Physical Therapy Exercise for Elbow Pain

Elbow pain is a less common condition in the physical therapy clinic, but still one that can be reduced with exercise. Elbow pain usually affects your daily activities like typing, opening jars, and gripping. However, high-level athletes can also suffer from elbow pain that limits their sport performance, especially baseball pitchers. This post focuses on 1 physical therapy exercise to reduce elbow pain and 1 exercise to avoid it in the future.

What causes elbow pain?

Elbow pain can be caused by a number of different things, but overall it is too much load on the tendons of your elbow. When you suffer from elbow pain it is usually isolated to the inside or outside of your elbow. The muscles in your forearm that perform wrist flexion (bending your wrist with your palm up) attach on the inside of your elbow. The muscles that perform wrist extension (bending your wrist with your palm down) attach on the outside of your elbow. 

This inside or outside elbow pain is often associated by a sudden and large shift in activity. Maybe you decided to write a book and have been spending hours typing. Or perhaps you started a landscaping job and are gripping power washers, rakes, and mower handles all day. 

Where to Start in Reducing Elbow Pain

Whatever activity caused your elbow pain, you’ll likely need to modify or stop that activity for a time until your pain reduces. In the early stages of pain, taking breaks from your activity to move your wrist and elbow may help calm things down. If the pain persists for several days and is felt most of the day, you’ll likely need to reduce the amount of time you do that that activity each day. However, if the pain has been around for weeks you’ll likely need to take a break from the activity altogether.

What physical therapy exercises help elbow pain?

Exercise is an important part of reducing elbow pain and reducing the risk of getting it in the future. You’ll need to calm down the pain and then increase the amount of load that your elbow tendons can tolerate. For pain in the inside of your elbow, focus on the flexion exercises below. For pain in the outside of your elbow, focus on the extension exercises. 

The first exercise below reduces pain and starts to build strength in the affected tendon. The second exercise promotes remodeling of of the irritated tendon and increases the load it can tolerate.

Although these exercises are a great step to reducing elbow pain, if you just target the elbow you may be missing a key cause of your pain. To truly prevent elbow pain in the future, you’ll want to make sure your upper back moves well and the muscles around your shoulders are strong. See my post here and incorporate these shoulder exercises into your routine as well. 

Physical Therapy Exercise 1: Isometrics

Isometric wrist flexion (bending your wrist with your palm up) and wrist extension (bending your wrist with your palm down) can cause an immediate pain-relieving effect while starting to prepare the tendons for heavier loads. 

How to perform: bend your elbow to 90 degrees and rest your forearm on a table, counter, or your leg. You should be able to relax your arm, not feel like you have to push your shoulder up or down. You can hold a small hand weight with this exercise or use an exercise band, however just using your other hand may be enough resistance especially when you just start. Ideally, you want to push at 70% of your max push (as hard as you can). But keep your pain level low during this exercise, no sharp pain is allowed. 

For pain on the inside of your elbow – turn your palm up. Bring your wrist in line with your forearm and push and hold for 45 seconds. 

For pain on the outside of your elbow – turn your palm down. As you push up, slightly rotate your palm up and provide resistance on the thumb side of your wrist. For more information specific to pain on the outside of your elbow, see this post by the Prehab Guys.

Parameters: push and hold for 45 seconds. Repeat 4 times. Perform 3 times per day. 

Physical Therapy Exercise 2: Eccentrics

This is where you really start to repair the injured tendon and strengthen it to avoid pain in the future. You’ll want to start with a light hand weight or resistance band but increase the weight or resistance as your strength improves. Proper levels of weight/resistance are key to strengthen your tendon. Use too much resistance and you may irritate the tendon, don’t use enough and you won’t really build strength.

How to perform: the setup is the same as the isometrics. Bend your elbow and make sure your shoulder is relaxed. Curl your wrist up from a bent position. Here’s the key, go back down slowly. Take a full 5 seconds to go back down. 

For pain on the inside of your elbow – start with your palm up.

For pain on the outside of your elbow – start with your palm down. 

Parameters: take 5 seconds to go down. Perform 20 reps. Perform 3 times per day. 

If you want to see these exercises in action, watch the video below!

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Parameters for these exercises were guided by this article from the British Journal of Sport Medicine.

Disclaimer: These exercises are not a substitute for full medical evaluation. You should consult your doctor if you are experiencing any new pain. If any of these exercises sound especially helpful for you, be sure to discuss with your doctor the best way to implement them into your health plan and ask for a referral to a physical therapist for a full musculoskeletal evaluation.