PHYSIOTHERAPY EXERCISES

Extensor Tendonitis

This exercise program is designed to help reduce your pain and improve your elbow function. Research shows that these exercises are the most effective treatment for extensor tendonitis.[1][2][3]

Important Guidelines Before You Start

• Exercises should cause mild discomfort but not severe pain

• If pain becomes severe or lasts more than 24 hours after exercising, reduce the intensity

• Be patient - improvement takes time, typically 2-3 months

• Consistency is more important than intensity

Your Exercise Program

Exercise 1: Wrist Extensor Stretch

Purpose: Improve flexibility and prepare tendons for strengthening

1. Straighten your affected arm in front of you with your palm facing down

2. Use your other hand to gently bend your wrist downward until you feel a stretch on the top of your forearm

3. Hold this position for 30-45 seconds

4. Rest for 30 seconds

5. Repeat 3 times

When to do it:Before and after your strengthening exercises (6 times total per session)

Exercise 2: Eccentric Wrist Extension (Basic - Weeks 1-4)

Purpose: Strengthen the extensor tendons using controlled lowering movements

1. Sit with your forearm resting on a table, palm facing down, with your wrist hanging over the edge

2. Hold a light weight (start with 1-2 pounds or a can of soup) in your hand

3. Use your other hand to help lift your wrist up as high as possible

4. Remove the helping hand and slowly lower the weight down over 3-5 seconds (this is the eccentric part)

5. Use your other hand to help lift it back up again

6. Repeat 10-15 times

Exercise 3: Eccentric Wrist Extension (Advanced - Weeks 5-12)

Purpose: Progress strengthening as your tendon heals

1. Same position as Exercise 2

2. Gradually increase the weight (up to 3-5 pounds) as tolerated

3. Perform the lowering motion more slowly (5-7 seconds)

4. Repeat 10-15 times

Exercise 4: Finger Extension Strengthening

Purpose: Strengthen supporting muscles

1. Place a rubber band around all five fingers

2. Spread your fingers apart against the resistance

3. Hold for 2 seconds, then relax

4. Repeat 10-15 times

Your Daily Schedule

Frequency:Once per day, 5-6 days per week[4][5]

Duration of each session:10-15 minutes

Total program length:8-12 weeks minimum[6][7]

Progression timeline:

• Weeks 1-4: Basic exercises with light resistance

• Weeks 5-8: Increase weight and slow down the lowering phase

• Weeks 9-12: Continue with heavier resistance as tolerated

When Will I Feel Better?

•2-4 weeks:You may notice slight improvements in pain[8]

•6-8 weeks:Most people experience significant pain reduction[9][7]

•12 weeks:Substantial improvement in both pain and function[6]

•6-12 months:Maximum improvement; most people (97%) fully recover within 2 years[10]

Additional Tips for Success

• Apply ice to your elbow for 10-15 minutes after exercising to reduce discomfort

• Avoid activities that aggravate your pain during the first 4-6 weeks

• Gradually return to normal activities as your pain improves

• Consider wearing a counterforce brace during daily activities[11]

• Continue exercises even after pain improves to prevent recurrence

When to Contact Your Healthcare Provider

• Pain significantly worsens despite 4-6 weeks of exercises

• You develop new symptoms such as numbness, tingling, or weakness

• You cannot perform daily activities due to pain

• No improvement after 12 weeks of consistent exercise

Remember:Recovery takes time and patience. Eccentric exercises are proven to work, but they require consistent effort over several months. Stay committed to your program, and you will see results.

References

  1. The Beneficial Effects of Eccentric Exercise in the Management of Lateral Elbow Tendinopathy: A Systematic Review and Meta-Analysis. Yoon SY, Kim YW, Shin IS, et al. Journal of Clinical Medicine. 2021;10(17):3968. doi:10.3390/jcm10173968.

  2. Effectiveness of Eccentric Strengthening in the Treatment of Lateral Elbow Tendinopathy: A Systematic Review With Meta-Analysis. Chen Z, Baker NA. Journal of Hand Therapy : Official Journal of the American Society of Hand Therapists. 2021 Jan-Mar;34(1):18-28. doi:10.1016/j.jht.2020.02.002.

  3. Clinical Management of Tendinopathy: A Systematic Review of Systematic Reviews Evaluating the Effectiveness of Tendinopathy Treatments. Irby A, Gutierrez J, Chamberlin C, Thomas SJ, Rosen AB. Scandinavian Journal of Medicine & Science in Sports. 2020;30(10):1810-1826. doi:10.1111/sms.13734.

  4. Effect of Resistance Exercise Dose Components for Tendinopathy Management: A Systematic Review With Meta-Analysis. Pavlova AV, Shim JSC, Moss R, et al. British Journal of Sports Medicine. 2023;57(20):1327-1334. doi:10.1136/bjsports-2022-105754.

  5. Addition of Isolated Wrist Extensor Eccentric Exercise to Standard Treatment for Chronic Lateral Epicondylosis: A Prospective Randomized Trial. Tyler TF, Thomas GC, Nicholas SJ, McHugh MP. Journal of Shoulder and Elbow Surgery. 2010;19(6):917-22. doi:10.1016/j.jse.2010.04.041.

  6. A Randomized Controlled Trial of Eccentric vs. Concentric Graded Exercise in Chronic Tennis Elbow (Lateral Elbow Tendinopathy). Peterson M, Butler S, Eriksson M, Svärdsudd K. Clinical Rehabilitation. 2014;28(9):862-72. doi:10.1177/0269215514527595.

  7. Chronic Lateral Elbow Tendinopathy With a Supervised Graded Exercise Protocol. Özdinçler AR, Baktır ZS, Mutlu EK, Koçyiğit A. Journal of Hand Therapy : Official Journal of the American Society of Hand Therapists. 2023 Oct-Dec;36(4):913-922. doi:10.1016/j.jht.2022.11.005.

  8. Exercise Interventions in Lateral Elbow Tendinopathy Have Better Outcomes Than Passive Interventions, but the Effects Are Small: A Systematic Review and Meta-Analysis of 2123 Subjects in 30 Trials. Karanasios S, Korakakis V, Whiteley R, et al. British Journal of Sports Medicine. 2021;55(9):477-485. doi:10.1136/bjsports-2020-102525.

  9. Role of Strengthening During Nonoperative Treatment of Lateral Epicondyle Tendinopathy. McQueen KS, Powell RK, Keener T, Whalley R, Calfee RP. Journal of Hand Therapy : Official Journal of the American Society of Hand Therapists. 2021 Oct-Dec;34(4):619-626. doi:10.1016/j.jht.2020.10.009.

  10. Lateral Epicondylitis. Wolf JM. The New England Journal of Medicine. 2023;388(25):2371-2377. doi:10.1056/NEJMcp2216734.

  11. Comparison of Kinesiotape, Counterforce Brace, and Corticosteroid Injection in Patients With Tennis Elbow: A Prospective, Randomized, Controlled Study. Hoseini SM, Taghipour M, Jokar R, et al. PloS One. 2025;20(7):e0328396. doi:10.1371/journal.pone.0328396.