Jeremy Swisher, MD
Evidence-informed home exercise program
Common Extensor Tendinopathy Home Exercise Program
Name: __________________________________
Affected side: ______________
Start date: __________________
Review date: _________________
Clinician or PT: ______________________________
Before you start
This starter program is intended for adults who have already been evaluated and told common extensor or lateral elbow tendinopathy is the likely diagnosis. It is not a self-diagnosis tool, a postoperative protocol, or a substitute for individualized care.
This program may fit
Gradual pain and tenderness at or just below the outside elbow, aggravated by gripping, carrying, palm-down lifting, resisted wrist or finger extension, or stretching the wrist extensors.
Get assessed first
A sudden injury, major swelling or weakness, inability to fully move the elbow, locking or instability, neck pain with radiating symptoms, numbness or tingling, or pain located farther down the forearm that may reflect radial nerve involvement.
Stop signs
Call 911 for chest pain, trouble breathing, fainting, or another medical emergency. Seek same-day urgent assessment for a sudden pop with bruising or deformity, rapidly increasing pain, marked or progressive weakness, or a new painful, hot, red, or swollen elbow with or without fever. Arrange a prompt evaluation for new numbness, persistent rest or night pain, or unexplained systemic symptoms.
Check the next morning
A small amount of familiar discomfort can be acceptable when it stays controlled, does not increase across repetitions, and returns to baseline by the next morning. These numbers are practical monitoring guides, not validated universal thresholds.
Fit and safety
Confirm this is the right diagnosis.
This starter program is intended for adults who have already been evaluated and told common extensor or lateral elbow tendinopathy is the likely diagnosis. It is not a self-diagnosis tool, a postoperative protocol, or a substitute for individualized care.
This program may fit
Gradual pain and tenderness at or just below the outside elbow, aggravated by gripping, carrying, palm-down lifting, resisted wrist or finger extension, or stretching the wrist extensors.
Get assessed first
A sudden injury, major swelling or weakness, inability to fully move the elbow, locking or instability, neck pain with radiating symptoms, numbness or tingling, or pain located farther down the forearm that may reflect radial nerve involvement.
Do not self-start with these warning signs
Call 911 for chest pain, trouble breathing, fainting, or another medical emergency. Seek same-day urgent assessment for a sudden pop with bruising or deformity, rapidly increasing pain, marked or progressive weakness, or a new painful, hot, red, or swollen elbow with or without fever. Arrange a prompt evaluation for new numbness, persistent rest or night pain, or unexplained systemic symptoms.
This is a diagnosis-specific home program, not a substitute for an examination. A clinician may change the exercise, dose, range, or timeline based on your history.
Your home program
Load the wrist extensors, then restore the task.
Use wrist-extensor loading as the main exercise. When the elbow is especially painful, start with the static hold. As slow wrist extension becomes tolerable, use a brief easy hold as a warm-up instead of doing both as full loading sessions. Add rotation and grip one at a time as tolerated; the row is optional. No single loading dose is proven best.
- Frequency
- Isometric daily when symptoms are sensitive; strength about 3 days per week
- Equipment
- Table, light dumbbell or water bottle, light hammer, towel or putty, optional band
- First checkpoint
- Look for improvement by 4 to 6 weeks
- Primary goal
- Comfortable grip, carrying, lifting, work, and sport
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Exercise 1Daily during the more painful phase
Isometric wrist extension
Dose5 holds of 30 seconds with about 60 seconds of rest
Sit with the forearm supported, palm down, and wrist straight. Place the opposite hand across the back of the hand. Try to lift the knuckles while the opposite hand holds the wrist still. Keep the fingers relaxed and breathe normally. Begin at light effort, usually around 20 to 40 percent, and use less if symptoms are highly irritable.
Make it easierUse 3 holds of 20 seconds at lighter effort.
Progress itBuild toward 5 holds of 45 seconds before increasing hand pressure. Change one variable at a time and keep the next-morning response at baseline.
My starting dose or notes
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Exercise 2Every other day, usually 3 days per week
Slow wrist extension
Dose3 sets of 12, progressing toward 15 repetitions
Rest the forearm palm down on a table with the elbow bent and only the hand beyond the edge. Hold a light dumbbell or water bottle. Lift the knuckles for 2 seconds, then lower for 3 to 4 seconds. Keep the forearm supported and avoid rolling the wrist sideways.
Make it easierUse 2 sets of 10 with less weight or a smaller range. If needed, help lift with the other hand, then lower slowly with the affected hand.
Progress itOnce 15 repetitions are controlled for two sessions without a next-morning flare, add a little water to the bottle or the smallest weight increment. Keep the same slow tempo.
My starting dose or notes
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Exercise 33 days per week
Forearm pronation and supination
Dose2 sets of 12 repetitions in each direction
Support the forearm with the elbow bent to 90 degrees and the hand beyond the table edge. Hold a light hammer upright with its head above the thumb. Slowly turn palm up and return to thumb up, then turn palm down and return. Keep the wrist straight and upper arm still. Count each return to thumb up as one repetition in that direction.
Make it easierPractice without the hammer, or grip close to its head and use a smaller comfortable arc.
Progress itMove the grip a small distance farther down the hammer handle to increase the lever length. Keep the same controlled range and speed before trying a heavier hammer.
My starting dose or notes
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Exercise 43 days per week
Controlled grip
Dose3 sets of 8 squeezes with a 5-second hold
Support the forearm and keep the wrist straight. Squeeze a rolled towel or soft putty at submaximal effort, hold, then fully relax between repetitions. Avoid maximal gripping.
Make it easierUse a lighter squeeze or a 3-second hold.
Progress itUse firmer putty, then try a light carry at your side with the wrist straight. Start with a brief carry and increase time or weight separately.
My starting dose or notes
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Exercise 53 days per week
Optional band row with a neutral wrist
Dose2 to 3 sets of 12 repetitions
Use this optional exercise when shoulder-blade strength or endurance is limited or it supports your task. Secure the band at lower-chest height. With a relaxed grip and straight wrists, pull the elbows toward the ribs without shrugging, then return slowly.
Make it easierUse a lighter band, stand closer to the anchor, or use 2 sets of 10.
Progress itTake a small step away from the anchor or use a slightly stronger band. Keep the wrists straight and avoid clenching harder to finish the repetitions.
My starting dose or notes
Optional video companion
See the movement principles in context.
The written program above remains the prescription. This independent third-party video adds a visual explanation of the condition and common exercise options.
E3 Rehab video
Tennis Elbow Rehab (Education | Myths | Stretching & Strengthening Exercises)
YouTube content does not load until you choose this button.
A visual overview of lateral elbow tendinopathy, activity modification, and progressive wrist and grip loading.
Watch on YouTube (opens in a new tab)Use this video for education and technique, not as a second exercise program. Follow the exercises, dose, progression, and symptom rules on this page. Video examples are options, not additions. Links or promotions inside the video are provided by E3 Rehab and are not part of this program. Static holds and slow wrist-extension loading are options within a progression, not two full daily programs to stack together. The video also discusses injections and surgery. Those decisions require individualized evaluation and are not part of this home program. Radiating pain, neck symptoms, or neurologic symptoms need an evaluation.
Symptom response
Let the next day guide the dose.
A small amount of familiar discomfort can be acceptable when it stays controlled, does not increase across repetitions, and returns to baseline by the next morning. These numbers are practical monitoring guides, not validated universal thresholds.
Green light
Pain stays between 0 and 3 out of 10, grip remains steady, and symptoms return to baseline by the following morning.
Yellow light
Pain reaches 4 to 5 out of 10, grip feels weaker afterward, or the elbow remains worse the next morning. Return to the prior tolerated dose or reduce one or more loading variables and add recovery time.
Red light
Call 911 for chest pain, trouble breathing, fainting, or another medical emergency. Stop and seek prompt assessment for sharp, electric, or rapidly increasing pain, new numbness or weakness, major swelling, loss of motion, or symptoms that worsen week to week. Use same-day urgent care for a sudden pop with bruising or deformity, rapidly increasing pain, marked or progressive weakness, or a new painful, hot, red, or swollen elbow with or without fever.
Change one variable at a time
When symptoms are too reactive, first reduce range, resistance, repetitions, or frequency. When the current dose feels controlled for several sessions, progress only one of those variables.
Progression
Build capacity in stages.
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Stage 1: settle symptoms
Reduce repetitive hard gripping and palm-down lifting. Use a neutral grip or palm-up lifting when practical and begin comfortable isometrics.
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Stage 2: build forearm capacity
Add slow wrist extension, rotation, and controlled grip every other day. Progress repetitions before adding weight.
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Stage 3: return to work and sport demands
Progress lever length, loaded carries, work tools, racquet handling, or lifting. Begin near half of your usual volume and increase only when symptoms return to baseline by the next day.
Signs you are ready for the next stage
- Elbow and wrist motion are full or nearly full.
- Daily tasks stay at 0 to 2 out of 10 without a next-day flare.
- Resisted wrist extension and gripping stay controlled.
- Two to three loading sessions and two graded task sessions do not escalate symptoms.
When to schedule an evaluation
Schedule a visit if neurologic or mechanical symptoms are present, pain is worsening, grip strength is progressively declining, or a correctly dosed program does not produce meaningful improvement after about four to six weeks.
Call UCLA Orthopedics at 310-319-1234Progress tracker
Use this tracker through the first checkpoint above. Mark up to three key sessions each week, check weekdays for frequent work, and note symptoms, resistance, duration, or activity gains. Continue through a longer condition-specific trial when useful.
| Week | Key sessions | Daily or most-day work | Notes | ||
|---|---|---|---|---|---|
| 1 | 2 | 3 | |||
| 1 | MTWTFSS | ||||
| 2 | MTWTFSS | ||||
| 3 | MTWTFSS | ||||
| 4 | MTWTFSS | ||||
| 5 | MTWTFSS | ||||
| 6 | MTWTFSS | ||||
Common questions
Questions about this program
Do I need complete rest?
Usually not. Reduce the most provocative gripping and lifting dose while keeping tolerable movement and progressive loading.
Should I stretch the forearm?
Gentle stretching is optional and should not provoke a sustained flare. Stretching alone has not shown durable superiority over a loading-based plan.
Will a counterforce strap help?
A strap or wrist support may improve pain during an activity for some people, but long-term benefit is uncertain and it should not replace progressive loading.
Do I need imaging?
Imaging is not routinely required for a typical presentation. It becomes more useful after trauma, with mechanical or neurologic findings, or when appropriate care has not worked.
When can I use the harder options?
Wait until the current dose feels controlled for at least two sessions, grip remains steady, and symptoms return to your usual baseline by the next morning. Reach the top of the repetition range before adding resistance. Change one variable at a time, such as weight, lever length, hold time, or task duration. A harder option replaces the easier version; it is not extra work to stack onto the session.
Evidence
Guidelines, reviews, and clinical studies
This plan translates current clinical guidance into a practical home program. The cited sources support the treatment principles, but they do not establish one universal exercise recipe for every patient.
- JOSPT Clinical Practice Guideline: Lateral Elbow Pain and Muscle Function Impairments, 2022 (opens in a new tab)
- Cochrane Review: Manual Therapy and Exercise for Lateral Elbow Pain, 2024 (opens in a new tab)
- Eccentric Exercise for Lateral Elbow Tendinopathy, Systematic Review and Meta-analysis, 2021 (opens in a new tab)
- Unsupervised Isometric Exercise for Lateral Elbow Tendinopathy, Randomized Trial (opens in a new tab)
- AAOS: Therapeutic Exercise Program for Tennis Elbow and Golfer’s Elbow (opens in a new tab)
- NHS Dynamic Health: Elbow Pain and Progressive Home Exercises (opens in a new tab)
Evidence and recommendations can change. Last clinical review: August 28, 2026.