I have tennis elbow. Can I still lift weights?

Short answer: Yes, you can still lift weights if you have tennis elbow – provided you do so in a way that is pain-free. 

I’ll provide some options for how to lift weights with tennis elbow towards the end (jump to that section here). Before we get there, I want to give you some insight into what happens when you have tennis elbow. 

What is tennis elbow?

Tennis elbow shows up as a small area of pain on the outside of the elbow that gets worse with movement and improves with rest. When it’s severe, even holding a cup of coffee can be painful. The proper name for this condition is lateral epicondylitis, which is 1000% why everyone calls it tennis elbow. 

It’s a repetitive strain or overuse injury characterized by changes to the cellular makeup of the common extensor tendon, leading to degeneration. This tendon connects some forearm extensors to the outside edge of the bottom of the humerus (the long bone in the upper arm). Tennis elbow is a type of tendinopathy. 

When there is a sudden change in how you use the muscles attached to the tendon, the tendon itself becomes stressed. Tendons have a relatively low blood supply and use only a small amount of oxygen, which makes them able to withstand extended use, but also means that they take a long time to heal. 

Common causes 

Despite the name, tennis is not the usual cause of tennis elbow – it only causes about 10% of cases. Any activity that involves repetitive gripping or wrist extension (pulling the back of the hand towards the forearm) or twisting, especially if loaded, can trigger the strain. Muscle weakness in the shoulder and arm can make it more likely to happen, as can smoking and obesity, likely due to their inflammatory actions. Other things that can trigger it: 

• Poor grip when playing racket sports
• Recreational activities like gardening, crafts, and playing a musical instrument
• Typing
• Painting, using a hammer or screwdriver
• Repetitive movements for two hours a day or more
• Lifting heavy objects, especially with an extended wrist

Wrist positions that can be aggravating include wrist extension and radial deviation of wrist (where the thumb moves sideways towards the forearm).

Wrist extension

Radial deviation of the wrist

How to lift weights with tennis elbow

The biggest change to lifting weights with tennis elbow is how you hold the weight. Here are some options for changing your grip when lifting weight to avoid stressing your forearm flexors. You won’t be able to substitute these alternate grip into every exercise, but it will give you more options than simply not lifting weights at all. 

No-grip weight lifting technique for front barbell position can be used instead of a high or low bar position on the back of the shoulders.

No-grip weight lifting technique for plate weight. This can be used instead of dumbbells at the sides, or in lieu of a goblet squat.

Once you’re pain free and advancing through your rehab, keep your risk of tennis elbow at lower risk by using a neutral grip. This still can be aggravating if you haven’t advanced far enough into your rehab yet. Check with the clinician you’re working with to see when you can start exercises that require gripping.

Tennis elbow treatment

If left untreated, tennis elbow will likely persist for many weeks or months, though it’s likely it will eventually resolve on its own within one to two years. Conservative treatment – that is, non-surgical treatment – can see this resolve within just a few months. From my experience, with consistent treatment it will slowly get better. And as with most conditions using conservative treatment, your best results will probably come from using a variety of treatment options. Of greatest importance: 

• Rest in the early stages (first few weeks after first appearance of pain) and avoid activities that make pain worse
• Pain management, which can include 
  • NSAIDS like ibuprofen (Neurofen, Advil), naproxen (Aleve), or diclofenac (Voltaren)
  • Ice after activity
• Physiotherapy/Physical therapy, which should include
  • Stretching exercises
  • Isometric and eccentric exercises, which have been shown to promote better tendon healing
  • Graded exercise is a must with tennis elbow rehab. In other words, there is a specific order in which rehab exercises need to be done to promote healing and prevent further injury. Get professional advice! 
• Massage or dry needling can help decrease the tension in the muscles attached to the tendon, which can decrease tendon stress. This is a pain-management activity rather than a strict resolution, but is still an important part of long-term recovery. 

Treatment options that may or may not be useful (varies per person):

• Ultrasound or cold laser treatments can help with pain management, but are unlikely to help long-term recovery.
• Cortisone injections may provide short-term pain relief. However, there is a chance that it will make no difference to pain levels, and repeated injections may actually further weaken the tendon. 
• Platelet-rich plasma injections (PRP), which is an injection of your own blood into the tendon to promote healing. 
• Forearm compression bands, which place pressure on a point below the tendon, decreasing the stress on the tendon. These may not be useful for everyone, as the pressure may not be enough to relieve pain at the elbow. 

Please remember, surgery is a last-resort treatment! 

What to avoid

To prevent further strain and overuse of the forearm and elbow:

• Avoid moving into the end range of motion with your wrist.
• Take frequent breaks if you must do repetitive activities, including sustained gripping.
• When lifting heavy items, keep your elbow slightly bent.
• Use a two handed grip where possible, if lifting heavy items or using a forceful grip (e.g. tennis racket, golf club).
• If a movement or exercises triggers your pain, stop doing it and speak to the clinician you’re working with about this. 

Want to know more? 

Buchanan BK, Varacallo M. Tennis Elbow. [Updated 2020 Nov 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431092/#

Flatt A. E. (2008). Tennis elbow. Proceedings (Baylor University. Medical Center), 21(4), 400–402. Available from: https://doi.org/10.1080/08998280.2008.11928437 

Lateral Epicondylitis. Physiopedia. (n.d.). Available from:  https://www.physio-pedia.com/Lateral_Epicondylitis