23 exercises for treating Lateral Elbow Tendinopathy | Lateral Epicondylalgia | Epicondylitis

Lateral Epicondyle Tendinopathies (LET) are one of the most common upper limb disorders. It causes great functional limitation in patients who suffer from it, and it is common to have to take time off work or stop sporting activities due to its symptoms. Its treatment is based on Exercise, education and Self-management of the load and symptoms, where Physiotherapists, Occupational Therapists, Traumatologists or Rehabilitators play a very important role.

Attached you will find 23 exercises to work on these disabling elbow disorders. IMPORTANT: these exercises must be prescribed by a health professional.

Remember! ReHand, the digital tool for Prescription, Treatment and Monitoring hand-wrist-fingers patients, has specific Exercise programmes for Lateral Epicondylalgia.

Let’s go there!

Wrist Extension with Extender Fingers

One of the specific tasks is the control and strengthening of the extensor muscles of the wrist, involving the activation of the frequently affected finger extensors.

Wrist Extension with Closed Fist

We can include variations in which the finger extensors are not involved, performing wrist extensions with a closed fist. In this way, we enhance the work of the Extensor Carpi Radialis Longus and Brevis, which so often lack strength and control in Epicondylitis or Epicondylalgia.

Wrist extension with fingers extended against resistance Isometric (opposite hand)

In those cases in which we can make progress due to the patient’s symptoms evolving again, we can work isometrically on wrist extension, involving the finger extensors.

Wrist Extension with Closed Fist against resistance Isometric (opposite hand)

Another way of working on the previous exercise, if what we are interested in is not to continue irritating the extensor muscles of the fingers, is to work isometrically against the opposite hand, with a closed fist.

Wrist extension against resistance (elastic)

As the patient progresses in sensation, we can perform work with movement and in an isotonic manner, including resistance against gravity and an elastic.

Wrist Extension with Closed Fist against resistance (Dumbbell)

In the same way, this isotonic work can be done with different grips, such as this cylindrical grip with the bar of a dumbbell. Obviously, we could add weight little by little to continue strengthening.

Bilateral Wrist Extension with elbow flexion (elastic)

Taking advantage of the elastic, we can work with elbow flexion, both isometric and isotonic, the musculature of the lateral epicondyle, by means of a bilateral wrist extension.

Dynamic Wrist Extension with flexed elbows and weight (Stick Twist with flexed elbow)

Another proposal for dynamic work against resistance of the epicondylar muscles is the “Stick Twist”. This exercise allows us to carry out an analytical workout of this musculature in a controlled and dynamic manner. It is also one of the most functional exercises for this musculature.

Dynamic Wrist Extension with elbows extended and Weight (Stick Twist with elbow extended)

In the same way, we can make the work more demanding by adding elbow extension and anterior shoulder flexion. This situation will make it more difficult for the patient and will involve more control and work of the entire upper limb.

Sensorimotor work of the extensor musculature with the ReHand Opened Flexion-Extension Exercise.

It has been reported in several clinical trials how patients with painful conditions such as Epicondylalgia or Lateral Epicodilitis, suffer from changes in the sensorimotor system corresponding to the hand. This limits and slows down their subsequent recovery.

An active rehabilitation that achieves an impact at a CNS and a reorganisation of the cerebral map is necessary. This could reduce recovery times and promote an early improvement in clinical variables such as strength, pain or function. Thus, working with a a touchscreen tablet such as ReHand app, with exercises that are challenging and that can be repeated frequently, will promote these central changes and greater muscle activation.

Here you have an example of extension exercise with ReHand App. Only extension AROM is included:

Sensorimotor exercise of the extensor muscles with ReHand Closed Flexo-Extension Exercise

When we need to prescribe exercises for Extensor Carpi Radialis Longus and Brevis, without coactivating extensor digitorum comunis, a specific exercise is included in ReHand App. A close-fist with a pen is used to perform this exercise:

Wrist flexion against resistance Isometric

An interesting workout is isometric work of the antagonist flexor musculature. The lack of strength of the whole limb must be approached from all sides. A number of studies have reported a direct relationship between the strength of the extensor and flexor muscles of the wrist. So let’s not forget it!

Radial wrist deviation against gravity

Another isotonic work against gravity is the mobility towards radial wrist deviation, in those cases in which we are interested in working specifically on this movement.

Wrist Radial Deviation against resistance (elastic)

And if it is an exercise that we really want to prescribe for our patient with Epicondylitis, we can increase its difficulty by adding resistance with an elastic band. We can regulate the ROM at which you work according to your sensation.

Radial Wrist Deviation against resistance (Dumbbell)

If we do not have elastic, we can do the same work against resistance with a weight such as a dumbbell or a bottle of water.

Sensorimotor work of the Lateral Deviation wrist muscles

As mentioned above, in order to achieve an earlier recovery from Epicondylalgia or Epicondylitis, and to promote changes in the patient’s sensorimotor cortex, we can use the specific ReHand exercise programme. In this case, the work is performed in lateral deviation.

Thanks to its pre-exercise calibration, the patient can regulate his ROM without pain:

ReHand includes a specific exercise programme for working on the sensorimotor level for lateral epicondylalgia or lateral epicondylitis:

Elbow Flexion or Biceps Curl (Supination, Neutral and Pronation of the Forearm)

Another exercise we can add to your programme is to work against elbow flexion resistance with a simple biceps curl. We can adjust the position of the forearm to work more specifically on the relevant flexor musculature.

Anterior Shoulder Elevation

And as we all know, the most normal is the open kinetic chain work of the limb. This is why exposing the patient progressively to loads in this work dynamic is fundamental. This is work on the whole limb against resistance:

Sensorimotor work of the Extensor Index muscle

In some cases, analytical work on the extensor digitorum proprio of the index finger will be useful. Thus, ReHand also includes analytical sensorimotor work of this motor component on the tablet:

Wrist flexor muscle reaction exercises

In more advanced stages of recovery, we can include reaction and proprioceptive exercises by throwing and receiving objects. In this case, the flexor muscles of the wrist and fingers are mainly involved. As mentioned above, there is a direct relationship between the epicondylar and epitrochlear musculature, and epicondylitis or epicondylalgia can benefit from this.

Wrist Extensor muscle reaction exercises

In this way, we can also change the priority work on the extensor muscles, performing the same exercise but varying the position of the forearm.

In this way, we have condensed 23 exercises that you can apply to your patients with Epicondylalgia or Epicondylitis with tendon involvement.

Do you have patients with Epicondylitis or Epicondylalgia?

Tell us about your case and we will advise you!

Pablo Rodríguez Sánchez-Laulhé

Physiotherapist and Health Researcher