Many people with tennis elbow can keep doing push-ups, though usually not the standard floor version pushed through pain. The real issue is how much load reaches the sore tendon, and that load can be adjusted. Complete rest isn’t the only safe option either, since carefully dosed loading guided by your pain levels can still allow recovery.
Why Push-Ups Bother Tennis Elbow
Tennis elbow is pain on the outside of the elbow that comes from overloading the muscles that lift the wrist and hand.1MelioGuide. Push Up Pain: How to Identify and Fix Pain During Push Ups You don’t need to play tennis to get it. Any repeated gripping or wrist-lifting can do it, from hammering to typing to lifting weights. In long-lasting cases the tendon tissue itself wears down, with cells breaking down and dying off, rather than simply getting inflamed.2PubMed. Apoptosis and autophagic cell death in extensor carpi radialis brevis tendon in patients with lateral epicondylitis That’s why the tendon needs gradual loading to rebuild, not just time off.
Push-ups hold the wrist bent backward while the forearm works to keep you stable, which sends load straight through the elbow.3Hand Therapy Experts. Exercises to Avoid for Tennis Elbow The bent-back wrist stretches and irritates the sore tendon.4Hand Therapy Experts. Exercises to Avoid for Tennis Elbow Tension then rises sharply as you lower toward the floor, so pain often hits at the bottom of the rep.5Hand Therapy Experts. Exercises to Avoid for Tennis Elbow In a standard push-up, the elbow carries a peak force of about 45% of your body weight.6PubMed. Hand position affects elbow joint load during push-up exercise A heavy barbell bench press loads the elbow in a similar way.7Hand Therapy Experts. Exercises to Avoid for Tennis Elbow
The pain usually sits on the bony bump on the outside of the elbow, and sometimes spreads down the forearm. It’s often worst at the bottom of the rep or just as you push back up. Gripping a cup or shaking hands afterward may hurt too, and a dull ache the next morning is a sign the session was too much.
The same wrist-lifting muscles work whenever you grip, so lifting a full kettle, turning a key or carrying a bag can hurt in the same spot. If daily tasks sting as well, the tendon is irritable overall, and even a well-modified push-up may need to be scaled back for now.
How Much Pain Is Okay
In a study of another tendon problem, people who kept running and jumping while keeping pain within set limits recovered as well as those who rested.8PubMed Central / American Journal of Sports Medicine. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study That evidence comes from the Achilles tendon at the heel, not the elbow. So pain-guided loading is a reasonable approach for the elbow, though not one proven for it.
A common rule is to keep pain at 5 or below on a 0-to-10 scale during exercise. Pain should then settle back to your normal level by the next morning. If a session pushes you past that, drop to an easier push-up version or fewer reps.
The scale only works if your scores stay comparable. Before you start, decide what the ends mean for you, with 0 as no pain and 10 as the worst elbow pain you can imagine. Rate the pain at its worst point of the set, usually the bottom of a rep, rather than the average, since that’s when the tendon is under the most tension. If the score climbs rep by rep, end the set early, because rising pain suggests the tendon is being overloaded.
A mild ache that fades within an hour or so is usually fine. Sharp, stabbing pain at the bottom of a rep means stop that set. Pain that keeps you awake or makes gripping harder the next day suggests you did too much. Swelling, numbness or weakness are reasons to see a doctor rather than adjust your training.
How to Modify Push-Ups for a Sore Elbow
An incline push-up, with your hands on a bench, counter or wall, puts less of your body weight on the arms. Elbow and shoulder forces drop as your body angle rises, with forces lowest at about 45 to 60 degrees.9Research Square. Joint Loading and Muscle Activation of Upper-body in Different Incline/Decline Push-Up Variants by AnyBody Musculoskeletal Modeling Floor push-ups and feet-raised versions put the most force through the joints.10Research Square. Joint Loading and Muscle Activation of Upper-body in Different Incline/Decline Push-Up Variants by AnyBody Musculoskeletal Modeling Start at a height that feels comfortable, then lower it gradually as the elbow tolerates more.
To find that height, do five slow reps and rate the pain, then pick the height where the score stays at or below your limit. The wall is the easiest option, a kitchen counter is harder, and a sturdy table or low bench is harder still, since the lower your hands, the more body weight they carry. Make sure the surface can’t slide, because a slipping hand can send a sudden jolt through the sore elbow.
Keep your wrists straight. Doing push-ups on a straight wrist rather than a bent-back one is recommended for strengthening after wrist injury,11PubMed. Force transmission through the wrist during performance of push-ups on a hyperextended and a neutral wrist and the bent-back position is what stretches the irritated tendon.12Hand Therapy Experts. Exercises to Avoid for Tennis Elbow Holding dumbbells or push-up handles, or doing push-ups on your fists, keeps the wrist straight. Choose dumbbells with hexagonal ends that can’t roll. On fists, use a soft mat and press through the first two knuckles, as hard floors can bruise the hand. Holding handles is itself a grip, so if gripping hurts, fists may feel better.
Hand width matters too. Placing your hands wider than normal lowers the force running through the elbow.13PubMed. Hand position affects elbow joint load during push-up exercise A wide stance cuts elbow strain to about 29% of the elbow’s maximum, against 71% with hands close together.14PubMed. Hand position affects elbow joint load during push-up exercise Some advice says very wide hands can aggravate tennis elbow, so aim for slightly wider than shoulder width.15MelioGuide. Push Up Pain: How to Identify and Fix Pain During Push Ups A narrow stance also works the muscles harder, which is useful later but not while the elbow is sore.16PubMed. Comparison of muscle activation using various hand positions during the push-up exercise
Two smaller tweaks help. Keeping a slight bend in the elbows at the top rather than locking them out can ease strain.17MelioGuide. Push Up Pain: How to Identify and Fix Pain During Push Ups Stopping short of the deepest point avoids the moment when tendon tension peaks.18Hand Therapy Experts. Exercises to Avoid for Tennis Elbow
To work back toward the floor, begin with wall push-ups if counter height still hurts. Move to a kitchen counter, then a sturdy table, then a low bench. Advance only after two or three sessions at one height stay within your pain limit, and return to the floor with handles before trying flat-palm push-ups.
When to Pause Push-Ups and What to Do Instead
If incline push-ups with straight wrists still bring sharp pain, pause push-ups for now. Other signs it’s time: the pain stays above your limit even at a high incline, the next morning is consistently worse, or the pain wakes you at night or makes gripping everyday objects harder. A pause is a temporary change of plan that lets the tendon settle while you rebuild strength with gentler exercises.
Some clinics advise avoiding bench presses and chin-ups too while the elbow is irritated.19Ortho Bethesda. Top Exercises to Avoid If You Have Tennis Elbow Lower-body work, planks on the forearms, and machine exercises that don’t need a tight grip keep you fit. Resistance-band shoulder rotations use little grip. Skip heavy carries and pull-ups until gripping stops hurting.
Strong shoulders protect the elbow. When the shoulder is weak or unstable, the forearm muscles can overwork to make up for it.20Physical Therapy Reviews. Subacromial impingement syndrome and lateral epicondylalgia in tennis players That extra strain on the small forearm muscles can feed elbow tendon pain, especially with repetitive movement.21Physical Therapy Reviews. Subacromial impingement syndrome and lateral epicondylalgia in tennis players Shoulder-blade and rotator cuff exercises are therefore worth adding during a push-up break.
Not every outer-elbow pain is tennis elbow. Pain lower down the forearm rather than at the bony bump can come from a pinched nerve. That nerve problem, called radial tunnel syndrome, is rare and often confused with tennis elbow, so it’s worth naming if you see a doctor.22PubMed Central. Radial Tunnel Syndrome: Case Report and Comprehensive Critical Review of a Compression Neuropathy Surrounded by Controversy Pain that doesn’t improve with months of rehab deserves a doctor’s assessment.
Exercises That Help Tennis Elbow Heal
Slowly lowering a weight while the muscle lengthens has helped tendon problems in many parts of the body, including tennis elbow.23PubMed Central. A new exercise for tennis elbow that works! Programs including it have reduced pain and improved grip strength and everyday function.24PubMed. Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review
The Tyler Twist, done with a flexible rubber bar, is a well-supported slow-lowering exercise for tennis elbow.25MelioGuide. Push Up Pain: How to Identify and Fix Pain During Push Ups Hold the bar upright in both hands, with the sore arm’s hand on top and the wrist bent back slightly. Twist the bar with your good hand so it bends, then hold the twist while you extend your sore arm forward. Slowly release the twist with the sore hand by turning the wrist forward, keeping the arm steady. Start with a lighter bar and build up as it gets easier, keeping pain within your limit.
A reverse wrist curl uses a light dumbbell, lifting with the other hand and lowering slowly with the sore arm. Rest your forearm on a table, palm down, with your hand over the edge. Use your other hand to lift the weight up, then lower it over about three seconds. Start with a can of food or a 1 to 2 kilogram weight, and aim for about three sets of 15 most days, within your pain limit. Expect weeks to months rather than days for change.
Do Braces or Injections Help You Get Back to Push-Ups
A forearm strap worn below the elbow may give a little short-term pain relief, possibly more in people 45 or younger.26PubMed. The effects of counterforce brace on pain in subjects with lateral elbow tendinopathy: A systematic review and meta-analysis of randomized controlled trials Over the long run, physical therapy works better than the strap.27PubMed. The effects of counterforce brace on pain in subjects with lateral elbow tendinopathy: A systematic review and meta-analysis of randomized controlled trials A strap can make a workout more comfortable but doesn’t replace rehab exercise.
Wear it just below the elbow crease over the forearm muscle, snug but not tight enough to cause tingling or numbness in the hand. Put it on for activities that irritate the elbow, such as workouts, and take it off afterward rather than wearing it all day.
Steroid shots ease pain and improve grip for about the first six weeks, but after that the benefit fades and can reverse.28PubMed. Corticosteroid injections for lateral epicondylitis: a systematic review A year after treatment, 83% of people who had a steroid shot had recovered, against 96% with a dummy shot.29PubMed. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial Tennis elbow came back in 54% of those who had steroid shots, against 12% with a dummy shot.30PubMed. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial Repeated steroid shots may also raise the chance of needing surgery later.31International Journal of Sports Physical Therapy. Platelet-Rich Plasma versus Corticosteroid Injection for the Treatment of Lateral Epicondylitis: A Systematic Review of Systematic Reviews Platelet-rich plasma shots, made from your own blood, seem to give better relief than steroids beyond about two months.32International Journal of Sports Physical Therapy. Platelet-Rich Plasma versus Corticosteroid Injection for the Treatment of Lateral Epicondylitis: A Systematic Review of Systematic Reviews
Before any injection, ask how long relief is likely to last and about the risk of the pain returning. Ask whether you should keep doing rehab exercises afterward, and whether a physical therapist should guide you first.
How to Tell You’re Ready for Regular Push-Ups
How hard you can grip before pain starts is a common way to track tennis elbow recovery.33PubMed Central. Development of a core outcome set for lateral elbow tendinopathy (COS-LET) using best available evidence and an international consensus process Experts haven’t yet agreed it’s a reliable standard measure.34PubMed Central. Development of a core outcome set for lateral elbow tendinopathy (COS-LET) using best available evidence and an international consensus process Use it as one rough sign alongside how push-ups feel.
A practical checklist: you can carry shopping bags or turn a door handle without pain, low-bench push-ups stay within your pain limit for two weeks, and you’ve had no next-morning flare after your last few sessions. Then try a few floor push-ups with handles and judge the next day.
Excess weight, diabetes, high cholesterol and similar metabolic problems are linked to tendon problems.35Archives of Medicine. Lifestyle Factors as Risk Factors and Treatment Options in Tendinopathy In an Achilles tendon study, people with metabolic syndrome had more pain after the same exercise program.36PubMed Central. Beyond Mechanical Load: Metabolic Factors and Advanced Rehabilitation in Sports Tendinopathy: A Comprehensive Systematic Review Slower progress may therefore reflect overall health, not just training errors. Setbacks are common and usually mean stepping back one level, not starting over.