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How to Treat Epicondylitis (Elbow Tendinopathy) for Guaranteed Results

  • Writer: Timothy Agnew
    Timothy Agnew
  • Oct 6
  • 6 min read

Updated: Oct 7


©2025 T. Agnew
©2025 T. Agnew
It pains me to write this — this is the price one pays for hammering a keyboard like Jerry Lee Lewis all day, every day for 15 years. — Ben Myers, the Guardian

When Giancarlo Stanton (New York Yankees) experienced difficulty swinging during spring training practice, a medical assessment of his lateral elbow revealed lateral epicondylitis (tennis elbow).


The injury took him out of spring training and led to rest and conservative treatment. Unlike many cases of epicondylitis where surgery is often the only choice, Stanton’s issue resolved with manual therapy, platelet-rich plasma (PRP) injections, and modified bat-grip strategies.


While epicondylitis can affect both elbows (tennis, or outer elbow, and golf, inner elbow) and appears in athletes attached to the moniker, it’s a common dysfunction in writers and anyone performing overuse flexion and extension of the wrist and elbow.


Like carpal tunnel, epicondylitis can be stubborn because it involves thick, semi-vascular tendons that take longer to heal.


If you have a soreness or are in a full-blown episode of epicondylitis, this article will offer you some valid treatment options that target the cause and help you heal faster.


For a comprehensive text on anatomy and human movement, see our book here.


Epicondylitis Explained

Like many “litis’s,” epicondylitis is more accurately overuse tendinopathies provoked by repetitive wrist/forearm movements. Tendinopathies involve tendons and ligaments, which do not get the same blood supply as muscles. This makes healing slow and is a valid reason to be proactive in your training.


Overuse causes micro-tears in tendons and degenerative changes and not acute inflammation. The likely culprits? For golfer’s elbow, the common flexor carpi radialis tendon, and for tennis, the extensor carpi radialis brevis. I only mention these because later I’ll show you how to specifically isolate these tendons where they attach on the elbow.


Elbow tendinopathies often develop slowly, so it’s prudent to notice sudden soreness before it becomes difficult to hold a coffee cup or type on a keyboard (writers develop lateral tendinopathies which occur in one to three percent of adults).


While tendinopathies can begin gradually, overuse activities with prime force velocity (i.e., swinging a bat) can bring on a sudden full-blown case. It’s also possible to have double elbow tendinopathies.


Traditional Treatments for Elbow Dysfunction

A national 2014 U.S. database study assessed 85,318 cases of elbow tendinopathies and discovered that only two percent of diagnosed patients underwent operative treatment.

That’s good news and shows how effective proactive approaches like Giancarlo Stanton’s conservative treatment are. Eighty to ninety percent of patients respond to manual therapy protocols with added modalities like cold laser.


Other non-surgical options (some are merely Band-Aids) include:

· Cold laser therapy (highly effective)

· PEMF (Pulsed Electromagnetic Field, highly effective)

· Corticosteroid injections (Band Aid, destroys soft tissue after too many)

· Platelet-Rich Plasma (PRP, can be effective)

In my clinical experience, I had solid success with cold laser and PEMF for tendon-based and soft tissue dysfunction when applied as adjuncts with manual therapy (kinesiology). I use PEMF daily for overall health, and it’s worth considering home units.


Helping Elbow Tendinopathies with Traditional Kinesiology (and Common Sense)

If you feel pain and tenderness on the epicondyle, and pressing on this protuberance causes pain, your tendons are irritated. In the exercises below, we will target the attachment of the flexor and extensor muscles to the epicondyle, as well as the wrist and fingers.


To address elbow dysfunctions with kinesiology (the science of human movement) we must first identify what we are trying to achieve. Since tendinopathies involve tendon microtears and misalignment of fibers, we must gently place the tendons under forces that use full range of motion (ROM) of the wrist and elbow.


Secondly, we must identify the structures are attempting to target — first, muscle/tendons on the medial and lateral elbow, extensor carpi radialis brevis, and common flexor carpi radialis. While other extensor and flexor muscles are involved, I want to emphasize these two structures because of their direct correlation to the epicondyle’s of the elbow (bone) and fingers.


Focusing on natural movements of the wrist and elbow — flexion, extension, and rotation — and the supportive fascia that wraps everything in our bodies from head to toe is imperative.


The Protocol

1. Wrist Roller (I included this in my carpal tunnel piece, and it’s valid here as well).

If one exercise helps solve elbow dysfunctions, it’s this one. The roller forces the wrist to extend and flex to lift the weight, but it also acts on the epicondyle of the elbow. As you perform this movement, you will feel the pull at the elbow.


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To strengthen the entire wrist, forearm, and shoulders, this one exercise does it all. While you can buy an apparatus like this, you can also make one from PVC pipe. Rotate the pipe both clockwise and counterclockwise (flexion and extension) for 10X each. Keep the arms extended (you will cry). Try and keep the shoulders and body relaxed. Don’t shrug the shoulders. Keep your chest and shoulder up and back.


2. Radial/Ulna (forearm) Rotation (the pictures show assisted, but the movement is the same).


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This unique and brilliant exercise acts on both the wrist and elbow. You can use a weight bar (pictured) because it has its own heaviness, but you can also add weight. Add duct tape to the handle to make it more comfortable.


You must perform the movement, including radial and ulnar rotation (forearm), correctly. Start with no weight and adjust the choke of the bar to make it easier or harder to perform (moving your grip down makes it easier).


Lie on a bed or table, tucking the elbow at a 90-degree angle under your rib cage. First, begin by clasping the bar with the thumb up. Holding the elbow steady, rotate the bar into external rotation. Move slowly, resisting the return (eccentric) position. This strengthens the lateral epicondyle extensors. Perform 3X10 sets. Only add weight when it feels comfortable.


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Next, clasp the bar with thumbs down pinky up and internally rotate — slow. This strengthens internal ulnar/radial tissues. Perform 3X10 sets.


This is a difficult exercise, and you will feel this at the elbow as internal rotation is often weaker. Rest in between sets. You can ice after, using a frozen Dixie cup, moving the ice in circles on the epicondyle.


3. Elbow/Wrist Strength and Flexibility: (I discussed the wrist in my other article). If you are a writer, gamer, or perform movements that tax the wrist and elbow, you must maintain strength and flexibility.


Stretching

See a more detailed explanation of this and full body stretches here. With the arm extended in front, start palm up and clasp the hand. Pull down and feel the stretch at the wrist (this also targets the elbow).


If you have painful wrists and elbows, go slow until the tissue warms up. You can also move the wrist and hand in circles to create blood flow, and you can stretch your wrist with a closed fist to target the metacarpal bones (a closed fist produces a sliding in these small bones).


Strengthening

Doctors often don't prescribe this exercise, but it's incredibly effective, especially for difficult elbow tendinopathy cases. To strengthen the finger, wrist and elbow, use a tennis or a toy ball.


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While squeezing the ball strengthens the hand and is good for grip strength, doing so also places uncomfortable forces at the attachments at the elbow.


Remember the structures I mentioned earlier, flexor carpi radialis the extensor carpi radialis brevis? Squeezing each finger separately engages these muscles. This helps with soreness at the attachments.


Keep the arm extended — this pulls the fascia taught and makes the exercise more effective. Squeeze the ball with each finger, working your way to the pinky finger. You might be surprised that you can barely squeeze the ball with the pinky, and you will also feel discomfort on the lateral elbow.


Squeezing the thumb separately, you will feel discomfort at the medial elbow.

You should do at least three sets of ten reps on each finger, repeated three-four times per week.


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To target the lateral elbow extensors, this time we use a rubber band (again, with an extended arm). Wrap the band around the fingers and open and close the hand into full extension. As with the ball exercise, you can work each digit separately, including the thumb. Again, once you reach the pinky, you’ll feel an intensity on the lateral elbow.


Review

If you have some pain in your elbow, it’s time to be proactive — wrist and elbow tendinopathies are avoidable when caught early. Once the dysfunction begins, it often can progress quickly. Don’t fall into the surgery black hole if you can avoid it. And don’t get cortisone injections — it’s like injecting acid into your tendons.


Eliminate poor work postures such as computer mouse overuse and misalignment. If you type all day, focus on the exercises that strengthen the lateral elbow, as that’s where you’ll feel pain. Try this: mimic typing on a table and notice the extensor muscles twitch as they spiral into the lateral epicondyle.


Besides the exercises above, try adding thoracic extension and fascia squats (also in the linked article) to your therapy. These movements “open” the chest, gently pull on your fascia sheets, and help correct slouching.


Second, add the wrist protocol and make weekly exercises part of your work protocol. They are powerful exercises that work backed by studies .


If you have suffered for a long time with tightness and pain in your elbows, see a medical professional.


Remember, as you work, exercise, or move, always pull up from the back of the skull and down with the sacrum (hips). Pull up, pull out, restore. Create space by opening the body.


 
 
 

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