Lateral epicondylitis, commonly known as Tennis Elbow, is an injury that causes pain on the outside of the elbow, specifically where the forearm muscles and tendons attach to the bone. This condition is caused by repetitive strain, which leads to micro-tears and inflammation, primarily in the tendon of the extensor carpi radialis brevis (ECRB). For active individuals, the question of continuing with upper body exercises like push-ups is common. While traditional push-ups are generally ill-advised during an acute flare-up, there are safe modifications and alternative exercises that allow for the maintenance of strength without worsening the injury.
The Risk of Traditional Push-ups
Traditional push-ups should be avoided when experiencing an acute flare-up of tennis elbow because they place significant stress on the already damaged tendon. The standard push-up position requires the wrist to be in an extended position, meaning the back of the hand is bent toward the forearm. This wrist extension heavily loads the wrist extensor muscles, including the ECRB, which is the main tendon affected by lateral epicondylitis.
The repetitive action of flexing the elbow and pushing up from this wrist-extended position overloads the inflamed area. This undue stress can exacerbate existing inflammation and delay the natural healing process. Ignoring the pain and continuing with standard push-ups can lead to chronic tendon damage and prolong recovery.
Modified Push-up Techniques for Reduced Strain
For those who wish to continue performing a pressing movement, modified techniques can effectively shift the load away from the wrist extensors. The primary goal of any modification is to maintain a neutral wrist position, which minimizes the mechanical strain on the ECRB tendon.
One effective modification is performing push-ups while gripping a pair of dumbbells or kettlebells. This neutral grip keeps the wrist straight and prevents the excessive extension that aggravates the elbow. Alternatively, performing push-ups on your knuckles, provided you are on a soft surface like a mat, also forces the wrist into a more neutral position.
Incline push-ups, performed against a sturdy wall or an elevated surface like a bench, are another way to reduce strain. Elevating the hands decreases the overall body weight being pushed, which reduces the force transmitted through the elbow joint. This modification is useful when pain is still present with the neutral grip variations, allowing for continued strength maintenance while protecting the healing tendon.
Alternative Upper Body Exercises That Avoid Wrist Extension
When even modified push-ups cause pain, substitute other exercises that target the chest, triceps, and shoulders without involving wrist extension. Dumbbell chest presses are a superior alternative because they can be performed with a neutral grip, where the palms face each other, completely avoiding the problematic wrist position. Cable chest flyes are also a good option, as the angle and resistance can be easily adjusted to find a pain-free range of motion.
For triceps, exercises that use a rope attachment, such as overhead triceps extensions, allow the wrist to remain in a comfortable, neutral position. Include rotator cuff strengthening exercises, as shoulder stability can reduce compensatory strain on the elbow. Using these alternatives allows the affected tendon to heal while preventing significant loss of upper body strength.
Assessing Readiness for Full Activity and Seeking Guidance
A return to full, traditional push-ups and other strenuous activities should be guided by objective criteria, not just a reduction in pain. The first condition for progression is the ability to move the elbow through its full range of motion without any pain. You should be able to perform modified exercises pain-free for several weeks before attempting the standard movement.
A significant sign of readiness is the return of normal grip strength when compared to the unaffected arm. If you attempt a traditional push-up and feel any return of pain on the outside of the elbow, stop immediately, as pain is a clear sign that the tendon is not ready. Persistent pain lasting more than four to six weeks, or a noticeable loss of grip strength, warrants consultation with a healthcare professional or physical therapist. These experts can provide a proper diagnosis and an individualized rehabilitation plan, often incorporating specific strengthening exercises like eccentric wrist extensor curls.