Tennis elbow: returning to sport step by step

Why it happens

Hitting technique (especially the backhand), equipment (strings too tight, unsuitable handle), increase in the number of strokes.

Coming back in four stages

1. 1

   Relative rest from the movements that hurt, pain-free activities.

2. 2

   Forearm strengthening prescribed or approved by your physiotherapist.

3. 3

   Light strokes with soft balls, short sessions, no matches.

4. 4

   Longer sessions, then matches, with equipment checked by a professional.

Move on to the next stage after 2 sessions in a row with discomfort of 2 out of 10 or less and no pain the next day. Each stage usually lasts 1 to 2 weeks, depending on your healthcare professional’s advice. For tennis elbow, gripping a handle or carrying a bag the next day is the test: if it hurts more, stay at this stage.

Movements to postpone

• prises et appuis sur la main from stage 3
• charges lourdes from stage 3

Strengthening exercises

• Isometric wrist extension

  from stage 1 of the plan

  Forearm on a table, palm down, hold the wrist extended against a light weight or your other hand, 30 seconds.

  To start: 5 holds of 30 seconds, once or twice a day.

  Variations, mistakes and progression

  Easier

  Very light resistance with the other hand.

  Harder

  Small dumbbell or a heavier water bottle.

  Common mistakes

  • Clenching the fist hard.
  • Lifting the forearm off the table.

  Moving on

  When 5 × 45 seconds stays at 3 out of 10 elbow discomfort at most.

• Slow wrist extension

  from stage 2 of the plan

  Forearm supported, palm down, lift the wrist with a light dumbbell then lower over 3 seconds.

  To start: 3 sets of 15, 3 seconds down, every other day.

  Variations, mistakes and progression

  Easier

  No weight, or use the other hand to lift and only do the lowering.

  Harder

  Slightly heavier weight.

  Common mistakes

  • Moving the whole forearm.
  • Lowering fast.

  Moving on

  When 3 × 15 is easy with no elbow pain the next day.

• Flexible bar twist

  from stage 3 of the plan

  With a flexible rubber bar, twist it with the healthy hand then slowly untwist it with the affected hand, wrist extended.

  To start: 3 sets of 15, 4 seconds to untwist, every other day.

  Variations, mistakes and progression

  Easier

  Softer bar, small range.

  Harder

  Stiffer bar.

  Common mistakes

  • Letting the wrist bend.
  • Going fast on the way back.

  Moving on

  When 3 × 15 is easy with the stiffer bar.

• Soft ball squeeze

  from stage 3 of the plan

  Squeeze a soft ball for 3 seconds then release, pain-free, keeping the wrist neutral. Increase firmness gradually.

  To start: 3 sets of 10 squeezes of 3 seconds, once a day.

  Variations, mistakes and progression

  Easier

  Softer ball, half-strength squeeze.

  Harder

  Firmer ball, 10-second holds.

  Common mistakes

  • Bending the wrist while squeezing.
  • Squeezing into pain.

  Moving on

  When you can squeeze a firm ball without pain.

• Forearm rotation with hammer

  from stage 4 of the plan

  Forearm supported, hold a hammer or a small weight by the end, slowly turn the palm up then down.

  To start: 3 sets of 10 each way, slowly, every other day.

  Variations, mistakes and progression

  Easier

  Hold the hammer closer to the head (lighter).

  Harder

  Hold it further away, towards the end of the handle.

  Common mistakes

  • Moving the elbow or shoulder.
  • Letting the hammer drop to one side.

  Moving on

  When 3 × 12 is done holding the hammer by the end, pain-free.

The doses are starting points. Stay at 2 out of 10 discomfort at most, during and the next day; otherwise switch to the easier version or go back to the previous exercise.

Rehab’s advice

First resume without matches, with few strokes and soft balls. Increase duration before intensity, and have your equipment checked by a professional.

What the Rehab plan does for this injury

The plan starts at 40% of your previous training volume and builds up to 90%, with a consolidation week every three weeks. If your discomfort reaches 5 out of 10, it stops and refers you to your doctor or physiotherapist.

In which sport?

• Nordic walkingRelax your grip on the poles and don’t squeeze the handle.
• TennisReview the grip, string tension and one-handed backhand; reduce session frequency at first.
• PadelChoose a softer racket, a wider grip and avoid cut shots at first.
• PickleballRelax your grip, avoid squeezing the paddle and shorten games at first.
• BaseballLimit throws per session, work on technique and avoid breaking balls while the elbow hurts.
• ClimbingAvoid very small holds and grip less hard; vary the holds and take breaks.