Lateral Epicondyle Tendinopathy Toolkit: Appendix C - Details of Exercise Prescription

Concentric/Eccentric Home Exercise Program (Peterson et al 2011[1])


  • Daily, 3-month program.
  • Forearm supported in pronation with elbow in some flexion.
  • Resistance 1kg women, 2kg men (1 litre of water = 1kg).
  • 3 sets of 15 once daily.
  • Increase resistance by 0.1 kg (100ml water) weekly.
  • No comment was made regarding pain during exercise.


  • Lift the weight by extending the wrist, then lower.
  • The original research used a water container that is unavailable in North America. We have substituted a water bottle in a bag.
Fig 1 of LET App C
    Figure 1

Supervised Eccentric Exercise and Stretching Program (Stasinopoulos et al 2006[2])

  • 3 times a week, 4 weeks.
  • Forearm supported in pronation with elbow extended.
  • Wrist extended as high as possible then lowered into flexion slowly counting to 30, return to starting position using the other hand.
  • 3 sets of 10, 1 minute rest between sets.
  • Resistance, free weights.
  • Increase resistance when the exercise is pain-free.
  • Exercise with mild pain. Stop if pain becomes disabling.
  • Passive stretching of the extensor carpi radialis brevis tendon (ECRB) done by therapist 3 times before and 3 times after the eccentric exercise. Forearm pronated, elbow extended, wrist flexed and ulnar deviated. Hold 30-45 seconds. 30 second rest between stretches.


  • Extend the wrist using the unaffected hand (2A).
  • Allow the wrist to flex (eccentric contraction of wrist extensors) (2B).
  • The original research used hand held weights. We have substituted a bag with weights.
Fig 2a of LET App C
    Figure 2A

Fig 2b of LET App C
    Figure 2B

The “Tyler Twist” Eccentric Wrist Extensor Exercise (Tyler et al 2010[3])


  • Daily, approximately 6 weeks.
  • Forearm pronated, elbow and wrist extended.
  • Allow wrist to flex slowly for approximately 4 seconds.
  • 3 sets of 15 once daily. 30 second rest between sets.
  • Increase resistance by using a thicker bar when the exercise is pain-free.

Fig 3a of LET App C
Figure 3A
Fig 3b of LET App C
Figure 3B
Fig 3c of LET App C
Figure 3C
Fig 3d of LET App C
Figure 3D
Fig 3e of LET App C
Figure 3E


  • Hold the bar in the affected hand (3A).
  • Place the unaffected hand as shown (3B).
  • With affected wrist in full extension, twist the bar with the unaffected hand (3C).
  • Stretch both arms out, elbows straight (3D).
  • Slowly allow the affected wrist to bend, i.e. allow an eccentric contraction of wrist extensors (3E).

Download Lateral Epicondyle Tendinopathy Toolkit: Appendix C - Details of Exercise Prescription


Developed by the BC Physical Therapy Tendinopathy Task Force: Dr. Joseph Anthony, Dr. Angela Fearon, Diana Hughes, Carol Kennedy, Dr. Alex Scott, Michael Yates, & Alison Hoens.

A Physical Therapy Knowledge Broker project supported by: UBC Department of Physical Therapy, Physiotherapy Association of BC, Vancouver Coastal Research Institute and Providence Healthcare Research Institute.

June 2013


  1. Peterson M, Butler S, Eriksson M, Svardsudd K. A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis). Uppsala Journal of Medical Science. 2011; 116: 269-279.
  2. Stasinopoulos D, Stasinopoulos I. (2006) Comparison of effects of cyriax physiotherapy, a supervised exercise programme and polarized polychromatic non-coherent light (bioptron light) for the treatment of lateral epicondylosis. Clinical Rehabilitation. 2006; 20(1): 12-23.
  3. Tyler T, Thomas G, Nicholas S, McHugh M. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial. Journal Of Shoulder And Elbow Surgery. Sep 2010; 19(6): 917-922.