Part of Tennis elbow
Lifting weights with tennis elbow: what to change in the gym
Warning signs, and when to get help
Can you lift weights with tennis elbow?
Most lifters can. Lifting weights with tennis elbow turns out to be a problem with a handful of grips and holds rather than with training as a whole, and the two groups who do worst are the ones who change nothing and the ones who stop for a season. One keeps feeding the tendon more than it can take. The other comes back to the same tendon on a weaker arm.
Before anything else, get the side right, because a surprising amount of gym advice on this gets it backwards. Tennis elbow is the outer side of the elbow and the muscles that lift the wrist and fingers. Pain on the inner side, the one you feel when you grip and bend the wrist forward, is the other condition, and gym, lifting and grip work with golfer's elbow is the page for it. If you are not yet sure which side is sore, or whether this is the tendon at all, start with elbow pain when lifting. Everything below assumes the diagnosis is the outer one.
Why the outer elbow objects in the gym
The wrist extensors are not the muscles doing the lift. They are the muscles stopping your wrist from collapsing while the hand holds something heavy, and they share one tendon into the bony point on the outside of your elbow. Load them by holding, not by moving.
That single fact explains most of what lifters find confusing. A heavy hold with no elbow movement at all can be the worst thing in the session, while a movement that looks much harder passes without comment. The AAOS lists straightening the wrist and fingers against resistance with the arm fully straight among the tests a doctor uses to reproduce this pain, which also tells you something practical: a straight arm under load is a more provocative position for this tendon than a bent one. Many programs work the early exercises with the elbow bent and straighten up later for exactly that reason.
Grip force is the other half. The harder your hand squeezes, the harder those muscles work to keep the wrist steady, and a nervous grip on a bar you do not trust is more work than a confident grip on one you do.
Which lifts set the outer elbow off
Look for the combination rather than the exercise name: a firm hold, plus a wrist being held back against something, plus often a pronated forearm or a straight elbow. Once you can see that pattern you can find your own culprits instead of working from somebody else's list.
- Hard pulling with the forearm locked in one position. Pull-ups, barbell rows and lat pull-downs with the palms turned down: the grip is hard, the forearm is held turned, and at the bottom the elbow is close to straight. Chin-ups on a straight bar belong here for a slightly different reason, because the forearm is pinned palm-up on a bar that cannot rotate with you.
- Heavy holds and carries. Deadlift top sets, farmer's carries, loaded shrugs, dead hangs. No elbow movement, maximal grip, which is the shape this tendon likes least.
- Reverse curls and wrist rollers. These go straight at the wrist extensors as training, with the weight trying to drop the wrist the whole way. A hammer curl is a neutral grip and is usually kinder to the outer elbow, though it still pulls on the muscle running from just above the bony point into the forearm (brachioradialis), so test it rather than assume it is fine.
- Reverse wrist curls, taken anywhere near failure. Useful at a rehab load on a supported forearm, a different animal as a hypertrophy set.
- Anything on a thick handle or a fat-grip attachment, because a handle your fingers cannot close around raises grip effort for the same weight.
- Kettlebell cleans and snatches, where the bell rotates around the hand and the wrist has to catch it, usually fast.
Two more that sit outside the list. A bar you are gripping nervously counts as a hard grip even if it is light, which is why a flare sometimes turns up on an easy week after a change of equipment. And long accessory sets of 15 to 20 reps with a firm hold can beat a heavy triple, because total time under grip matters as much as peak load.
What to change before you drop a lift
Here is the order, and it puts the barbell weight last on purpose.
Start with how hard you are holding. Straps or hooks on the heavy pulls, chalk instead of a death grip, a handle that fits your hand, and a bar you trust. This is the single biggest lever and it costs you almost nothing in training quality.
Then change the grip position. Neutral handles and rings on pulling work take the forearm out of the turned-down position, and a narrower grip is often more comfortable than a wide one. This is the change that genuinely tends to help on the outer side, and it is reasoning from the mechanism rather than a finding from a trial. A supinated grip takes the forearm out of that position too, with one caveat: take it on rings or a handle that can rotate rather than on a fixed straight bar, because a straight bar pins the forearm palm-up, which is why straight-bar chin-ups are in the list above.
Then the elbow angle. Avoid a dead straight arm under a heavy hold where you can: start a pull-up from a slight bend, keep a soft elbow at the bottom of a row, and come off the full lockout hang.
There is one place that advice does not go, and it is worth being blunt about. Never bend your elbows under a loaded barbell you are pulling from the floor. A bent arm, and particularly a bent arm with the palm turned up on a mixed grip, is the way the biceps tendon tears off at the front of the elbow, which is the pop in the warning list below. On a deadlift the arms are hooks and they stay straight.
Then tempo. The sore moment is usually the fast one, where the wrist snaps to stop something moving. Slowing the lowering and stopping the bar swinging takes load off the tendon without touching the weight.
Load last, and only on the lifts still complaining after the first four. When you do cut it, cut it on the offending lift rather than across the whole session. A strap gets asked about at this point: tennis elbow braces and straps has the evidence, and the short version is that it may make a set more comfortable today and nobody can tell you it changes anything else.
Which gym exercises should you avoid with tennis elbow?
There is no universal list, and a page that gives you one is guessing, because the same exercise is fine with straps and a neutral handle and miserable without. What we usually park for the first few weeks is the group that cannot be modified much.
Timed dead hangs, thick-bar holds and maximal grip work. These are maximal grip by design, held still, which is the exact shape that loads this tendon hardest.
Direct wrist extensor work as training, as opposed to as rehab. The distinction matters because the same exercise sits on both lists: a slow wrist extension with a weight on a supported forearm at a rehab load is part of the program, and a set of reverse wrist curls pushed toward failure for forearm size is not the same exercise even with the same name.
Reverse curls and wrist rollers, for now, for the same reason.
Any lift that is reliably worse the next morning after you have already fixed the grip, the position and the tempo. One sore morning tells you nothing. The same lift three sessions running tells you to leave it out and rebuild to it.
What stays is most of your week: lower body, pressing, machine and cable work that does not need a hard squeeze, and conditioning. Losing a whole training block for one forearm is a bad trade.
Where the rehab work fits into a training week
The program owns the stages and the numbers. What it cannot tell you is how they sit beside training you are already doing, so here is how we usually arrange it. If you have high blood pressure, breathe steadily through every hold and never hold your breath.
Early on, the gym is where the changes happen and the elbow work is small. Isometric wrist extension goes in on its own, the grip-heavy lifts get straps and a neutral handle, and direct extensor training comes out. As the holds get easy, wrist extension with a weight becomes the main job and the lighter grip work starts coming back, one lift at a time so you can tell what caused a flare. Later, forearm rotation with a dumbbell and a reverse grip curl can rejoin the session as the loaded forearm work rather than as rehab.
Many programs use 2 to 3 sets of 10 to 15 slow repetitions for the strength exercises, once a day or every second day, with a weight light enough that the last few repetitions still look controlled. A 500 ml water bottle, about 0.5 kg (1 lb), is a normal starting weight for the wrist work and will feel absurd next to your working sets. It is not meant to be a training stimulus. Your physio will adjust the exercises and the numbers to your elbow and to what you need to get back to.
Two scheduling details earn their keep. Do the elbow work after your session or at another time of day, not immediately before a lift that needs grip, because a tired forearm grips harder to compensate. And keep it going once the lifts are back, because the week people stop is the week it tends to return.
Judging a session by the next morning, not by the set
A little discomfort at the outer elbow during the exercises is common. Many programs accept mild discomfort that settles within a few hours and is no worse the next morning. Sharp pain during a repetition means stop that exercise. If the elbow is clearly worse the next morning, the load was too much. Drop back a step rather than stopping altogether.
Apply that to the training as well as to the rehab, and base progression on pain-free grip and the 24-hour response rather than a fixed sheet. The pain monitoring model explains why the response the following day is a better guide than the sensation during the set.
Keep one everyday task as your gauge, something like carrying a full shopping bag by the handle or turning a stiff tap, and check it the morning after rather than checking the elbow while you sit still. And change one variable per week. A session where you added back barbell rows, dropped the straps and tried a fat grip tells you nothing about which of the three your elbow objected to.
Getting back to the lifts you dropped
Add the dropped lifts back in the order you took them out, slowest to most provocative, one per week. Reverse the modifications one at a time too: keep the neutral handle while you take the straps off, or keep the straps while you go back to a pronated grip, and never both in the same week.
Volume before intensity on this tendon. A pronated row at a light weight for a few sets usually passes before a heavy triple does, because the hold is shorter and the grip effort lower. The guideline suggests a phased return for people with high-demand occupations and hobbies, on expert opinion (grade F, Lucado and colleagues, 2022), and the general rules for loading something that has been injured are on returning to the gym after injury, with the rest of the training material in gym and lifting. For how to step a load up without guessing, exercise progression sets it out.
Expect this to take longer than the pain does. Coombes and colleagues (2015) reviewed the field and describe outcomes running from symptoms that clear after simple advice to pain that persists whatever is tried, and how long tennis elbow lasts has the figures. Grip under load is the last thing to come back, which is awkward if grip under load is your sport.
When gym pain means stop and get it checked
Some of what happens in a gym is not a load management question, and a lifter is exactly the person who will try to train through it.
Tingling, numbness or pins and needles in the hand, a wrist or fingers that will not lift properly, or a hand that is getting weaker rather than sorer: stop the exercise that brings it on, and read the warning list below, where each of those has its own time frame. A pop or snap at the front of the elbow during a heavy pull or curl, or a muscle at the front of the upper arm that changes shape, is a same-day sign and not something to finish the session on.
Chest symptoms during training belong here too, because arm pain and chest pain can arrive together. If chest pain, pressure or tightness does not ease quickly when you rest, spreads to your arm, neck, jaw, stomach or back, or comes with sweating, feeling sick, feeling light-headed or being short of breath, call emergency services straight away, as this can be a heart attack. If it eases quickly and none of these happen, get medical advice the same day, and do not exercise again until you have been checked. If you faint while exercising, call emergency services, even if you feel fine again quickly.
Arm pain that arrives when you exert yourself and settles when you rest has its own line in the list below, with its own timing, and a gym is where that pattern tends to show itself.
The NHS advises seeing a GP if elbow pain is still there after at least 2 weeks of looking after it yourself. If you already have a program and it is not helping after several weeks, a physio can check the diagnosis and change the load. The warning signs below need prompt medical attention. In the United States that assessment usually comes from a physical therapist or a PT; elsewhere from a physio or physiotherapist, and either way bring your training log, because the lift that did it is normally in there. If you have had surgery on the elbow, follow the program your surgeon or physio gives you rather than this one.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: any sign of a stroke, even if it goes away. That means a face that droops on one side, an arm you cannot lift or keep up, slurred or muddled speech, weakness or numbness on one side of your body or face, sudden blurred vision, double vision or loss of sight, trouble swallowing, sudden dizziness with unsteadiness or falling over, a sudden severe headache, or a sudden fall where your legs give way but you do not black out (a drop attack). Call emergency services straight away.
- Jaw, neck, shoulder or arm pain that comes with chest pain or tightness, sweating, feeling sick, feeling light-headed or being short of breath, or that comes on when you exert yourself, feel stressed or go out in the cold and does not ease within a few minutes of rest. Call emergency services straight away, as this can be a heart attack. If it eases quickly with rest and none of these happen, get medical advice the same day, and do not exercise again until you have been checked.
- Chest pain or tightness, which may spread to your arm, neck or jaw, or shoulder or arm pain that comes with shortness of breath, sweating or feeling sick. This can be a heart attack. Call emergency services straight away.
- Emergency: after a fall or a blow to the elbow, the arm has changed shape or sits at an odd angle, a bone is showing through the skin, a cut is bleeding heavily, or the hand has gone numb or tingly or turns cold, pale or blue. Go to an emergency department or call emergency services straight away, and do not drive yourself.
- Your arm, hand or fingers turn cold, pale, blue or gray compared with the other side. Call emergency services or go to an emergency department straight away, and do not drive yourself. The blood supply to the arm may be blocked.
- The pain started with a fall or a blow to the elbow, and the pain is severe, you heard a snap, the elbow is swollen or bruised, or you cannot bend or straighten the arm. Go to an urgent care center or emergency department the same day.
- A sudden pop or snap at the front of your elbow, sudden sharp pain there, or the muscle at the front of your upper arm bunches up or changes shape. Stop and go to an urgent care center or emergency department the same day, even if you can still bend the elbow, as this can be a torn biceps tendon.
Get help today
- Your wrist or fingers will not lift properly (the fingers may droop at the knuckles), or your hand keeps getting weaker, not just sore. Get medical advice the same day, as this can be a problem with a nerve rather than the tendon. If the weakness is getting worse by the hour, go to an emergency department.
- You have numbness, tingling or pins and needles in the hand or fingers, or pain that spreads from your neck down the arm. Stop any exercise that brings it on and see a physio or doctor, because this points to a nerve or to your neck rather than the tendon. If the pins and needles do not go away after you stop, or part of your arm or hand goes numb, get medical advice the same day. If one side of your face or body suddenly goes numb or weak, or your speech becomes slurred or muddled, call emergency services, even if it goes away.
- The elbow is hot, red and swollen, or you have elbow pain with a high temperature or feel hot, cold or shivery. Get medical advice the same day, and go to an emergency department if you feel very unwell. This can be a sign of infection in the joint, which needs treatment quickly.
- The pain is there at night or at rest and keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- The elbow locks, catches, or feels unstable, as if it slips or gives way. Get it assessed before you start these exercises, and ask your doctor or physio for an appointment within a few days.
- The pain is there at night or at rest and keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- The pain is there at night or at rest and keeps getting worse. See your doctor within a few days.
Common questions
Can you lift weights with tennis elbow?
Usually yes, once the grip-heavy work is modified rather than endured. The order that works is straps and grip first, then grip position, then elbow angle, then tempo, then load, and most lifters reverse it: they strip 20 percent off everything, squeeze just as hard, and wonder why the elbow is unchanged. Keep every lift that does not need a firm hold, because there is no benefit to the tendon in losing your squats and your pressing. The guideline suggests a phased approach for people with high-demand occupations and hobbies, which is a gym exactly, though it rests that on expert opinion rather than trials (grade F, Lucado and colleagues, 2022). Then give the tendon graded work through the stages on the tennis elbow program and judge each session by the next morning.
Can I do pull-ups with tennis elbow?
Often not at first, and of the common lifts this is the one we park most. A pull-up puts a pronated grip, a near-maximal hold and a straight-arm start together, and the AAOS names trying to straighten the wrist and fingers against resistance with the arm fully straight as one of the tests a doctor uses to provoke this tendon, so the bottom of a pull-up is close to that test with your body weight attached. Things that make it workable: rings or a neutral-grip handle so the forearm is not held turned, starting from a slightly bent elbow rather than a dead hang, and fewer, shorter sets. If the elbow is still sore the next morning after all of that, swap to a chest-supported or machine pull for a few weeks and come back to the bar from stage 3 of the program.
Can I deadlift with tennis elbow?
Usually, and more easily than lifters expect, because the fix is the hold rather than the weight. A heavy double overhand hold is close to a maximal grip with the bar trying to roll out of the fingers, and the muscles fighting that are the ones whose tendon is sore. Straps or hooks on the working sets take most of that away without taking anything off the bar, chalk means you are not squeezing to stop a slip, and a bar that is not excessively thick helps more than people think. Mixed grip is worth a mention for two reasons. It holds one forearm turned palm-up under load, which the outer elbow may or may not like, so try it rather than assume. And keep that arm dead straight: a bent, palm-up arm under a heavy bar is how the biceps tendon tears off at the front of the elbow, which is a same-day problem and has its own line in the warning list on this page. General handle and strap advice for elbow pain is on elbow pain when lifting.
Should I stop training until tennis elbow heals?
We would not advise stopping altogether, and the evidence points the same way. Across 30 trials in 2,123 people, exercise did better than passive treatments for this condition, with the reviewers noting a small effect and low certainty (Karanasios and colleagues, 2021), and complete rest removes the one thing that rebuilds a tendon's tolerance for work. Stopping also costs you the rest of your training for a problem in one forearm. What does need to stop, for now, is the specific loading that provokes it: maximal grip work, direct wrist extensor training as training, and any lift still sore the next morning after you have changed the grip. If the elbow is not improving at all after several weeks of that, get it assessed rather than pushing on.
References
- Lucado AM, Day JM, Vincent JI, MacDermid JC, Fedorczyk J, Grewal R, Martin RL. Lateral elbow pain and muscle function impairments: clinical practice guidelines. Journal of Orthopaedic and Sports Physical Therapy. 2022;52(12):CPG1-CPG111. https://doi.org/10.2519/jospt.2022.0302
- Karanasios S, Korakakis V, Whiteley R, Vasilogeorgis I, Woodbridge S, Gioftsos G. Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials. British Journal of Sports Medicine. 2021;55(9):477-485. https://doi.org/10.1136/bjsports-2020-102525
- Coombes BK, Bisset L, Vicenzino B. Management of lateral elbow tendinopathy: one size does not fit all. Journal of Orthopaedic and Sports Physical Therapy. 2015;45(11):938-949. https://doi.org/10.2519/jospt.2015.5841
- American Academy of Orthopaedic Surgeons. Tennis elbow (lateral epicondylitis). OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/tennis-elbow-lateral-epicondylitis/
- NHS. Tennis elbow. Page last reviewed 31 May 2024. https://www.nhs.uk/conditions/tennis-elbow/
- NHS. Elbow and arm pain. Page last reviewed 26 January 2024. https://www.nhs.uk/symptoms/elbow-and-arm-pain/
- NHS. Chest pain. Page last reviewed 8 August 2023. https://www.nhs.uk/conditions/chest-pain/
- NHS. Septic arthritis. Page last reviewed 3 September 2026. https://www.nhs.uk/conditions/septic-arthritis/
- NHS. Symptoms of a stroke. Page last reviewed 12 September 2024. https://www.nhs.uk/conditions/stroke/symptoms/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-24.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.