Tennis elbow, or lateral epicondylitis, is a painful condition affecting the tendons in the elbow, usually caused by overuse of the arm, forearm, and hand muscles. This plan outlines a phased approach to rehabilitation. Always consult with a physical therapist or healthcare professional before beginning any new exercise program.

Phase 1: Pain and Inflammation Management (Week 1-2)

The primary goal of this phase is to reduce pain and inflammation and protect the injured tendon from further stress.

Goal	Activity/Intervention	Frequency
Pain Relief	Rest: Avoid activities that cause pain.	As needed
Inflammation Reduction	Ice: Apply cold pack to the painful area.	10-15 minutes, 3-4 times daily
Protection	Bracing: Use a tennis elbow brace or counterforce brace as recommended by a clinician.	During activities and as directed
Gentle Motion	Passive Range of Motion: Gently move the wrist and elbow through pain-free ranges.	2-3 times daily

Phase 2: Gentle Stretching and Strengthening (Week 3-6)

Once the initial pain has subsided, focus on restoring flexibility and initiating gentle strengthening. Stop any exercise that causes sharp pain.

Stretching

Hold each stretch for 30 seconds and repeat 3 times.

• Wrist Extensor Stretch: Extend the affected arm straight out with your palm down. Use your opposite hand to gently bend your wrist down, pulling the hand toward your body.
• Wrist Flexor Stretch: Extend the affected arm straight out with your palm up. Use your opposite hand to gently bend your wrist down, pulling the fingers toward your body.

Strengthening (Isometric and Low-Weight)

Perform 3 sets of 10 repetitions for each exercise.

Exercise	Description	Equipment
Isometric Wrist Extension	Place forearm on a table, palm down, with wrist hanging off the edge. Gently try to lift the hand up against minimal resistance (e.g., opposite hand). Hold.	Minimal resistance
Isometric Wrist Flexion	Place forearm on a table, palm up, with wrist hanging off the edge. Gently try to lift the hand up against minimal resistance. Hold.	Minimal resistance
Supination/Pronation	Hold a light object (e.g., hammer or can). Rotate forearm back and forth, keeping the elbow close to the body.	1-2 lb weight or household item

Phase 3: Progressive Strengthening and Endurance (Week 7-12)

Gradually increase the intensity and duration of exercises, introducing eccentric loading (where the muscle lengthens under tension), which is crucial for tendon healing.

Key Strengthening Exercises

Exercise	Sets x Reps	Focus
Eccentric Wrist Extension	3 x 15	Slowly lower a light weight (2-5 lbs) from a fully extended position. Use the non-affected hand to lift it back up.
Eccentric Wrist Flexion	3 x 15	Slowly lower a light weight (2-5 lbs) from a fully flexed position. Use the non-affected hand to lift it back up.
Ball Squeeze	3 x 20	Squeeze a stress ball or tennis ball.

Phase 4: Return to Activity and Prevention (Week 12+)

Before returning to sports or heavy use, ensure you have full pain-free range of motion and strength equal to the unaffected arm.

Return-to-Sport Guidelines

1. Start with short durations and low intensity.
2. Ensure proper technique. Consider working with a coach or professional for evaluation.
3. Always warm up before activity (dynamic stretching) and cool down afterward (static stretching, ice).
4. Monitor symptoms; if pain returns, reduce activity level.