, and grip/forearm work. Start light, move slowly, and progress the weight as it gets easier. A little ache during the exercise is acceptable; sharp lingering pain means back off.
- 1. Eccentric wrist extension (the key move). Rest your forearm on a table, palm down, holding a light dumbbell (start 0.5–1 kg). Use your other hand to lift the weight up, then lower it slowly over 3–4 seconds using only the painful side. Reset with the good hand and repeat. 3 sets of 15, once daily. A 6-week eccentric program of this type significantly improved pain-free grip strength (Söderberg et al., 2012). Progress the weight as 3×15 becomes easy.
- 2. Wrist-extensor stretch. Arm straight out, palm down, gently bend the wrist down and in with the other hand until you feel a stretch along the top of the forearm. Hold 30 seconds, 3 times, twice a day. Do this after the strengthening, not before.
- 3. Grip and forearm rotation. Squeeze a soft ball or putty for 5 seconds × 10, and slowly rotate the forearm palm-up/palm-down holding a light weight, 2 sets of 15. These rebuild the gripping and twisting strength you use all day.
Pair the routine with one change to daily load: use a wider grip, lift with the palm up where possible, and take micro-breaks from sustained gripping. Consistency over 6–12 weeks is what changes the tendon.
Should I get a cortisone injection?
Usually not as a first step. A large systematic review found corticosteroid injections reduce pain in the short term but lead to worse outcomes at 6 and 12 months than no injection at all for tennis elbow (Coombes et al., Lancet 2010). Loading the tendon is slower but durable; injections are a last resort.
The injection can feel like a quick fix, which is exactly the trap: the relief fades, the tendon was not loaded, and many people end up back where they started — or worse. Serious complications are rare (under 0.1%), but the long-term outcome data is the reason we lead with exercise.
What happens in your first visit
- A confirmed diagnosis — we check it is the tendon and rule out look-alikes (a neck-referred pain, radial nerve irritation, or a joint problem).
- Your starting load — the exact weight and reps that challenge the tendon without flaring it.
- A written home plan you take with you, plus a tweak to your work or training grip.
- 1–2 exercises to start that day.
Common worries, reframed
- "Should I just rest it?" Short rest from the aggravating task helps, but complete rest weakens the tendon. Controlled loading is what rebuilds it.
- "Do I need a cortisone shot or surgery?" Rarely. Most cases settle with loading. Injections often worsen long-term outcomes, and surgery is reserved for the small minority that fails months of good rehab.
- "It's been months — is it too late?" No. Even long-standing tennis elbow responds to progressive loading; it just needs a bit more patience.
- "Will lifting make it worse?" Loading the right amount is the treatment. We set the dose so it challenges, not flares, the tendon.
Outer-elbow pain that won't settle? Recovery TLV builds you a loaded, individualized plan — in English, Hebrew or Spanish.
Book an assessmentHow long does it take to get better?
Most people feel meaningful improvement within 6–12 weeks of consistent loading. Recent or mild cases respond faster; long-standing cases can take 3–6 months. The biggest predictor of success is doing the exercises consistently and progressing the load — not the severity at the start.
| Situation | Typical timeframe with consistent loading |
|---|---|
| Recent (< 6 weeks) | Noticeable improvement in 4–6 weeks |
| Long-standing (> 3 months) | 3–6 months, with steady gains |
| Resting only, no loading | Often recurs when you return to gripping |
| Cortisone instead of loading | Short relief, worse at 6–12 months (Coombes 2010) |
When to see a doctor first
Scope note: Recovery TLV treats musculoskeletal and sports conditions; we do not treat vestibular (dizziness/balance) or pelvic-floor conditions, and will refer you on if that is what you need.
Frequently Asked Questions
What is the best exercise for tennis elbow?
Should I rest or exercise tennis elbow?
Do cortisone injections work for tennis elbow?
How long does tennis elbow take to heal?
Can I keep lifting or training with tennis elbow?
References
- Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376(9754):1751-67. PubMed · DOI
- Söderberg J, Grooten WJ, Ang BO. Effects of eccentric training on hand strength in subjects with lateral epicondylalgia: a randomized-controlled trial. Scand J Med Sci Sports. 2012;22(6):797-803. PubMed · DOI
- Rodríguez-Huguet M, et al. Pulsed negative pressure myofascial vacuum therapy and percutaneous electrolysis in the treatment of lateral epicondylalgia: a single-blind randomized controlled trial. J Hand Ther. 2024;37(4):644-652. PubMed · DOI
Related
Elbow pain that won't quit? Let's load it properly.
Recovery TLV · Yaakov Apter 9, Tel Aviv-Yafo · 050-717-1222 · ★5.0 (187 reviews)