When I first started to experience tennis elbow pain, I thought it was temporary. Days and weeks passed by and it wasn’t getting better at all. I tried to do so many things to make it feel better but it literally took months to figure out what works and what doesn’t. There were many times where I felt utterly hopeless and depressed because I thought it was never, ever going to go away. I thought it was a permanent condition. Well, luckily for me (and you!), I figured out how to keep the pain at bay. I learned that it doesn’t have to be permanent. It’s more about pain management and understanding what makes it worse and what makes it better.
Note: These are all tools in your toolbox. Not one thing is going to completely fix everything. You have to try many things and have patience!
Rest. Avoid moves that create pain. Never work through the pain.
You MUST stop doing the thing(s) that caused the elbow pain to begin with. Was it practicing muscle ups? Was it dips? Was it bench pressing? Was it tennis? It could be one or many things. If you aren’t sure what caused it, well, you’ll have to be aware of what causes it to hurt next time so that you stop doing that. Also, if any new exercise aggravates the pain, you must avoid that as well. So anytime you feel something is causing the pain to flare up or the elbow to get “hot” you must take care of yourself and stop that. You must never, ever work through the pain thinking it will simply get better that way. So yes, this probably means that you have to take a SERIOUS break from one or more of your favorite activities. You might find this really sad, but you HAVE to take care of yourself first if you ever want to be pain free.
Take note of the small, subtle moves as well! For example, twisting a bottle cap open with my injured right arm would cause my pain to come up ever so slightly. So I stopped opening my water bottles with my right hand. You might think it’s not a big deal to just twist open a measly water bottle cap, but if you open and close it 20 times a day, it all adds up! Also, when driving and making a u-turn solely with my injured arm caused some pain too from spinning the wheel, so I stopped using that arm for that purpose. So be aware of even the little moves!
Implement Specific Exercises for Rehabilitation
Now, while I said that you must rest, that doesn’t mean you have to be completely immobilized. In fact, tendons NEED tension and motion to heal and stay healthy. It’s just that the motions you put it under need to be very specific: to strengthen the extensor muscles in your forearm. Tendons have very poor blood flow and healing doesn’t automatically happen like with other body parts (like muscles, skin, internal organs, etc). In other words, you have to do something about it.
Too much rest and too little movement can cause muscles and tendons to come to a stand still. Complete immobilization causes the muscles to weaken, atrophy and that decreases blood circulation even more. The idea is to stop the aggravating activity and motions, but not to stop ALL motions.
So what motions are you supposed to do? When it comes to tennis elbow, you have to do motions that specifically strengthen the forearm extensor muscles and the tendons associated with it. That’s the next section.
Strengthen the Extensor Muscles
I did the follow exercises almost every day and I still do them about 3 times a week to keep the pain at bay. All of these work in one way or another because they focus on strengthening the extensors through eccentric movements which create the most microtears in tendons without having to lift heavy weights. (These microtears create inflammation which jump starts the healing process in that area!)
Eccentrics Using a Thera-Band Flexbar (Highly Recommended)
This is here due to a recommendation from this article forwarded to by many others commending its effectiveness. IT WORKS. I want my tendons to be strong as hell year round. The Thera-Band Flexbars come in 3 strengths. My advice is to start with the lightest band, no matter how strong you think you are.
Watch this 3 minute video that explains the eccentric motion that strengthens the muscles. This works really well.
Key points: Start with just a 2 pound weight. This could be a small water bottle or a small weight that fits in your hand. Lower it slowly. For the first week, do 2-3 sets of 10 reps every day. For the second week, ramp it up to 3 sets of 10 twice a day. You want to experience some fatigue at the end of the 3 sets. So after the first week, if you’ve just been using a 2 pound weight or a water bottle, it’s very likely your muscles are used to this weight already. So it’s time to use something a little bit heavier. Something that weighs 4 pounds. You could also find some bag with a strap that you can hold and put some weight in it to make it heavier as time goes on. Every week, keep increasing the weight by a couple pounds and keep doing 3 sets of 10 repetitions once or twice a day.
The Zottman Curl
This exercise in particular felt really, really good in an unusual way. Everytime I did it my elbow and wrist would make cracking or popping sounds and there was no pain associated with it whatsoever. In fact, it actually felt like my bone positions were getting reset in some magical way. I can’t put my finger on it but I really felt the benefit from this…
Key points: Do NOT use a heavy dumbbell. Start with a light weight. I started with a 6 pound weight and that felt good. A few days later I said, “Let me try a 12 pound dumbbell since I can easily curl 25-30 pounds.” The 12-pound dumbbell immediately caused pain to flare up. So always start lighter than you think you’re capable of. Your biceps/brachioradialis may be plenty strong, but your extensor muscles in your forearm are weak, and this is why we must start with light weights and move up slowly over the weeks.I’m also sharing this video because the man gives a great explanation of how tennis elbow develops. The ART technique he does in the video didn’t help alleviate the pain, but it felt good regardless.
Stretch your wrists, fingers and arms
Learn to stretch everything by following this incredible video. It may not directly help strengthen the extensor muscles, but it will help to at least loosen all the surrounding structures.
Cross Friction massage
In the video below, they explain how tennis elbow develops after 4:00 in they explain the cross friction massage. This cross friction massage helped alleviate pain in a different way than the muscle strengthening exercises above. If the cross friction is PAINFUL, then the injury is too early for now and you need to save it for another time when it’s healed up a bit more.
Roll all over a Lacrosse Ball
I am an extreme fan of foam rolling. I use it primarily to get the muscle knots out of my upper back and all around my thighs and calves. But I can’t get into the smaller spots like the shoulders, triceps and forearms. Solution? The lacrosse ball! It’s like the size of a tennis ball but it’s very hard and perfect for releasing knots in all the tiny areas a foam roller is useless in. And the reason this will help with tennis elbow is because you have to take care of not just the forearm but also the surrounding tissues. You are, after all, one unit working all together. Foam rolling the triceps, for example, will initially be quite painful, but it’s the good kind of pain and it will in turn release tension in the triceps tendon, which inserts into the elbow. Similarly, I also roll over all around the front, side and back shoulder. And of course, I roll my forearms (both upper and lower) all over it as well. All of these things act like a domino effect of release. Even just pressing my palm into the ball back and forth provides some much needed release that I otherwise would not have known if I had never tried it. I like to use the lacrosse ball against a wall because it provides a good amount of pressure. If you want even more pressure you could simply lay on the floor. I bring the lacrosse ball with me in the car if I know I’m going to be stuck in heavy traffic and sometimes will use it to massage my forearms while I’m stopped.
Your forearms need love. Lots of love. Massage them by following this video. She also shows how to use the lacrosse ball after 2:45. So simple and therapeutic.
MobilityWOD’s unorthodox (but extremely powerful) method
The following video is really the big one that helped show me the light. It gave me a glimpse as to the possibility of being completely pain-free. It requires the use of a long elastic band and ANOTHER PERSON to help wrap it around for you super tight. You could use a stretch/elastic band (like a theraband for pilates) or a mountain bicycle tube with the stem cut out. The results I got from following this video are what initially gave me the glimmer of hope that I may not have to learn to live with this pain for the rest of my life because the pain was gone 100% for several days thanks to whatever it does. Now, with that said, this isn’t a catch-all-solution and it DOESN’T replace the extensor-muscle strengthening exercises above. You must continue with them even if this band causes complete pain relief because it probably won’t be permanent with this alone. I did it once every week or two and it felt phenomenal each time.
Sleeping Position: Learn to sleep on your back
Do NOT sleep on the arm with pain. This extra pressure on your arm is the last thing you need. Blood flow is already low enough to the connective tissues. When you sleep on your side and put pressure on your upper and lower arms, you reduce blood flow even more. And it’s even worse at night only because you may be in that position for hours. Precious hours that are supposed to be going toward recovery will instead be impaired. Also, if there is an issue with your ulnar nerve, do not sleep with elbows bent if you can avoid it.
OH YEAH, SPEAKING OF SLEEP… You gotta be getting 7-9 hours of sleep everyday! I noticed my aches would be worse after 6-hours of sleep and it only gets compounded if you keep doing that everyday.
Supplement with Collagen and Vitamin C (but avoid separate Calcium/Vitamin D supplement)
I firmly believe these collagen protein powder and vitamin C powder products helped accelerate the healing process for my tendinitis. The tendons and ligaments are pretty much almost completely (75%!) made up of collagen. The collagen is literally what gives these connective tissues all that strength. And the Vitamin C is needed for the repair of ALL living tissues, but most importantly in our case, the body can’t make and use collagen without the vitamin C. I wrote about these and other supplements in great detail in this blog post if you want to read about it. I took them to help cover my bases and made sure I was giving my body everything it needed to stay healthy in regards to dietary means.
Personally, I’m avoiding taking the rest of my calcitrate: I just want to say that I noticed that when I take Calcitrate (Calcium + Vitamin D) supplement that my tennis elbow pain would come back!!! So I avoid calcium supplements! I still take a multivitamin and drink calcium fortified almond milk so I’m surely not avoiding calcium but I’ve noticed this time and time again that taking the calcium supplement brings back the pain. And I could feel the pain not only where the tennis elbow is but pretty much in the entire forearm and elbow joint. Pretty strange. And the only reason I actually caught on to this pattern was thanks to Lyle Mcdonalds Ultimate Diet 2.0 plan. UD2.0 recommends large amounts of it to further help enable fat metabolism in the first 4 days of each cycle. So in those four days, I was thinking my tennis elbow had come back due to all the exercise, but it actually dissipated in the final three days of the cycle. Then when it came back on the week after, I thought maybe it was due to that. Sure enough, anytime I’ve tried taking it, the following day my forearm has been in pain. Anecdotally I found other people on the internet with this experience. Some have experienced the pain initially coming up but going away after several days of persistently taking it. I’ve tried taking it for two weeks straight hoping it would go away, but to no avail, so I’ve decided not to mess with it. It could also be the Vitamin D that’s causing it, as I’m not certain.
Tennis Elbow STRAP: For the laborer (or pro athlete) who cannot avoid pain-inducing movements because their job depends on it.
I’ve used this tennis elbow pad/strap and it was a great help for actually reducing the pain dramatically. It is simply an excellent way to help stabilize the tendons so that you are not in pain when you HAVE to use your arms. This is great for people whose job depends on repeatedly doing things that constantly inflame their condition (such as lifting bags of whatever). In fact, the way to know if the pad is on right is the following: Do some motion or pick up something lightly that causes the pain to occur. Then put the strap on (the pad goes on about a couple inches from the elbow more or less) and try that same move. If the pain doesn’t occur, then you’ve put it on properly! If the pain still occurs, play with the position until you get it on right. However, the pad itself is NOT a replacement for the extensor-strengthening exercises! This is merely to try to help prevent the tendinitis from worsening due to overuse.
Feeling Better? Want to go back to working out? Great! But rest one MORE week and when you start, keep the weight low and the reps high!
If you do some or all of the things above, you will feel the pain go away quite quickly. You may feel elated and ready to go back to your workout. But wait! I know you’re pain-free and feeling great, but there’s this great thing Lyle Mcdonald said once, he said after you’ve recovered from an overuse injury and you feel you’re 100% ready to go back to the gym, rest one more week. That is great advice.
Also, you can’t just jump into the same workout at the same level you were at before. Injured tissue doesn’t respond well to high-intensity loads! You need to not focus on hypertrophy and strength once you start working out. You need to purposely choose lighter weights (or easier progression exercises if you do bodyweight exercise). This will allow you to do higher reps. And higher reps are exactly what you need to do. Generally, very high reps (~50+) are pretty good for connective tissues because of blood flow. If it increases blood flow, that results in an increase in repair abilities. Because 50 reps sound really nuts, I recommend 20-30 reps as a compromise (50 reps take a lot of time). Also, this increased movement helps calm down the nervous system because it trains it to understand that there is no pain anymore. This will help you regain good neuromuscular control over the joint and surrounding tissues.
Anyway, I hope these things help provide some insight. I know there are even more exercises that can be used to help you, so please don’t give up hope. And remember, these exercises aren’t going to do themselves. You have to be proactive in your health. Most importantly, remember that tendinitis is an overuse injury. If you’ve learned anything from this post, it should be that you need to take a long break from the motions that aggravate the elbow for you and work on strengthening everything else. Muscles may heal in a couple days but tendons and bones take a lot longer than that so just do everything in your power and have patience! Once you start becoming pain-free, don’t stop the exercises! The stronger you can make your arm through gradual and safe progress, the better! And last but not least, don’t hesitate to go to a physical therapist.