Shooter’s Elbow (aka Tennis Elbow / Golfer’s Elbow)

Shooter’s elbow is a bit of a made up term. If it hurts on the outside of your elbow, then it’s the same as tennis elbow (lateral epicondylitis) and if it hurts on the inside of your elbow it’s golfers elbow (medial epicondylitis). I don’t know if any of my friends play tennis, and only a few of them golf; but as a competitive pistol shooter most of my friends shoot, and a lot of them get tendinitis of either their wrist flexors or extensors. So I think the term “shooter’s elbow” works just fine.

Before I go further I want to give Steve Anderson of credit for making this blog happen. A while back I was listening to his podcast and he was talking about his elbow pain and all the advice and treatments he was getting. I thought not only is this something I could help him with, but it’s something I could help him with over the phone. So I contacted him, told him I was a shooter myself (12th at Nationals even), a physical therapist, and more importantly Rob Leatham’s physical therapist. So Steve tried out some home exercises I recommended, said they worked great, and he was kind enough to talk about how well they worked in his podcast.  He later messaged me saying people had been contacting him about what to do but said he didn’t want to give away my secrets. I told him no worries, I’ll give them away.  Hence this blog.

Shooter’s elbow is tendinitis, however even that name is contentious. The “itis” in tendinitis implies inflammation which biopsies reveal is NOT present. This makes tendinitis a misnomer. More modern terms are tendinosis and tendinopathy. I have actually heard people refer to tennis elbow as lateral epicondylopathy, but correct or not “epicondylopathy” is a ridiculous word and I’m not going to use it.  As for the rest of those names, I use them interchangeably and I lament having to waste yet another paragraph on semantics trying to avoid sounding either like an elitist or an uneducated fool.  Since the vast majority of the people I know who get tendinitis of the elbow are pistol shooters, this blog is for them. However Rob Leatham told me his elbow got sore from breaking the action open on his sporting clays shotgun, so the condition is not only limited to pistol shooters. Tennis players, golfers, and people who get the condition for no apparent reason at all can still learn a lot from this blog as the principles and techniques of treatment are identical as I draw upon tendinitis research from all sports.

Before going further it’s worth noting that shooter’s elbow is a self-limiting condition. That means if you do absolutely nothing at all, it will eventually go away. The problem is it often takes as long as 18 months to just go away, and often goes away for no apparent reason. So, anyone who suffers from shooter’s elbow will swear by whatever they did (or didn’t do) when they got relief, regardless of if it helped or not.  The good news is that almost nothing you can do will make it worse except let your doctor give you a cortisone shot. People like cortisone shots because they do make the pain go away in the short-term, and if you are lucky it stays away. However in the mid- and long-term, people who have cortisone shots often relapse, shown by this study where a group of people who have cortisone are consistently worse off than if they did nothing.  So my first bit of advice for shooters elbow is DON’T GET A CORTISONE SHOT, EVER!  If it hurts, think of it more as an annoyance rather than a debilitation. If you do your exercises properly it won’t hurt very much, for long anyway.

So what has changed since my 2006 paper? One thing that changed was in 2010 I got medial epicondylitis in both my elbows. I had a motorcycle crash in 2010, straining ligaments in both wrists in the process.  The ligament strain took about 8 months to heal but I could still shoot just fine, so long as I taped both wrists. However  due to the wrist strain I wasn’t doing any weight training. My elbows were fine at first but after several months of  shooting high volumes, the continued gripping and shock absorption gradually got to both arms. I felt it coming on, but at first there was little I could do about it; the wrist curl exercises I liked were too much for my wrists. Finally the wrists healed but by then my tendinitis was severe.  I could finally start my standard eccentric exercises but they didn’t work as well as they did back when I was a golfer. I took short times off from shooting and finally a month off, only to have it feel worse when I returned. Finally I just thought screw it, kept shooting, started lifting weights regular, and as my strength increased it felt a lot better.  So that’s part of my advice now: just keep shooting and don’t think of it as a big deal because resting it doesn’t help anyway.

My experience of not resting turns out to have been backed up by research as I later came across this study that found taking time off from your sport does nothing to help recovery. So, you may as well continue to train.  My personal experience is that every time I took a few days off from shooting and came back to it I would feel some increase in pain (and this happened with my USPSA pistol, my sporting clays shotgun, my air rifle and air pistol). Each one had somewhat different muscle actions or stressed the elbow from a slightly different angle.  I took great notes at this time and found that if I missed several days of pistol shooting (live fire or dry fire) and came back to it, it would hurt more. However, after shooting 2-3 days in a row it would be pain free. If I transitioned to another type of firearm, it would hurt again. So while it’s anecdotal, I tell all my shooting friends and patients with tendinitis to continue to handle their gun either in live fire or dry fire at least 10-15 minutes daily just to keep the tendons used to the stress.

In my earlier paper I cited studies saying eccentric exercise worked but concentric did not. However a newer paper found that regular (concentric and eccentric) heavy lifting did more to improve recovery from tendinitis than did eccentric only exercise.   This is advantageous for a number of reasons. First concentric/eccentric exercise is more intuitive and simpler to perform than eccentric-only exercise. Regular weight training is more efficient; you can work both arms at once with regular lifting, but for eccentric you can only do one at a time. Last, you never have to decide when to discontinue eccentric exercise and start regular weight training (which is what most people do when they workout) because you are doing it all along. So with research being a bit conflicting, I used both ways for a while. After finding that the combination concentric/ eccentric exercise worked as well or better than eccentric alone, I finally retired my eccentric-only method.  If any of that eccentric/concentric talk is confusing, in this video I demo the difference:

In my original paper, I said I would do some ultrasound and soft tissue mobilization after the exercise to help make the patient feel better in the short-term. I don’t do either anymore as I don’t think they add much (if anything) to the healing process.  Plus, I notice once a person does their exercises they usually feel better in the short term anyway. Generally they do a set of an exercise that works the injured tendon and it hurts a little.   If they have good form I move up the weight and they do another set and it hurts a little, but often less than the first set. If they had good form on the second set I move up the weight again and usually they tell me the heaviest set feels the best. They are generally no worse as a result and often report feeling just as good as when they got the ultrasound and massage. After 2-3 days of this the exercises hardly hurt at all, in spite of the fact that I am increasing their weights every visit until they cannot get 15 good reps.  That’s the sweet spot for training: where you are training to failure on the 3rd set. The exercises I recommend now are these:

  • Dumbbell Curls
  • Reverse Grip Lying Triceps Extensions
  • Wrist Curls
  • Reverse Wrist Curls

Demonstrated below:  

The video talks about me doing 3 sets (easy-medium-hard) of 15 reps on each set, which is what I do for patients. If the person gets 15 reps with a full range of motion, pain or not, I ALWAYS increase the weight an increment for the second set. If they get 15 reps with full range of motion then, again, I ALWAYS move the weight up for the third set. If the person gets full range of motion on the 3rd set, then the next day I have them start out with their medium weight before and move up from there. I want to quickly (over a 2-3 days) get them to where they are unable to get all 15 reps on the third set. Only then do I stop increasing the weight until their strength progresses. In my experience 3 times per week works, but 7 days per week works a lot faster.  My starting weights are almost never less than 5 lbs. On rare occasions I have worked people up to as much as 50 lb for the dumbbell curls and wrist curls and to 30 lb in the reverse wrist curls and triceps extensions.  The idea is you want to make gripping a pistol easy in comparison.  I think an adjustable dumbbell set is ideal for home use with the ability to change weights from 5 to at least 30 lb.

Since adopting the above protocol the treatment has always worked. However, I do tell people that I see two kinds of responses, both great but the first obviously better. The first is that the pain goes away completely in a few weeks (maybe 3-6)  the person is a lot stronger and able to do everything without pain. The second common response is that the pain gets 90% better in 3-6 weeks. Strength and activity are fully restored, but there is still a little nagging pain (maybe a 1-2/10 with activity) that can last as long as 6 months.  While the second is the worst case, if I tell people about it from the start they all agree it’s still a good outcome.  As a therapist I have driven myself nuts trying to get rid of that last bit of pain, but now I tell people that it’s normal and to just stick with their exercises.  Once strength has been restored and plateaus, I tell my patients they can reduce their training frequency to just 2-3 times a week. Eventually they will notice they haven’t had any pain in a while and their elbow is no longer tender to the touch.

Lastly, I want to give a word about safety.  Over the internet I can’t properly diagnose anyone so for all I know a person’s elbow pain could be from bone cancer.  However, greater than 90% of people I see with elbow pain have either medial or lateral epicondylitis, so the odds are with you.  I find the pain decreasing rapidly with daily exercise to be so consistent that if it does not work I start to question my diagnosis.  So if pain increases a bit from one day to the next that’s not a big deal.  If it’s getting worse week after week, that’s a red flag you should consider getting checked by a physician.  A common method of grading appropriate exercise and activity is to limit the weights you use and the amount of sporting activity (in this case shooting) to that which causes 5/10 pain or less.  There is no research that says greater pain is too much, and in fact many of the successful studies told people with Achilles tendinitis to keep running so long as pain was not “debilitating”.  A 5/10 on a pain scale might be overly cautious, but I think it’s a reasonable guideline.  If I find any other bit of research that changes my advice I’ll be sure to blog about it here.

[5-17-16 UPDATE] So endorsement makes me feel especially good. For most people when you cure their shooter’s elbow, you help them with their hobby. However if you are a professional shooter, you’re helping them with their lively hood. Plus it’s cool to pick up an endorsement by a National Champion. For those who don’t shoot IPSC, this is Shannon Smith, and when Rob texted me saying Shannon was having elbow pain, I knew exactly who he was talking about. Shannon’s case is one that I would describe as a ‘worst case scenario’ as was mine when I had it. As described above, a best case scenario, the person is often 100% healed in 3-6 weeks. Worst case, they are A LOT healed in 3-6 weeks, a LOT stronger but will still have some lingering pain that takes some weeks or months to fully go away. Anyway here’s what Shannon had to say:                                              

Hey Chad,

I have thanked you personally but wanted to leave a comment on your blog for the benefit of others. I am a National Champion pistol shooter, full time competitor and instructor and thought I was going to have to give up shooting last year due to shooters elbow. To the point I didn’t have grip strength to put a tub of sour cream in the fridge. One thing I noticed is everyone has the ‘fix’. Just trying to help I’m sure but everyone had a different remedy and swore by it. I tried compression (as an avid crossfitter I had high hopes for that), motrin, Jamesons (that was pretty decent), ice, heat, deep massage at chiro, some magnet bs thing, nothing worked.

Was talking to Rob Leatham at Nationals in Oct of last year about it and he referred me to you. Of course you said you had ‘the’ fix…just like everyone did. But I was seriously wondering if I would be able to compete at the top levels of the game again and was willing to try anything and everything.

After talking with Chad and viewing all the videos I went to work. Couldn’t even do a 3lb dumbell, started with a can of soup. It was extremely painful. I kept a journal of every days workouts. I hit it every day as heavy as I could. Started at the beginning of Oct. 2015. Within 2 weeks I was up to 15lbs. Journal note Oct 21 “Still painful, may be slightly better, may also be wishful thinking” / Nov 5 “Definitely felt better shot 3 matches in 2 days” / I suck at keeping journals and stopped on Nov 29 with 25lbs on all 4 exercises and the note “Convinced it’s not placebo, shit is definitely working”.

It is now the end of April 2016. The pain isn’t 100% gone if I’m looking for it, but it’s 98% gone and I don’t notice it while shooting. I’ve been pretty consistent staying with the exercises 2-3 days per week. Normally along with my regular workout schedule. Weight training, pull ups, rowing, no pain on any of it! I can say without a doubt doing as Chad said saved my career. All the tricks I was trying and all it took was a few months of pain, sweat, and hard work! Imagine that.

Thanks Chad!!

Thanks for reading my blog. If you have any questions or comments (even hostile ones) please don’t hesitate to ask/share. If you’re reading one of my older blogs, perhaps unrelated to neck or back pain, and it helps you, please remember Spinal Flow Yoga for you or someone you know in the future.

Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed his Yoga Teacher Training at Sampoorna Yoga in Goa, India.

134 thoughts on “Shooter’s Elbow (aka Tennis Elbow / Golfer’s Elbow)”

  1. Chad,

    First, thanks for the blog post! I’ve struggled with arm and hand pain from dryfire and (unbalanced and/or aggressive) grip strength training. Although I’ve been pain free for the past year, I do have some questions – I presume this workout could be used preventative maintenance? Also, has your view changed on compression bands from your 2006 paper?


    • Yes, I think those exercises will work really well for prevention. I think that’s another benefit of just doing the regular concentric/eccentric exercises vs the eccentric only, as the eccentric only was “specialized” for treatment but not very good for general conditioning. For general conditioning I would probably vary the reps, however, from maybe 8-15 rather than 15 all the time like I do in rehab. Also, I think daily is best for rehab but for prevention just 2 times per week is probably plenty.

      About the forearm bands, I think pretty much the same as before. If they do anything I think it’s marginal and likely psychological. However given that the newer studies (and my experience) indicates rest does not help, the psychological help of wearing a band may turn into physiological benefits if it gives the person confidence to continue training.

      Thanks for reading, if I can clarify anything further let me know.


    • Hi Eric,

      With pain on the outside of your elbow it sounds like your shooter’s elbow pain is the tennis elbow/lateral epicondylitis variety, such that any exercise in which you forcibly activate your wrist extensors is likely to cause pain. That said, it’s by performing those exact types of exercises in both a frequent (daily preferably) and systematic way (progressively increasing resistance levels) that you heal the tendon. So reverse curls in the gym might hurt the elbow, but I don’t think would necessarily damage it, and other exercises would likely be the same. Bench press I would expect to be fine. When patients come to my office I will often have them do more comprehensive strengthening exercises than the ones given above, this includes bench press type movements, and they pretty much always do fine with them. So in short, it’s not uncommon for people “aggravate” the condition during whatever activities, but I don’t think they are impeding their recovery when they do so as evidenced both by my experience and by the volleyball study on patellar tendinitis where continuing with practice and games did not impede recovery. That said, my advice is general, you are an individual, I haven’t evaluated you so I can’t say for sure if the diagnosis is correct, yadda yadda yadda.

      I hope that helps and if you have any other questions let me know.

  2. I suffer from tennis elbow or as diagnosed a 6 x 9mm common extensor tear… which I suffered from working as a slaughterman but agrivated by the fact that I’m a recreational shooter… I slowly healed as I slowly worked my way back to the point where I was back doing the exact same job pre injury since then I’ve been told that tears of this kind can be caused by your muscles in your shoulder and bicep not taking their proper load and the common extensor doing work when it shouldn’t

    • Hi Craig, In my experience tears of the tendon are most likely to result from one or more cortisone injections. All the research indicates that cortisone weakens tendon material. In a recent study on injection to the plantar fascia they found a single injection increased the risk of rupture 18 times. I do think it’s beneficial to strengthen the entire arm, to include the biceps and shoulder, and in a perfect world as part of a general total body routine. If an MRI shows a tear in the extensor tendons there isn’t any real data with regards to how you should proceed with exercise or if you should treat it the same as tendinitis or not, so my routine may be a bit aggressive. MRIs of the shoulder show a lot of people have tendon tears with normal function and no pain and I expect the same likely true with the elbow as well, so the exercises might be just fine. In other words I would recommend some caution, perhaps don’t let the exercises bring your pain above a 5/10 and be sure that you are not feeling worse afterwards or week over week.

  3. Talk about timing. I just finished the Hard as Hell 3 Gun a couple of weeks ago and noted pain in my right outer elbow area. First time. Used the wrap and it does help but stopped lifting completely. Thought I’d make it worse. Then I stumbled across your post on Tactical Triangle’s Facebook. As of tomorrow I’ll be back in my gym doing the exercises you recommend. But. Are there any I should be avoiding? For instance. I normally do heavy bench twice a week, working up to my one rep max in the mid 300s (depending on how my 55 year old body is feeling). Is there a danger of aggravating things by going that heavy? Any others I should avoid?

    Thanks for the great post Chad. It was very informative!

  4. Thank you very much Chad. I’m hitting the gym hard and I’ve already noticed a lessening of the pain. Which is good as I have a 3 Gun match coming up in early February!

  5. I just stumbled onto this blog post after reading Hilton Yam’s issues with Shooter Elbow. I am interested in this therapy because I have been experiencing pain in my elbow. I think this was caused by doing pull-ups. I was doing the Recon Ron pull-up program and started getting pain in the inside of the my elbow. I researched it some and decided it was Climber’s Elbow. Is this the same as Shooter’s Elbow with the same treatment as above?

  6. Hi Adam, without doing an evaluation on you myself I can’t correctly diagnose your injury. However if the pain is on the inside of the elbow, exactly where I point to it in my video when I describe “golfers elbow/medial epicondylitis” then the odds are with you that that’s what you have. Climber’s elbow and shooter’s elbow are colloquial terms describing the same condition, so yes if that’s what you have I would treat it the same. Since you got it doing pull-ups I would probably have you continue the exercises if it does not hurt too much. I would at least do lat pulldowns so you can work your strength back up, and know for sure that you are getting better rather than just resting from the offending activity.

    Someone posted Hilton Yam’s article to my facebook and I read it and appreciated the publicity. However he kind of implied my program was a foundation for which you should later add additional exercises for rotation, radial and ulnar deviation, etc. For what it is worth, I used to do all those exercises for epicondylitis but took them out of my program because they didn’t really add anything to the program. The forearm muscles just aren’t that big to require all that additional work. I even have the IronMind Heavy Hammer, which I think is really cool for some applications but I rarely use it for epicondylitis. For what it is worth I think there is a general trend in fitness to make things more complicated than necessary plus everyone wants to market new techniques and devices. However last time I checked the best weightlifters in the world, the Bulgarians, really started beating the pants off the Russians when they started eliminating most of the assistance lifts from their program doing only 6 exercises for the total body, other teams copied the trend and when the Greek team one at the Olympics in 1996 they were doing only 5 exercises for the total body. So 8-10 exercises just for the forearms to me just seems a bit much. A great book about strength training and what the best lifters in fact do is Arthur Drechsler’s Weightlifting Encyclopedia, it’s very informative and no-nonsense.

    If I were to additional exercises to the program I would (and often do) go more proximal for general strengthening, which is what I am doing with the curls and triceps exercises. If I were to add more it would be in the form of rows, presses, lat pulldowns, squats and lunges, etc. Exercises that would make more of a difference in generalized health and performance rather additional exercises acting at the wrist. As for all that self massage, acupuncture, braces, anti-inflammatories etc., I haven’t noticed any of that to make much difference at all. So I think if you are hitting the major muscle groups as hard as you can, without worsening your condition, and you are continuing to practice your sport, you are doing about all you can do. I’ve been playing around with using EMS on the muscles above and below the site of injury (wrist flexors/extensors/biceps & triceps) and it does seem to increase the rate of strength recovery, but putting EMS right on the bone/tendon site of injury just seems to irritate it though.

    So I know that more than answers your question but I was kind of waiting for someone to ask. As for strength training for recoil management (if you aren’t injured) Rob Leatham doesn’t do any forearm exercises.

  7. So I read this AFTER getting a cortisone injection for lateral epicondylitis, and of course now Im paranoid of ripping a tendon. So now that I had the injection would you advise same training or wait a period of time after injection. By the way the injection did nothing to relieve pain 10 days later its as bad as it was prior to injection.

    Thanks for the help for fellow shooters,


    • Hi Ger,

      That’s a good question. I’m definitely against the cortisone injections so I’m not surprised that they didn’t help. Usually they do in the short term, even if the odds are you are worse off in the long term, so it sounds like you got short changed there. There isn’t any direct evidence that I am aware of regarding tendon/muscle tears after a cortisone shot for medial or lateral epicondylitis but there was a study done on plantar fasciitis which found the increase risk of rupture after 1 shot was 18.8 times, 2 shots got you to 34.6 times and 3 shots 125.8 times. Probably after one shot the odds are still well in your favor that you wouldn’t have a tear. I recall reading a study years ago that strength training helped to offset muscle weakness after taking corticosteroids (I think orally) so if that extrapolates to injections the exercises might help offset the risk of rupture. That’s just an educated guess though.

      Anecdotally, in my office I get referred patients who have had shots right before coming in for treatment, I treat them the same and I can’t tell that they do any worse than those who didn’t have the shots so maybe the exercise does counteract the increased risk. I have also been asked if the cortisone shot plus strength training would give you the best of both worlds, to which I responded maybe, but it’s not anything I would recommend without data to back it up.

      So that said, I’d just do the exercises as recommended and if you progress as expected, you are probably good. So think positive.


  8. I enjoy both shooting and bicycling, but do much more of the latter. My doctors about a year and a half ago diagnosed me with lateral epicondylitis, and they recommended that I only do stretches and take the occasional Aleve. About a year ago I had a cortisone shot. It seems like things have been going fine until a bike ride about a week ago on my traditional road bike where after only riding for 10 miles the pain has again flared up. I am to the point where I am ready to give up shooting altogether and switch to a recumbent bike.

    I just stumbled across your blog and to my surprise I see you recommending weight training. Do you have any other exercises for the epicondylitis that would benefit bicyclists, or are those you have already suggested sufficient?

    • Hi Don,

      In short I think the exercises given are enough.

      If anything the research shows that the reverse wrist curl (which most effectively strengthens the wrist extensor muscles and tendons) should be good enough for your lateral epicondylitis/tennis elbow. The way I demonstrate the tricep exercise with the supinated grip position also emphasizes stabilization of the wrist with the forearm extensor muscles so that’s some extra exercise that I think is worthwhile. The wrist curls and biceps curls are hitting the opposing muscles (to directly strengthen the muscles and tendons for medial epicondylitis/golfer’s elbow) but I would still use in your case for more general/overall/balanced strengthening of the grip and arms. I can probably come up with 20 more exercises off the top of my head from wrist rollers, to Digiflexors, Dyna-Flex Ball, to the Heavy Hammer, to isometrics and I would expect they all help to some degree on their own. I just don’t think they add anything to the program I describe in my original post/videos.

      The one big exception would be the cycling and the shooting. I would continue to do both those activities as I have noticed quitting the offending activity only makes it feel worse when you try to come back, but if you keep them up a little bit at least, each day, your elbow should just get used to it, so there should be no reason to give up anything. I wouldn’t expect the stretches to do much good at all, the Aleve to do nothing, and the cortisone to do exactly what it did, make you feel good in the short term but leave you weaker and prone to re-injury in the long term.

      Remember I’m just a guy on the internet who could be wrong. So I would recommend reading through the research page I linked in my original post, or since then I have listed most of those studies as individual blog posts regarding the elbow in particular and tendinitis/tendinopathy in general and make your own decision.

  9. Chad,
    I have dealt with tennis elbow before. I would like to do the exercises you show as a way to get stronger and also make sure I don’t get another case of tennis elbow from dry/live fire, but I am worried that what you show will flare up the tennis elbow which currently is fine, zero pain.

    What you say about “ignoring” the pain is really counter intuitive, when I ignored the pain the first time and kept lifting on it, it just got worse and worse until I couldn’t do simple daily stuff without nasty pain. After that it took forever to heal. I really don’t want round two of that. Ignore the pain, really?

    Also, do you have any input on grip trainers and how they relate to tennis elbow? Again, I am inclined to work on my grip but really gun shy about aggravating the elbow.

    They really need a different name for tennis elbow, something like elbow plague or elbow wasting disease, tennis elbow doesn’t do it justice.

    • Hi Drew,
      Good questions! I’m unsure of any data that would say if your risk was higher or lower, or if having it real recent vs. a long time ago changes things. My general observation on my patients and myself is that once it’s cured (and you are able to do everything without pain) it’s cured and to get it again you would have to do something exceedingly different and stressful. However if your pain went away, and you had quit doing that stressful act (in this case maybe shooting) it’s fairly likely to come back as soon as you resume that activity, because the tendons aren’t used to that stress. That’s part of why I like to have people keep doing the sports or activities that caused the pain (maybe lessen the duration for a while), so that you know when you are really healed.

      That said if you are shooting now and nothing hurts, I would maybe add in my exercises with some caution. With my tendinitis patients I want them maxing out on their painful/target exercise (for tennis elbow that would be the reverse wrist curls) around their 2nd visit because the increased resistance level is what makes the pain go down, and their max is probably less than normal anyway. So it’s not just that I say ignore the pain, I want them to make note of it and notice that after their 3rd set it almost always feels better than their first even though the weights are heavier. If it doesn’t happen like that, then I start to question my diagnosis. For example yesterday I was working with a guy doing leg extensions who had patellar tendinitis and also knee arthritis, and his pain was really sharp and didn’t go back to normal after his set was over, so I had him stop the exercise early and because I thought the pain he was feeling was likely arthritic or some other pain, that I didn’t want him to work through, rather than/or in addition to tendinitis. In his case I had him do some other pain free exercises and then strengthened that leg with EMS.

      If it’s just tendinitis then I think pain (within reason, 5/10 or less is frequently used as a safe cutoff in the research) is a symptom of you working at a resistance level that stresses the tendon. And you have to stress the tendon to get it to get the collagen fibers (usually in random disarray with tendinitis) to realign normally. However, if you are not hurting now, I don’t think you need to be in any big hurry to stress the tendons, such that I would start relatively easy, still do the 3 sets, easy medium and hard, and progress at a rate that has you maxing out somewhere around your 5th workout. Also I recommend daily strengthening for tendinitis, at first, but in your case where you don’t have pain and you just want to get stronger 2-3 times per week should be fine.

      About the grip trainers, I have had all the Captains of Crush grippers for years and I on 2 occasions made a big push to get good at them. For me they never did much to improve my strength, and both times I ended up with hand pain that took longer than a year to go away. So I don’t really like them (and I love Randy Strossen’s IronMind and have bought a lot of stuff from him over the years that I use in my clinic). That said, I probably overdid them both times, gripping them every time I would walk past them in my office the first time, and the second time gripping them the whole time as I would drive to the range. I think they come with directions, and I think I well exceeded those directions both times, so I would caution against doing the same. Still, for me, twice bitten…

      Also while I love my exercises for elbow tendinitis, and they will strengthen your arms, I don’t think they do a lot to make you a better shooter unless you have a particular weakness. Most of the top shooters I know (and I know a lot of them) will tell you just to grip the gun harder. I do think there is a lot to be said about doing general strength and cardio for health and fitness, and most of them won’t even do that:) Female shooters I think might have a lot to gain from doing generalized strength work.

      Last it’s an interesting question about how you first got it. Did you continue to lift and it got worse? Or once started would it have continued to worsen anyway even if you went easy? With lifting I don’t think you should just gut through what caused it (and I feel like I’m contradicting myself somewhat but I think this is mostly about matters of degree) if what caused it was a truly pathological movement, or you weren’t prepared for the intensity/duration you were starting to do. If I were lifting and felt tendon pain coming on, I would back off (not necessarily stop) on what was causing it. I would maybe train around the pain with some other movements, and if that didn’t stop the pain in a week or two, I’d start thinking about the rehab exercises. It’s not so much that you just ignore the pain with them, but that you start light, find an amount that works the muscle/tendon, and then gradually progress from there. You shouldn’t be, and I wouldn’t be, ignoring increasing pain as you do so. An exacerbation here and there aside, the pain should be generally decreasing daily (and certainly weekly) as you do the exercises. So it’s more about increasing your dose of exercises in a measured way. However if you don’t increase the dose, then the muscles and tendons won’t get stronger and the pain may last a long long time. It’s early, so let me know if that made sense or not.

  10. Chad,

    Thanks for the input. I’ve been a weight lifter since 15, now at 37 I think father time is catching up with me a bit and I have been having to change what I used to do to protect joints, namely my shoulders and elbows. It was three years ago that I injured by left elbow, classic tennis elbow. It had been hurting for months and I had ignored it, well one day doing pull ups for sets of ten (I weight 235) it just flared up and was very painful in the middle of the last set. It takes a fair amount of grip for me to pull myself up for a pull up. So that left me on a year long journey of anti-inflammatory drugs (didn’t work), PT most of which didn’t work, ice (no), topical steroids (no), eccentric exercises (no), and rubber band finger extensions (I swear those made it worse), the only thing they did that did help was electric stim, that did calm it down. But then it just dragged on from months being mildly bad and annoying, I just babied it so it wouldn’t flare back up. So I babied it for about a year (keep in mind this is my weak hand so I could get away with that) while it slowly got better. Finally I did some ART and acupuncture, that took me to 100 percent pain free. In that time I started shooting USPSA and IDPA and recently I decided to get more serious about it. Some books made a big deal about grip and dry fire…well I am going to guess me gripping really hard daily during dry fire is a recipe for tennis elbow. So I started researching and stumbled across you.
    I did your four exercises tonight, started off with ten pounds and on the tri extensions that didn’t feel good, so I dropped down to three pounds and then I had no pain. The other three exercises didn’t bother me. So anyway, I am going to give it a roll and do this routine of yours three times a week slowly moving up in weight only as I can pain free. Right now I have zero pain I want to keep it that way.
    I will let you know how it goes.



    • I don’t use the rubber band things, but I expect they would have worked if continued, but maybe not as good as the reverse wrist curls. Looking at a bulk of the research almost every exercise helps, it’s just a matter of which ones work well enough to be worth doing. I’ve noticed that if you try something new, and the rubber band things were probably new, then they would hurt at first. However, if you did them every day for 2-3 days you would have gotten used to them and they would have helped. Same with the eccentric exercises. I used eccentric exercises for tendinitis for years and it worked a long time before I figured out that regular concentric and eccentric worked just as well or better. Usually when they don’t work it’s because your physical therapist is afraid to hurt you and therefore doesn’t give you weights heavy enough to help. I had a guy come from another clinic who was there for 3 months and he only used 1-3 lb dumbbells, and it’s just too light to do any good. I think I started him on 5 or 8 lb and worked him up to 12 lb on the first day and he started feeling better almost immediately.

      If you are dead lifting over 300 without straps I would expect your grip to be pretty good, but tennis elbow affects the ‘anti-grip’ muscles more so your wrist extensors could be on the weak side. Just taking a stab at it with your history, body weight and deadlift strength I would expect you should be able to do reverse wrist curls with maybe 25 lb dumbbells if normal, so that might be a reasonable goal, plus or minus. And yeah you might be over thinking it. Rob said in one of his classes, “see my right hand, all I know is I grip REALLY HARD with it, and see my other hand, all I know is I grip REALLY HARD with it.”

  11. Chad,

    Oh and the shooting thing is interesting. I would call my current grip firm and balanced but not “crushing”. And using that grip I have zero issues, usually shoot at least 200 rounds a session at least once a week. And dry fire with that grip is fine as well. Now gripping as hard as I can daily just seems like a recipe for problems, I am really gun shy about doing that. My generally theory is if I can increase my grip strength overall my “firm but not crushing” grip will be firmer, 70 percent of more is, well, more.
    But maybe I am overthinking this grip thing. I can dead lift over three hundred pounds without straps. And if general strength is a thing, well I still have that. But from observation it does not appear athleticism is really required to be an elite shooter…a few GM USPSA guys look like very doughy.

    I can’t find anyone to give a general guide on how much grip strength is enough; maybe there isn’t a consensus on that. I have seen it said that weight lifting doesn’t really translate to grip strength, but “they” say all sorts of stuff, it is hard to sort through the BS sometimes.

  12. I’m on a break from work, and don’t have time to read through ALL of this, but I haven’t seen if you answered the question, ” Do I wait to start the exercises till it’s less inflamed or hurts less? or start anyway?” My elbow is extremely painful right now.. i’ve tried ice and ibuprofen, the arm strap thing.. I can’t even lift a water bottle anymore. It’s incredibly sore when i wake up in the mornings. I used to get “tennis elbow” occasionaly with my photography job, but now that I shoot, It’s almost unbearable. I also use a computer and mouse a lot in my photo editing.

    • Hi Erinn,

      I can’t say for sure what’s going on in your case. However with my patients if I am sure about the diagnosis of, in this case tennis elbow, I start the exercises right away. Generally there is nothing to get inflamed, as biopsies of diseased tendons generally don’t show any inflammatory cells, which would explain why the ice and ibuprofen you tried probably didn’t do much.

      I tell my patients that it’s the exercises themselves that make the elbow feel better, such that if you wait for it too feel better first, you might be waiting a very long time. So yeah, I’d start right away and definitely start pushing the weights. If you do the exercises right, and you use heavy enough weights, and you’re diagnosed right (meaning you don’t have bone cancer or something) I’d expect you to feel better immediately after your third set of 15 reps. In my office the immediate pain reduction is so reliable that I’ll doubt my diagnosis of tendinopathy if I don’t see it. Let me know if it works, or doesn’t.

      For a female with tennis elbow if I were being conservative I’d probably start my biceps curls, triceps extensions, and wrist curls with maybe 5 then 8, then 10 lb and work up from there. I would expect the only the triceps exercise to hurt at first. The reverse wrist curl will be your ‘money’ exercise and those muscles are weaker, so I’d maybe start with 3, then 5, then maybe 8 lb, but if it’s really sore 5 lb might be your max at first.

      Let me know how it goes, and feel free to hit me with more questions.

  13. Hi Chad, i have been so busy I just read your response! I’m sorry I waited so long cause it really hurts! No wonder the ice and Advil doesn’t work… Makes sense now. I thought it was inflammation. I’m going to try the exercis s ASAP. I have a match on Friday and the last week in oct. I’m so tired of it hurting… It really hurts when I wake up in the am. And now it hurts on the inside of the elbow! Thanks!

    • Hi Erinn, the good news is the exercise program in my videos should strengthen up both sides of your elbow, whether it be the tennis elbow or golfer’s elbow variety, equally well.

  14. Thanks for a good site and some good tutorials.

    This might be a little outside this topic but would you use same protocol for someone who suffer from De Quervain Syndrome? Case: Positive Finkelstein test, Swollen over the extensor pol. brevis/longus, pain under extension of the thumb and loss of ROM (no loss of ROM or pain when extension is done passive. 7months of pain, status quo. No pain when resting.

    What protocol would you use and which exercises/treatment would you suggest?


    • Actually, that’s not very off topic at all. I’ve been meaning to make up a video on De Quervain’s because much of the standard advice given (rest, ice, cortisone, surgery) is so crappy and in my experience, it’s very easy to treat. I treat it just like tendinitis/tendinopathy, and in fact that’s all that I think it is. I don’t put much credence to the idea that it’s tenosynovitis (inflammation of the tendon sheath, which you might have read about) or at least not that it should be treated very different than just a regular tendinopathy.

      Like other tendinopathies, resting/babying it gets you nowhere. So, you are generally better off just ignoring the pain, and living your life (within reason) and in doing so you will likely have less pain than if you baby it. I certainly wouldn’t get a cortisone shot or surgery. I don’t see that many cases of De Quervain syndrome (so I don’t have a big personal database to go on) but the ones I have seen did exceptionally well; pain decreased substantially immediately after exercise, and cured in about 3 weeks.

      What I have my patients do is wrist curls and reverse wrist curls as above in the shooter’s elbow videos. That serves as my warm-up, then for specific exercises I’ll do what’s called a radial deviation with a “heavy hammer” (I bought from with my thumb hooked over the rim of the handle having them pull with the affected (painful) thumb tendons as much as possible. I expect you could do much the same with a dumbbell. I’ll have them do thumb extension exercises with rubber bands as resistance (I use some fancy IronMind ones) but regular rubber bands should be just as good and can just double and triple up on rubber bands to add more resistance. Last, that Finkelstein’s test? I use the Finkelstein’s test as a stretch for maybe 10 reps 10 second each and I’ll tell my patients to keep it up a few times throughout the day. If anything, I expect the exercises I have people do are overkill, and I wonder how much less I could have them get away with and still get the same result. The last lady I had did everything but she thought the Finkelstein’s “stretch” really made her feel better. So maybe experiment and let me know what you think. This is all way easier to show than to write about so let me know if you think a video will help.

      Besides the basic internet precautions about my having not evaluated you, this is just advice, I may be wrong, bla bla bla… I would be a little worried that you say it’s swollen. All the De Quervain syndrome cases I have seen did not have any visible signs of inflammation. Meaning, no visible redness or swelling, rather they all just hurt really bad, with signs and symptoms otherwise pretty much as you describe.

  15. Hi Chad.

    Thanks for the fast answer. I will try “your” suggested protocol. I never seen the logic in only doing eccentric work only anyway. Its more difficult and requires more time. HSR = Heavy Slow Resistant training have showed equal or even slighty better results in some studies(achielles). But i go for the controlled eccentric phase with fast/explosive concentric phase with a minimum of 3 sets easy-medium-heavy around the 15 reps as you suggested.

    I will return with an update in 3-6weeks.

    • Sounds good. I don’t know if I would call my concentric phase explosive (at least not like Olympic lifting explosive), just kind of normal, so maybe a half second up and half second down. Not slow but not jerky if that makes sense. Explosive might work just fine though, as it’s usually better for most everything else. I just don’t think you want to get the set done too quick, you want to keep tension on the tendon for some amount of time, which I do by using higher reps, and the HSR and some of the eccentric protocols do by using slower reps.

      I taught the eccentric protocol for years. It never made sense to me either but at the time there was a study showing eccentric helped but concentric made tendinitis worse. However, I think that study was bogus as later researchers found both concentric and eccentric contractions helped. And yeah, eccentric exercise is tedious.

  16. Chad,
    I am a competitive water skier and have been using your advise for a little under a week. I have tennis elbow in one arm and golfers in the other. The one with golfers is not bad, but the tennis elbow one is screaming at me. First couple of times using your method I found good results. Now I’m finding it harder to do the reverse wrist curl with the heavier weight. I have more pain now than earlier in the week. Is this normal and should I just muscle through it? I just don’t want to make things worst.
    Thanks for your help!

  17. Chad,
    I have been doing your exercises for my tennis elbow. I have little to no problem with the first two sets of the reverse wrist curls, but the third set with the heavier weight is a problem. I found that either I can’t complete the 15 reps and/or there is to much pain involved. I’ve been doing it for a little under a week and the first couple times went well, but the last one was more painful and had more pain after. Is this normal? If so do I continue and it will get better because it is getting stronger. I just want to make sure I’m not making it worse by muscling through the pain.
    Thanks for your help!

    • It’s hard to say, it might depend on what weights you are using. Usually the third set feels better than the first two sets, but if the first two aren’t heavy enough to warm up the tendon then the third might feel worse. 9 times outta 10 I’m telling my patients not to worry about it and to move up in weight. However, 9 times outta 10 they feel better as they go, so…

      If you are getting to the point where you can’t get 15 reps on the 3rd set with good form because it’s just too heavy, then that’s a good place to be. Just stay there and don’t increase until all the reps are good. 15 reps full range of motion with good technique generally means it’s time to move up even if there is some pain. You are trying to put enough stress through the tendon to get it to adapt positively and there was a recent paper I blogged on regarding tension and tendon adaptation that adds additional support to my basic program. A rule of thumb being used in some of the more recent papers is to have people stop if pain rises above a 5/10. 5/10 pain is an arbitrary cut off but those papers still showed good results, so that might be a good thing to try if you are having a bad day.

      It’s not uncommon for there to be some bad days, here and there, and if my patients have increased pain on a given day I’ll usually have them keep the weights the same as the last session and see what happens. If things go well, then I’ll start working them up again. So one bad day wouldn’t worry me but if pain is getting worse week over week, I would wonder if something was wrong.

      Remember this is all internet advice, so I can only tell you what I usually do with patient that I have diagnosed with tennis elbow. There is always the possibility that you have something different, or are responding atypically, and if that’s the case it might be worth having someone local look at it.

  18. Hi Chad,

    Thanks for providing this resource! I have been using Therabands recently after a recommendation by a fellow shooter. Are these effectively the same as doing normal and reverse wrist curls, but without the ability to scale up resistance as I get stronger?

    Also, I have been using those at times with my elbows bent instead of straight out, trying to find the point where my golfers elbow feels most stiff, and then doing curls at that position. This seems to bring the most immediate relief AFTER I stop, though it is mildly uncomfortable while doing the exercise. Is this okay, or should my arms always be fully extended?

    • Hi Scott,

      Yeah, you seem to be on the right page. Are you talking about the Theraband flexbar? I bought the blue one, which is the hardest resistance to see what it was all about. If you twist it enough it will give a decent workout and I expect it will work for shooter’s elbow (both the tennis and golfer’s variety). It’s definitely not worthless; you can scale them up a bit if you buy several colors and/or choke up on it and twist it further. Still I think dumbbells are more versatile and more definitive with regards to how strong you are.

      I think the Theraband flexbar came with instructions on how to do a “Tyler twist” so that you can work the forearm muscles with an eccentric action only. Eccentric only exercise based on older research that suggested that eccentric action only would make the tendons heal better, but concentric action would make the tendon worse. However, that older research hasn’t been repeatable with newer studies which found concentric action helps too. Not as much as the eccentric, but it still helped. So if I were using the flexbar I wouldn’t do the Tyler twist, I would do both wrist flexion and extension with it, with both concentric and eccentric actions. The other thing you miss out on with the Theraband flexbar is you can’t do the curls and triceps extensions with it so it’s less of a comprehensive workout. I’ve been meaning to do a blog on it with a video on how I would use the flexbar if I were to use it. However, I just never do it because I like real weights better. It’s kind of the same with the Theraband “bands” for resistance for other muscles. You can mimick a lot of real weight training exercises with Therabands, and they are handy for travel, but real weights are pretty much always better.

      If the Theraband stretch bands or tubing is what you are talking about, then for tennis or golfer’s elbow, I think they would be too easy to do much good. The flexbar would be better I would think, but real weights are still the best option.

      As for how much to bend your elbow, I don’t think it matters that much. I once heard some strength guru was recommending wrist curls be done with the wrists both flexed and extended, suggesting it would work the muscles more completely due to the length tension relationship, similar to how bodybuilders will train their calf raises with with knees bent and straight. However, what the guys apparently didn’t know was that the forearm muscles all attach right at the axis of the elbow, such that how much the elbow bends doesn’t affect the length tension relationship appreciably, if at all. So in other words, doing it with your elbows bent should work just as well, and it’s how I would do it. I hope that helps, let me know if you have any other questions.

  19. Chad, thanks for the response. I did start your recommended workout using free weights and will relegate the Theraband for travel and other times when it is more convenient. Appreciate the feedback and love this article!

  20. So i continued training for about 6 weeks with heavier and heavier weight. I ended up using 14kilos for wrist extension and 20kg for flexion. Supination/Pronation i worked up around 6-8, a bit more tricky to handle if u dont have the right equipment.
    I did also not respect any pain coming from other exercises or training.
    Now 15months after first pain appeared i have 5%left, i rarely feel pain and if i do its only 2/10 in some handstand drills.

    Thanks for advice.
    I think the approach with heavier weight really helped and i also think that time helped me too.
    – have patience 🙂

  21. Chad,

    Thanks for the extremely informative video and write-up. I have had tennis elbow for almost a year and recently considered getting a cortisone shot until reading your blog. In your discussion you mention adjustable-type dumbbells for home use. Is there a particular brand you recommend that work well for the exercise motions shown in your video? The block style (Powerblock) would appear to restrict the wrist curl completion, though they otherwise seem to be rated highest by users.

    Thanks very much

    • Hi Bill,

      I haven’t personally worked with the PowerBlocks but I have heard mostly good things about them. For wrist curls and reverse wrist curls I do think you are right that the cage around them would be restrictive. I have used these type of dumbbells before and I think they would work great and be economical. If you wanted to go higher end, I just got some Ironmaster dumbbells for my office and they are pretty great, but perhaps a bit overkill for tennis/golfer’s elbow.

  22. Hi Chad,

    Thanks very much for the reply and insight. The Ironmaster dumbbells look quite appealing, especially since I am a 50ish year old guy in need of additional workouts. But the cheaper weights may be a better place to start for now. And I am looking forward to using your suggested exercises to eventually reduce elbow discomfort when using a revolver. If I was not in the diagonally opposite part of the country I would inquire about your Personal Training Program. As with the other folks above, I greatly appreciate your writing the article and creating the videos – and keeping them short but very thorough (and for taking the time to reply).

    • Hi Erinn,

      Those exercises would likely be PART of my rehab protocols for radial tunnel syndrome, but probably my program would be a lot more comprehensive. I would likely also do more total body exercises working on scapular stabilizing muscles maybe with rows, presses, lat pulldowns, dumbbell pullovers, shrugs, etc. I would also look at posture as I would wonder if the nerves in the arm might be getting pinched at least partially at the neck, often from looking down too much, which is really common in shooters who spend a lot of time looking down at their benches when reloading ammo, loading magazines, fixing guns, or looking at phones or computer monitors etc. like most people do. Also a lot of pistol shooters get in the habit of shooting with their neck flexed forward, which doesn’t do the neck any good.

      Also radial tunnel is a less common/definitive/more controversial diagnosis. I think I have only diagnosed one in my career, that I thought was true radial tunnel. So I’m considerably less sure regarding telling someone over the internet how to treat it and what to expect compared with tennis or golfers elbow. Still my instincts would be relatively aggressively core and upper body strength, but backing off if there are increased symptoms. I would almost certainly make EMS part of my treatment to better strengthen the affected muscles in the arm, decrease any pain, and perhaps improve nerve conductivity.

  23. Hey Chad,

    I have thanked you personally but wanted to leave a comment on your blog for the benefit of others. I am a National Champion pistol shooter, full time competitor and instructor and thought I was going to have to give up shooting last year due to shooters elbow. To the point I didn’t have grip strength to put a tub of sour cream in the fridge. One thing I noticed is everyone has the ‘fix’. Just trying to help I’m sure but everyone had a different remedy and swore by it. I tried compression (as an avid crossfitter I had high hopes for that), motrin, Jamesons (that was pretty decent), ice, heat, deep massage at chiro, some magnet bs thing, nothing worked.

    Was talking to Rob Leatham at Nationals in Oct of last year about it and he referred me to you. Of course you said you had ‘the’ fix…just like everyone did. But I was seriously wondering if I would be able to compete at the top levels of the game again and was willing to try anything and everything.

    After talking with Chad and viewing all the videos I went to work. Couldn’t even do a 3lb dumbell, started with a can of soup. It was extremely painful. I kept a journal of every days workouts. I hit it every day as heavy as I could. Started at the beginning of Oct. 2015. Within 2 weeks I was up to 15lbs. Journal note Oct 21 “Still painful, may be slightly better, may also be wishful thinking” / Nov 5 “Definitely felt better shot 3 matches in 2 days” / I suck at keeping journals and stopped on Nov 29 with 25lbs on all 4 exercises and the note “Convinced it’s not placebo, shit is definitely working”.

    It is now the end of April 2016. The pain isn’t 100% gone if I’m looking for it, but it’s 98% gone and I don’t notice it while shooting. I’ve been pretty consistent staying with the exercises 2-3 days per week. Normally along with my regular workout schedule. Weight training, pull ups, rowing, no pain on any of it! I can say without a doubt doing as Chad said saved my career. All the tricks I was trying and all it took was a few months of pain, sweat, and hard work! Imagine that.

    Thanks Chad!!

  24. I have had this over the years, especially heavy shooting Glocks after a distraction injury to my right arm which left me unable to hold a book, much less a gun. I have always appreciated Chad’s kind of shooters approach and his demonstration videos. He also wears black, which is cool. I needed neuromuscular therapy, regular massage therapy, cortisone shots (one), stretching, and bourbon. The bourbon is for after, because rehab and therapy hurt. Lots of ice, too. Thanks for posting this Shannon. Thanks Chad for sharing your expertise with all of us. It is nice to know you are not alone when you have to go through this.

  25. Hi Chad,

    First of all, thanks so much for your video. I’m a USPSA shooter from MN, who developed tennis and golfers elbow in my right arm after dry firing twice a day for a month. I noticed that I had lost a great deal of strength and flexibility in my right hand. For instance, I could no longer bend my hand back enough to do a push-up without intense pain, and my wrist and forearm were constantly tight, like I could not fully unclench my hand. I rested the arm for three weeks (and despaired of shooting this summer) to no avail, before finding your sight through Steve Anderson’s podcast.
    Since then, I’ve done the exercises every other day for four weeks. I have full strength and flexibility back in my hand a wrist and have returned to shooting weekly and dryfiring once daily without any pain. I am incredibly relieved and unbelievably grateful for the info you have shared here. I would not be shooting this summer without it.
    Most of the pain is now gone, with one odd exception. During the day, my arm will occasionally go numb from the elbow down. It will have a tingling, weak sensation, coupled with a temporary loss of dexterity and skin that is noticeably cold to the touch. This is most pronounced when I am sitting with the arm bent. I sit at a desk a lot for a job, and volunteer for an online non-profit, and it is at these times, or when I am driving in the car with my arm bent at the elbow when I notice it most.
    I know you cannot diagnose ailments over the internet, and that I should get checked out by a physician in person because it could be anything (I am planning on doing so). That said, have you noticed this issue with any of your patience during their recovery?
    Again, thank you so much for video. I am so relieved to be shooting once more.

    • Hi Samuel I’m glad your elbow is feeling better!

      About the numbness, it’s possible that there can be nerve entrapment at the elbow, but from what you tell me, my first instinct it to suspect a neck issue. I’ve been meaning to do a blog and video sometime called “shooter’s neck.” I remember some years ago I was getting scapular (upper back, lower neck pain) pain while shooting and I was wondering, “what the hell?” while I was practicing in the desert. Then it dawned on me that my neck was in full flexion when I was reloading my magazines on the tailgate of my truck. Neck flexion is a perfect recipe for a bulged or herniated cervical disc which could have easily progressed to the point where it might cause numbness down one or both arms). As a USPSA shooter I could empty a magazine in seconds, but it took a lot longer to reload them, such that the majority of my practice time was in full neck flexion. The other thing I noticed was when I shot my neck was ‘protracted’ jut forward like a turtle, which isn’t as bad as looking straight down, but with regards to the lower cervical spine was flexion all the same, just my upper c-spine was extended so I could look still see my sights and target. On top of that I noticed was was looking down for prolonged periods as I was reloading ammo or working on guns at my bench. When I shot a rifle or shotgun, I noticed my neck was really protracted (lower neck flexion combined with upper neck extension) as I rested my chin against the stock in a “nose to charge handle” type position. On top of that at work my computer monitor was low such that I looked down, and when I drove my truck seat was reclined such that my neck and low back were in flexion/protraction so I could see out the window.

      Since you mention the numbness while sitting at a desk and driving it really makes me think your neck might be the problem.

      What I did was change my shooting style such that my head/neck were kept more erect. Loading magazines for practice I either did by feel (only a few cartridges went in backwards;) or I loaded from a higher surface, or sat down to lower my body relative to what I was looking at. I have a 50 caliber ammo can and 2 large books under my monitor as I type this. I both tilted and moved my seat forward in my truck so I could lean back fully against it and still fit get my wrist over the top my steering wheel without strain. Oh and I set up a mirror on my wall at eye level behind my Dillon press so I could watch my loading without looking down. I later quit using the mirror as I got in the habit of looking down with my eyes rather than my neck but the rest of the habits I have kept or at least attempted to keep to this day and no more neck/upper back pain and I didn’t have to do a single exercise.

      So while I can’t make a good diagnosis over the internet those are all things that are free fixes, have almost zero chance of hurting you. If it works let me know.

  26. Hi Chad,
    Sorry about the slow reply; I didn’t see this until now. That would make sense. When I think about it, I do all those things with my head bent forward. I will give it a try and let you know what happens.



    • Hi Erin, sorry for the belated reply. I swore I responded to you already, so maybe wordpress ate it. For scapular exercises I would be inclined to try lat pulldowns to the front, and rowing exercises, maybe some dumbbell pullovers. I think I have videos demonstrating how I do each on my youtube channel.

      For radial tunnel syndrome, unlike tendinopathy, I think you would want to avoid training through pain. I would also think you would want to look at your neck posture, as radial nerve could be getting pinched where it exits the neck as well as in the arm. I think I recently gave a pretty long reply about neck postures for another guy on this same page and I think all those comments would be relevant. If you are having tendinopathy issues as well as nerve entrapments, I think you might want to stop thinking about a few exercises for ‘this and that’ and just start thinking about a good general total body strength training program done 2-3 times a week.

  27. I have been having elbow (lateral) troubles for six months now. Had an injection, felt great for two months, then pain came back gangbusters. I am excited to try your program, started tonite with 5#, will prob go to 10# tomorrow. My question is, should I slow down on dry firing for awhile, since that seems to exacerbate the pain? If I understand correctly, you suggest in your blog that continued shooting is suggested and that curtailing the activity in question is not beneficial.


    • Hi Robbie,

      Yeah, as long as the dryfire you are doing is reasonable (which is a relative term) I think it’s better to keep it up. If it’s like 4 hours per day (which I’ve done) it might be worth cutting back, but anything up to maybe an hour should be fine. I couldn’t tell you exactly where the cut off is, and maybe their isn’t one. I do think 15-30 minutes daily is better for your tendons than 30-60 minutes every few days. So I definitely wouldn’t tell you to stop, just average your gun handling out every day over the week if at all possible. I expect things will go well, but if they go bad, let me know.


  28. Thanks for your prompt reply! Weird that neither my post or your reply are showing up in the comments section above.

    In any event, thanks again and I’ll keep the dry fire to 15-30m daily.


  29. I need a little guidance. I have right arm lateral epicondylitis, and started your program a few days ago. I am on day 5 today. I went rapidly from 5 to 10 to now 12# weights. With those, I can barely do third set of triceps extensions, esp with left arm but I am able to complete all three sets of all other exercises without failure, but marked muscle burn, some soreness next day. Should I go to 15# or stay at 12# for another few days?

    Also, on reverse wrist curls, I really feel that in my right lateral epicondyle…i guess that is normal and to be expected? I am keeping my elbows straight but not locked when i do those, is that correct form?

    Robbie H

    • If you can get all 15 reps on the third set with full range of motion with 12 lb, regardless of how difficult, I’d move up to 15 lb. Even if it means you can’t get all 15 reps with good form. Also it’s ok if you can’t do 15 reps on the third set, just stay at that weight until you can, then move up. So if it were me I’d probably do a set with 10, 12 and 15 pounds each. Reverse wrist curls are the hardest exercise so it’s normal to train with less weight on them than with the other exercises. Each exercise progressed individually.

      And yeah it’s normal for it to hurt, but usually (>9/10) people say they feel better afterwards. Correct form depends on who’s teaching you. I learned reverse wrist curls with the elbows bent and my forearms flat on my thighs as correct form, and to an extent I’m “cheating” by doing them with my elbows almost straight. However, I teach them that way because in doing so one can train with their low back in a better position (more neutral) decreasing risk of back pain. So “straight but not locked” is how I teach it, but someone else might tell you you’re doing it wrong.

      Most welcome, good questions!

  30. Thanks again for your help.

    It does actually feel better after I finish. My elbow hurts again later, but I’m feeling good about building strength and hopeful I’ll see reduced pain over time.

    I’ll try progressive weights, 10, 12 and 15 as you suggested.


  31. I am three weeks into this project. I was doing the exercises daily initially, but I developed very sore arms and my right triceps really started hurting, so I cut back to every other day. I think my muscles needed some recovery time and lifting everyday was too much?

    My elbow still hurts on and off, but I have found i have some days with minimal to mild pain, other days back to the usual constant “toothache”. I also find that the exercises, particularly the reverse wrist curls, make the elbow hurt more later that evening, but the next day, the pain abates again.

    I am up to 12/15/20 and can barely complete 15 reps with the 20 with good form. Still on 10/12/15 on my triceps, prob go up a weight level soon.

    Any additional suggestions? Comments about how many days per week I should be performing the exercises?

    Thanks again
    Robbie H

    • If your shooter’s elbow is the tennis elbow variety then I think you want to do the reverse wrist curls daily. Less should still work, but in my experience (and there is research to back it up) daily is better. The other exercises 2-3 times per week should be fine. Definitely go easy on the triceps exercise as you don’t want to injure something new while you are making something else better. Otherwise keep getting strong.

  32. Chad,

    I have lateral epicondylitis, am a shooter but the initial insult was after a long day of trying my hand at windsurfing back this past winter. I had an injection early on, worked for awhile and the pain returned after two months. I tried all the usual stuff, no joy. I started your program four weeks ago. I am now up to 12/15/20 on the forearms and 15/20/25 on the wrist curls. For the first three weeks, i noticed some mild improvement in symptoms. However, this week, the pain is back in spades. It seems worse than it has ever in the past. I’ll have a brief period shortly after the training session when the pain abates some and it doesn’t hurt as much upon awakening. However, most of the day, I am very aware of the pain, hurts to shake hands, lift a cup, etc.

    I am determined to make this get better, and despite the pain, my arms are stronger, which makes me feel good about it overall. However, the current level of pain has me a bit concerned. Any suggestions?

    Robbie H

    • Remember this is the internet and I haven’t looked at your elbow, so what I say might be totally wrong. BUT, with tennis elbow there are often a lot of ups and downs. Particularly if it’s a bad case, and likely worse if you have had cortisone shots. Fortunately you only had one.

      Often the pain will be worse if you have done a new activity (even if it’s not that stressful), or if you have missed your daily reverse wrist curls for more than a couple days, but sometimes you just don’t know why. With my patients I always stay the course, keep the exercise increasing in weight and as long as the muscles are getting stronger, I believe they are getting better. So far I have always been right. But you never know. So if it were me, I’d keep lifting and expect things to feel better in a few days. If they get way worse, then you might want to rethink things. Also maybe start rating your pain on a 0-10 scale, and write it down. It will help you be more objective with regards to how you are feeling now, compared to later and when you started.

  33. Chad,

    Thanks for the support. I stayed the course and continued the lifting exercises despite how my elbow was feeling last week and I’m really glad i did. Its amazing how much better my elbow is feeling right now. The past two days in particular, I have had minimal pain! Today, its up a bit, but overall, I have seen significant and increasingly sustained improvement. I’m very excited, encouraged and thankful!

    You might have seen an article in the NY Times last week echoing much of what you have discussed on this blog. They mentioned a study comparing injections combined with “usual care” versus “usual care” alone and injections did indeed make the pain worse after the effects “wore off”. The study followed folks for more than a year and in the end, just about all study participants experienced resolution of pain after 12-18 months or so, no matter which arm of the study they were in. The one thing they didn’t mention was your strengthening program, which I am now convinced would have shortened the course for many of those subjects!

    Thanks so much for putting this information out there for all of us folks with elbow pain!


    • Awesome great to hear it! Also thanks for the follow up. A lot of people with tennis or golfer’s elbow have temporary set backs but if you just keep plugging usually (actually it’s 100% thus far) you get over it.

      Also, I didn’t see the NY Times article, but I think I have the paper it’s based on which found exactly what you said. It’s good to see the word is getting main stream regarding cortisone because it has been known to be damaging to tendons in the research for years now, but doctors keep shooting people up.

  34. Chad,

    Thanks for the great article and videos. I’m pretty sure I have lateral epicondylitis, from trying to strengthen my shooting grip.

    I was using the Heavy Grip brand hand grippers in the 100lb strength. These are similar to the Captains of Crush Hand Grippers.

    I was doing 3 sets of 8 reps, every other day. After several weeks of using the Heavy Grips, I started to get pain on the upper/outside of my elbow – especially when gripping with the same motion.

    What is weird, is that I had used the grippers in the past with no issues. I was up to the 150lb gripper for exercises. Never had any issues in the past.

    Anyway, 2 questions for you:
    1. With your exercises – will the pain eventually go away, or will I need to keep doing these exercises indefinitely.
    2. What are your thoughts on the IronMind Expand-Your-Hand Bands, and the TheraBand FlexBar for helping to rehab this?

    Thank you for your help!

    • Hi Eric,

      The pain should go completely away and then you should be done with needing the exercises. However, I think (based on some newer research and what people report to me) that sometimes the exercises make the pain go away faster than it takes to completely heal the tendon. So that if you have a worse case of tendon degeneration (aka tendinosis) the exercises might lessen or get rid of the pain before the tendon is actually healed, in which case if you stop the exercises the pain might return. This is why I think you want to continue training until you know you are 100% with regards to both strength and pain. And if that happens really fast, it might be worthwhile to continue the exercises on for maybe a total of three months, or a month or two past which point you feel 100% recovered, to ensure adaptations of the tendons.

      2. I have both the FlexBar and Expand-Your-Hand Bands in my office and honestly never use either of them. I think they will both work but dumbbells are more versatile/adjustable and just better. I don’t think adding either the rubber bands or the FlexBar to my program adds to it or helps in any way. If I wanted to add more exercises I add more total body stuff rather than continue to focus on the wrist and hands. They need just enough exercise to get better, and more than enough isn’t better. That’s how they got hurt in the first place.

  35. I’ve read your blog and many references regarding shooters elbow. I have in my hand rather than my elbow, from gripping hard and training grip (I’m a USPSA shooter). Your article seems to be the closest to what I’m going through, and measures/exercises in mitigation.

    Can you suggest anything further specified toward the hand, or point me in the right direction?

    For context, it seems to be in the lower part (near the edge of hand, on the pinky/ring finger side) of my support hand. I have – and continue – to use CoC trainer and 1.5 (can’t close the 1.5 yet), and your exercises.

    Thanks much,

    • Hi Alex,

      I wonder if instead of shooter’s hands, you have Captains of Crush hands. I was into grip strength training to help my shooting for a while too, and both times I made a big push with the CoC grippers. I ended up with hand pain in my hands that I thought was arthritis or maybe a stress fracture. I went so far as to get x-rays but nothing showed up. However, both times it took over a year to heal. Also I have a grip dynamometer that measures my grip strength and as hard as I worked with the CoC grippers it never made a consistent difference in my strength. So maybe I just overdid it, but I’ll never use them again. For the most part I think just gripping the pistol is enough, and a bunch of grip work on top of that doesn’t necessarily make you shoot better (I know Leatham never does any grip work besides shoot) and might just increase the risk of injury. A lot of older shooters have some pretty bad arthritis. I’d have to do a thorough hand evaluation on you to know better, but my instincts are to have you take a break from the grippers and see if that helps. Unfortunately, it may take a long time (months) to help, but on the bright side it’s easier than more exercise. 🙂 Let me know if it works or not.

  36. Shooter’s elbow (lateral epicondylitis) has hit me hard. I’ve been doing your PT program for about a week, since I first started feeling the symptoms. Over this past weekend, I did one dry fire session and one live fire session and it is now worse than ever. I guess the next step is to shut shooting activities down completely? Or do I train through the pain? Any harm or benefit to doing the rehab exercises more than once a day? I have my first major of the year in 4 weeks and am freaking out a bit because I’m struggling to even hold my coffee cup this morning. I know that it is impossible to tell me what exactly to do without examining the elbow.

    • So far everyone I have had train through the pain has ended up alright. That doesn’t mean you will, but the odds are with you. So if it were me, I’d train through the pain, IT’S WHAT WORKED FOR ME WHEN IT WAS ME! When I rested a full month it just made me lose a month of practice and my elbow still hurt worse when I tried shooting again. If you took time off from shooting, and then went back to it, then it’s very likely it will hurt real bad, but if you keep with the shooting and/or dry fire everyday for a few day in a row (and keep doing your exercises) then I would expect your pain to decrease substantially over a just few days. I think 20-30 minutes of gun handling everyday will be a lot better than an hour or two of practice once or twice a week if that makes sense. Just a few days off from either shooting or doing my exercises is enough to make the pain worsen when you return to either activity, in my experience.

      There is research showing benefits from doing eccentric resistance exercises twice a day but none that says twice a day is better than once (I have yet to see that tested). Studies have shown progress with exercise just 3 times a week, but daily was better. Based on a combination of reading most all the research and observing what’s worked for me, and what’s worked for my patients, I think once a day, everyday, is the sweet spot for the most progress for the least effort. So I never recommend twice a day anymore. I’m sure it works, I just don’t believe it works better.

      Also it’s real important that you get your weights up heavy enough to matter. Too light of weights is too little “medicine” to get the tendons to heal, so if you’re playing it too cautious and just lifting coffee cup type weights, that’s not enough to do any good, so a coffee cup will always hurt. That said don’t go nuts with too heavy a weight either. I think you want the middle road using weights, reps and frequencies as I describe above.

      Let me know if that helps, or if it doesn’t. I expect it will help though.

  37. Hi Chad,
    I’m a competitive pistol shooter and just signed with Walther for this shooting season. The last few weeks I’ve noticed some nagging pain on the outside of my elbow, especially after a grueling dry fire session and I am getting a bit nervous about it. Now that I think of it, since I’m happy about how my upper body has developed, I’ve been focusing mostly on lower body in the gym over the last month or 2, maybe this is why I’m starting to feel it again. I had the same pain about 2 years ago when I first started shooting and it got so bad, I couldn’t brush my hair. I noticed it got worse when I stopped lifting, so I kept lifting and it eventually went away. I am an avid weight lifter so I’m happy to see that I can and should still be lifting and shooting. I’m going to give your exercises a shot and see how things go. I have my first major this weekend and hope I can keep the pain at bay. Let you know how it goes, thanks!

  38. Chad,
    i’m not sure if this is in the same ball park but thought I’d see what your thoughts were. I’ve been having some competitive shooting related pain in my mid forearm on the under side. no amount of stretching really seems to help. I recently started dry firing more consistently on a daily basis and am sure this is the cause of the flare up. I have no history of injury in my arms or wrists. doing some reading it sounded a bit like carpal tunnel but seems a bit far back of the wrist. Thoughts? thanks!

    • Hi Jeff,

      That’s tricky. If the pain is mid-forearm you might start thinking of a muscle strain rather than tendinitis. It’s probably not carpal tunnel syndrome as that would cause pain and tingling in the hand distal to the wrist (usually the palm side of the thumb, index and ring fingers), rather than the forearm. If it’s just a muscle strain, of the wrist extensors and flexors I have had good results having people strengthen with wrist curls and reverse wrist curls just like with tendinopathy, however with a muscle strain I’ll start lighter and move up in weights less aggressively. If there is pain in the forearm and tingling, I might start to suspect something like radial tunnel syndrome. If radial tunnel syndrome treatment gets more complicated. Rest from aggravating activities and gradual but more global strengthening is probably what I would do for that. However, I would also look check for neck pain and poor neck postures, likely aggravated by the forward head “turtle” shooting technique. I’ve always wanted to do a blog on the latter and call it “shooter’s neck.”

  39. Hi Chad,

    I have been doing the lateral epicondylitis exercises every day (almost) for 5 months straight. I’m up to a 30lb dumbbell on the reverse wrist curls, and can do 3 sets of 15 without failure.

    Do you think the tendons are strong enough now to start training with Captains of Crush?

    • Hi Eric,

      30 lb reverse wrist curls sounds pretty strong so you probably could start using the Captains of Crush grippers. However, if it were me, I wouldn’t. Rather I’d just shoot and grip my gun real tight. Check out my answers above on dates June 30, 2015 and February 2nd, 2017 where I comment on my experience with them and why I quit using them.

  40. Chad,
    Thanks for sharing your protocol and results! I believe I have captured your most important points below–please share any corrections. You have commented to others in this blog that your protocol is the same regardless of the stage of tendinitis. Assume during the”reactive stage” you dont do a wait and see approach or unloading of tissues? In other words, if your patient states 6/10 pain medial/lateral elbow consistent with tendinopathy began a week ago, you would still begin exercises and clinically this has worked just fine.


    •Dumbbell Curls
    •Reverse Grip Tricep Extensions
    •Wrist curls
    •Reverse wrist curls

    General Guidelines:
    •Exercises are ideally performed 7 days a week.
    •Exercises must be done with good form
    •Starting weight on Day 1 is typically no less than 5lbs
    •When one plateaus on weights used in rehab protocol, then shift to 2-3x week workouts as one would for a typical strength training routine

    Pain Guidelines:
    •May experience pain in elbow with exercise, but stay under 5 pain on 0-10 pain scale
    •Can continue with usual activities as research does not suggest it impedes therap- no more than 5 pain
    •Not unusual to have “flare-ups” of pain over time as rehab progresses. Continue as usual with protocol giving faith to the program.
    -If pain progressively worsens over 2 weeks, then protocol may not be indicated for condition.

    Day 1
    3 Sets (easy – medium – hard) x 15 reps
    Set 1:
    •15 reps with good form and some to no pain (easy weight)
    Set 2:
    •Increase weight 2-5lbs x 15 reps
    Set 3:
    •Increase weight 2-5lbs x 15 reps
    •On this set if able to get all 15 reps with good form, then tomorrow start the exercises using the weights used on “Set 2”
    -Immediate therex goal is to have patient “discover” weight that he is unable to perform 15 reps by the 3rd set

    Typical Responses:
    •Pain may initially increase over first week but drops off sequentially over next 3-6 weeks
    •Pain achieves ~90% resolution over 3-6 weeks, but has residual that “lingers” for as long as 6mos.
    •Provided diagnosis is correct, clinically >90% success rate

    • Hi Will,

      I think you pretty much got it. Regarding the “reactive stage” I think if a person just started having tendon pain, while doing an activity or earlier that day (the prior day tops) I would recommend they call quits and rest so as to avert the onset of tendinopathy if possible. However, I almost never see a patient in the reactive stage as it usually takes a few weeks for a person to decide something isn’t getting better on its own and for them to seek treatment. I might suggest they lessen how much they were doing an offending activity if I really felt they were overdoing it but I almost never want them to stop. Also I might suggest they spread the same amount of work out in smaller chunks every day as opposed to a lot of something once or twice a week. Frequency is your friend for tendinopathy (I just made that up).

      The only other thing I’ve been thinking about lately is that I think the exercise makes the tendon “feel better” before it’s fully healed. Such that if a person is a fast responder and gets early relief, they might stop the exercises thinking they are better before they really are and the pain will return. So, while I have not seen any data to corroborate this, I have been telling people to continue to exercise as described for a month after the symptoms seem fully gone. I think it lessens the chance of a relapse.

      It’s very rare that pain will increase with the exercise at any time. Almost always they feel immediately better. What might make a person feel different from one week to another is they did some different (and not necessarily a more stressful activity) that made it hurt more.

      Thanks for you interest, and let me know if you have any other questions or comments.

  41. Chad,
    I really appreciate your blog, when I ran across your website I was had an injured shoulder and your post on Coracoidopathy was a game changer for me. After the orthopedic surgeon gave me a cortisone shot that did not help your blog was a complete success for me.

    Now several months later I am dry firing quite a bit, and have been having some pain (hands and elbow). At first it was in my hands (between the knuckles) and I started wrapping a rubber band around my fingers and extending them and after a few days of that my hands felt much better. Now I have pain in my strong hand elbow (lateral side). I have been doing the exercises in this post on and off, but recently the pain has worsened so I decided I better buckle down and do the exercises every day. I have a few questions. First, the weights I have been using have been fairly light, and after re-reading your blog today it sounds like I need to go as heavy as I can, correct? Second do you prefer to do all three weights on one exercise and then move to the next or do all four exercises with one weight and then move up the weight? Does that even matter? Also the motion that I discovered is the most painful is like a arm curl, but with my palm facing down (discovered while picking up a water bottle while driving). Is it good to do that motion with dumbbells or just stick to the four exercises? What do you think about the finger extensions with a rubber band with shooters elbow?
    I know that I am asking a lot from you especially when you can’t see me in person for an evaluation, but any help you can give is very much appreciated so that I can be in top shape for nationals this year. Thanks again for your blog and sharing your knowledge.

    • Ahh Collin, that’s so cool that my coracoidopathy blog helped with your shoulder pain!!! I worked so hard on that blog and it’s unappreciated.

      I’ll make you a deal. I’ll answer your shooter’s elbow questions (first) if you write up your experience using my coracoidopathy treatment and post it to that blog. I feel like that’s my best write up ever, and can help so many people, yet it gets almost no internet views. So any comments, and especially a positive testimonial will help it’s search engine visibility. Plus I’m curious how you did it. Did you have do the comprehensive program? Or if just the SFRs were enough? How many weeks did it take to be cured? I would love to hear anything like that.

      As for shooters elbow. Yes, the way I teach my program is to use three different weights that get reasonably heavy. I say (easy-medium-hard) with the first set being kind of a warm-up, the second set working your pretty hard, and the third set you more or less go till failure (however, I don’t usually have people really go to failure until they have learned to do the exercises properly, which takes maybe 3-5 days). If on the third set the person can do 15 good clean reps (pain or not, so long as it’s not severe) I have them move up the next day, so that what was their medium set becomes their warm-up, their hard set becomes their medium, and they strive to get stronger on a new hard set. That way the third set of each exercise stays as much as you can do and you are always striving for more. I think that if the weights are too light, it does not stress the tendons enough to get them to heal. Too light of weights are like, not enough medicine, but you don’t want to OD either.

      I do this on all four exercises and I do each exercise for 3 sets in a row, before moving on to the next. So it’s an easy set of curls, followed by a medium set of curls, followed by a hard set of curls, before moving on to triceps, etc., taking about one minute rest between exercises. The weights on each exercise should not be the same. If you use the same weights on all four exercises you will probably be overworking some muscles and underworking others, when what you want to do is make each muscle as strong as possible. Wrist curls really should be stronger than reverse wrist curls because there is more muscle on that side, but you want to make both sides as strong as you can.

      If you had a lot of dumbbells ready to go, and you were trying to save time, you could do what bodybuilders call “supersets,” where you could superset your biceps curls with your triceps extensions, and your wrist curls with your reverse wrist curls. That way each one muscle would get to rest while it’s opposing muscle is working, and the rest would be an appropriate amount of time (about a minute). If you tried to do all four exercises in a row, that would be a lot more like “circuit training” which I have never been a fan of. I feel like that wouldn’t work as well because the rest periods between each exercise would be longer than optimal.

      I think you just want to do the four exercises. When people start adding to the program I think they are risking that OD (overdosing) on exercise. I went through a phase where I really tried mimicking everything that felt like it would hurt with weights to hit the tendon from every angle and I think it just make the program longer and didn’t help anything. I do think one should practice with their gun (some) every day instead of (a lot or only some) on weekends. I don’t have a problem with the rubber band exercise particularly if it is helping your fingers. I wouldn’t think an extra 3 sets of 15 or so reps of rubber band extensions would cause an OD, but I don’t think it would add anything to the program (with regards to your elbows at least) if you are doing your other exercises heavy enough. So I wouldn’t tell you to stop if you think they help.

      And I SO want to hear your experience with my coracoidopathy program. It’s like shooter’s shoulder. In fact I basically took my shooter’s elbow protocol and applied it to the tendons at the coracoid process. Good luck at Nationals! If you have any other questions feel free to hit me up.

  42. Chad,
    After about a month of doing the four exercises religiously I have a few observations and questions. First, I have some tendencies to get carpal tunnel syndrome, but since doing these exercises any symptoms of CTS are gone. Second, I tried to do the exercises six days a week, but I think that it was a little too much. I started feeling pretty fatigued in my arms so I went down to two days doing the exercises and one day rest or doing the exercise every other day. My hurt arm is much stronger now than it was a month ago. I am now able to do about 1-2 reps more on the hard sets with my injured arm than I am with my left arm. Also, the pain in my elbow is about 60%better, with the worst pain being as I grip fairly hard and move my elbow. After how quickly my shoulder healed based on your advice I guess I had a little higher expectations. This brings me to my questions. Do you think that I should vary the exercises in some way, like maybe wrapping towels around the dumbbells to force me to grip harder while I do the exercise, or do some of the crush grip things? Do you think that I could be overdoing it as I try to dryfire 15 min in the morning and 30 min in the evening as well as doing the exercise? Should I just let it rest for a while even though that is contrary to the normal approach? Please let me know what you think. I really appreciate all the help that you have been to me so far.

    • Hi Collin,

      It’s interesting what you say about the carpal tunnel syndrome! I might have to quote you for a new blog. I have a few papers looking the etiology of CTS that I always wanted to write an in depth blog about. Most people don’t get referred to physical therapy for CTS, rather they get splints, surgery, and maybe taught some lame stretches. But what those studies found was that the finger flexor tendons were thickened and with degeneration very similar to what’s found with tendinopathy like tennis or golfer’s elbow. So it wasn’t a narrowing of the tunnel that was pinching the median nerve, but rather thickening of the tendons and their sheaths that was shutting down space for the nerve. With Achilles tendinopathy there is a similar thickening of the tendon that decreases as the tendon gets better with resistance exercise very much like what we are doing for shooter’s elbow. So my theory, that you are maybe proving works, is that the strength training not only increases muscle strength and normalizes tendon structure at the elbow, but it’s also normalizing tendon structure (decreasing size) at the other end, where the tendons pass through the wrist. My theory is the same exercises should work for another similar condition called trigger finger too (no relation to shooting). So very interesting and I’m really glad you shared this!

      For your question it’s good that pain is down and strength is better than your uninjured side. That should give you confidence that you are out of the woods, and moving in the right direction. And I agree that once strength is up to normal or better you might want to decrease exercise frequency to 2-3 days per week to give your muscles more recovery. However, more recovery for the muscles might make the tendons heal slower, so that’s just something to consider. An option would be to do the full program at a lesser frequency but still do the focused strengthening on the injured tendon every day, which would take less than 5 minutes. So if yours is the the tennis elbow (lateral epicondylitis) variety, then do just the reverse wrist curls daily.

      As for varying the exercises, I went though a period with my patients where I thought that might be a good idea, but I didn’t notice it made any difference. On the two times I tried the crush grip things, all I got was hand pain that took over a year to heal. I probably overdid it, but twice bitten… Your dryfire doesn’t sound excessive to me, and I don’t expect rest will help. I think it’s maybe going slower with your elbow than with your shoulder because the tendon degeneration was worse there, and/or you are straining your forearm muscles more during the day than your shoulder. So you sound like the typical “worst case scenario,” you get a lot better and a lot stronger fairly fast, but there is lingering pain that might take several months to fully go away. At this point everyone looks for something else to do, but I think the right thing to do is just be patient, stay the course with the exercises and keep shooting. My success rate with that method so far is 100%. It just takes longer than you want sometimes.

  43. I have had the symptoms for about a month after several matches back to back and started your program 3 days ago. Yes 3 DAYS and I am much better. I have been practicing both dry and live fire during this time. BTW, I am a doctor! I was doing the RICE treatment and going no where. THANK YOU!

    • Awesome! I’m very happy to hear that. My thoughts are that when it works that fast, the pain is gone faster than the tendon is actually healed. So I have been telling people to continue the exercises for about a month after they last feel the pain. It’s anecdotal but far that advice seems to be helping prevent recurrence.

  44. Chad, In September 2017 I developed shooter’s elbow by doing dry fire draws for hours on end. Not smart. I heard about you and your therapy methods and I followed them religiously. It is now December and I think I am 80% and I never stopped dry firing the entire time. I highly recommend your methods. Thank you very much! Tom

  45. Hello Chad!

    I like the thinking of this program as I myself had developed a painful shoulder tendonitis that went away with time and training in the gym with weights. I recently developed golfers elbow in my left forearm and bought the therband flexbar (which made the injury A LOT worse and got my opposite arm golfers elbow as well ironically). I am tempted to try your Protocol but am scared about the crushing pain coming back that I made a lot worse by doing the eccentric only therband flexbar twisting exercises. I also was curious about how many seconds do you recommend between each set of 15 reps under each exercise as well? And what about other movements such a Pec Flys on a machine, am I still okay to do my other routine with this in conjunction? I had just cut all isolation arm work out and my pain has gone down (not totally gone but less than sure), so would this program seem counter-intuitive for me?

    • Hi Bill!

      Wow you’re the first person I’ve heard of that gave themselves golfer’s elbow on the other arm with those flexbar. I knew there was a reason I didn’t like those things. Thinking about it now I can totally see how that might happen. For what it’s don’t believe in eccentric only exercise. Not that eccentric only doesn’t work, but I don’t think it works as well as normal reps, and eccentric only is so much more complicated to perform. Between sets I’ll rest maybe 30 seconds if the weights feel light, about enough time to work the other arm. And if the weights are feeling more difficult maybe a minute, certainly not more than 2 minutes. All other exercises should be OK. Even if you feel some pain gripping curls or lat pulls, I really wouldn’t sweat it that much. You should feel better immediately after doing the wrist curls/reverse wrist curls.

      Exercising and stressing the tendon that’s hurt was counter intuitive for me too, but it’s the only thing I have found that works. I don’t know if it will work for you, but it’s 100% in my office. This blog has been up for a long time and so far everyone has said it helped and nobody has said it made them worse. Maybe read through the feedback and see if it gives you more confidence with it. The other nice thing about dumbbells is you can vary the resistance, lighter and heavier than you could with the flex bar so I think you can work up slower and steadier. In my experience most people start too light and progress too slow, but the flex bar is all or nothing unless you want to buy a bunch of them. If you try my program I would love to hear what you think.

  46. Thanks for your well-thought out response Chad!

    I decided to put your program to use and am now on DAY 5 of the protocol. I have some initial inquiries that I am hoping your experience with the matter can clear up. My arms have been very sore (especially my bicep and wrist flexors), is it really smart for me to keep doing this day by day (I noticed you said the 7 DAYS a week is the fastest and best protocol in your opinion)? Second thing is, I have noticed that I am pretty prone to tendonitis over the years. Can doing this protocol actually give me forms of tendonitis such as in my bicep tendon by doing these set of curls daily? I would love your insight on the matter especially in light of the responses and reactions you see in every day life in the office. Get back to me whenever you can, and best regards!

    • It’s especially important that you do the reverse wrist curls every day if you have tennis elbow, and the wrist curls every day if you have golfer’s elbow. The biceps and triceps work could be done everyday or just 2-3 times per week in theory, but they do help warm up the elbow before doing the wrist curls and reverse wrist curls, so they don’t hurt as much when you start them.

      Definitely my program could give you tendinitis (or tendinopathy being the better word). The pain in the tendon is often considered (and I agree with this) the tip of the iceberg. So there is probably tendon degeneration prior to the onset of pain and adding new exercise that you are not used to might trigger it. So regarding your curls you might have started off to heavy. Maybe lighten them up a little. Biceps tendinopathy at the elbow is fairly rare, however. If it did give you tendinopathy I would suggest going easy for a bit, and then continuing the program as the program is what would make your tendons stronger and make the pain go away. I hope that makes sense.

  47. Chad,

    I have stuck to your program very thoroughly for 3 weeks and I am optimistic that my condition is getting better. The pain fluctuates between the days, but it is a lot better and less painful than when I was doing nothing at all and trying to let it heal. I wanted to get your opinion on using this same type of weight and every day training protocol for a knee tendonitis problem. I have had pretty bad knee tendonopathy and inflammation right above my patella that developed after a week of heavy squatting and incline sprints (not patellar tendonitis as it does not hurt below the patella but rather right above). The area right above the patella stays inflammed and puffy, and gets worse when put into heated positions or coverings. MRI’s have shown nothing over the last year and rest has not worked so well either. I tried a few traditional PT protocols but they were all failures in treating it as well, doctor’s want to “Scope it” but I refuse. This elbow protocol seems to be helping and I thought it wouldn’t hurt to throw in a same 3 set 15 rep easy-med-hard exercise in the mix as I make a trip to my gym everyday for the elbow protocol as it is. I was curious as to if you would recommend trying this treatment with squat exercises or a leg extension machine. Have you ever dealt with a case like this and see it heal after following your prescribed protocol? Your thoughts and expertise are greatly appreciated.

    • Static stretching makes your pain worse, and every PT tells you to do it but me? Hmmm, that’s interesting.

      As for you knees if it’s patellar tendinopathy (pain just below the patella) or quadriceps tendinopathy (the pain is just above your patella) then my current go to fix that so far has 100% success is 100 alternate lunges a day, everyday. Performed in as many sets as it takes, but ideally one set done in about 3 minutes total. 3 sets of 15 reps easy medium hard with leg extensions should work if they are single leg extensions so you know your bad knee is doing it’s share of the work. With squats it’s real hard to isolate one side, so that’s why I have gone towards lunges for my preferred program, especially if you don’t have a gym. And the daily aspect of the exercise is important, so even people with a gym membership don’t usually go every day, so bodyweight lunges might still be best. Though you might have to work up to 100 reps.

      However, that’s only if tendinopathy is the injury and tendinopathy almost never causes swelling as you describe, so I wonder if it’s patellofemoral pain, or arthritis, or something else causing the knee to swell up. With an elbow, probably 90% of the time or more that a person has pain it’s tendinopathy but knee pain I’d guess it’s maybe only 10-20% of the time, so it’s more tricky. So in that case it might be good to have a local doctor or physical therapist diagnose the injury and hope he’s right, then I could tell you what I would do with an injury like that. Very often with knee pain there is a hip and hamstring weakness. And even with quadriceps tendinopathy there is often hip and hamstring weakness so I’ll often do single leg leg presses to see if one leg is stronger than the other, then RDLs, hip in and hip out machine (adduction and abduction if you speak latin), calf raises too. If the hamstrings are tight, it would be worth stretching them, but only if you can be sure you aren’t stretching your low back too, because that’s what causes back injuries. I think RDL strength should be more than squat strength and the nice thing about focusing on all the hip and hamstring work at first is that it shouldn’t hurt your knee at all. However, I’m a lot less sure of what to tell you without having seen you regarding your knee than I would be with an elbow unfortunately.

  48. Chad,

    I am ALSO curious as to what your thoughts are on static stretching for these conditions as well (elbow and knee). I tried them way before when working through several PT programs for my knee but all they seemed to do was make the pain worse (for both knee and elbow). I see you have not mentioned it as treatment or help for the rehab, but every single PT i’ve talked to stresses stretching the affected areas. What are your thoughts?

  49. Hello Chad,

    I’ve been dealing with recurring shooter’s elbow since 2012. After quite a while it always ends up 80%-90% better but then something or another makes it flair up again. The most recent flair-up was about a month ago. I’ve seen your video and done the weights off and on, but never really dedicated myself to it until I read your blog. I’ve been doing the four exercises every day for the past couple weeks and my arm feels significantly better than it did, but I’m concerned because I can feel a snapping/popping in my elbow as if (or when) extending a pistol. I also feel it when doing the reverse grip tricep extensions and reverse wrist curls, but it usually goes away by the end of the third set. My arm definitely feels better on the third set and immediately after the exercises, but the popping comes back relatively quickly.

    I read the comments and didn’t see anything about this popping feeling so I just wanted to make sure I’m not doing something to potentially make things worse.

    Thanks for your time!

    • Hi William,

      I think the trick to making your shooter’s elbow non-recurrent is to stick with the exercises until it feels 100% better, and then continue with the exercises for another month after that. In my experience the exercises work so well that they often get the pain gone, before the tendon is fully healed. Such that if you stop the exercises too early it will sometimes return. So keeping up the exercises for a full month beyond 100% resolution helps guard against that.

      The snapping popping you are feeling probably is not related to the tendinitis. It could be nothing at all, some joints just pop, we usually don’t know why and usually (if it doesn’t hurt) there isn’t any consequence to it. However, your elbow could have a “floater” in it, a loose piece of cartilage or bone that is sometimes mucking up the gears and sometimes not, that causers periodic joint noise. If that’s the case I would try and avoid what causes that popping. If it’s just in the triceps perhaps try holding the dumbbells with your wrists at a different angle, or try another tricep exercise like pushups instead. I wouldn’t worry so much about an elbow pop during the reverse wrist curl because there isn’t any elbow motion going on, so you you wouldn’t be grinding anything away but it’s hard for me to say for sure not being there. I would think that the fact that you feel better afterwards is a good sign.

      FWIW I have a floater in one of my elbows and I generally only feel it if I lean on that arm locked outstretched, at which point I’d feel a pop and have a shooting pain. However, since I learned not to lean all my weight on that outstretched arm, I don’t think I’ve felt it in over a year. I can still pushups but that’s probably why I don’t like to lock out. So that’s another option for your triceps. If it only pops when you lockout, or when you bend it fully, you can just avoid that portion of the range.

  50. Howdy,
    At the ripe old age of 65 I have found a love of pistol shooting. I had a two day lesson scheduled with frank Garcia at universal where Shannon is as well. I had to schedule this four months in advance. Three months before the lesson, I was shooting a few hundred rounds every weekend. One week I notice soreness in my strong arm. Then I went to my farm and really irritated it putting up tree stands. I googled the crap out of this and just didn’t find anything that seem to seem right. Fortunately one of the articles I found was yours and it mentioned Shannon smith. I laid off shooting and went for my lesson. I wondered how I was going to survive 2000 rounds with frank in two days but I went, excited but wondering. Well the first day my arm was sore afterward but not bad. The second day I survived, even saw huge improvement in my shooting. Tho at the end of day the elbow was difficult to extend. Shannon was there and I went over to meet and talk to him will he was setting up16 for the IPSc shoot that weekend. He told me how he though his career was over and I left thinking I need to try what Shannon had been doing. I have been doing your four main excercises and my other lifting and dang, it’s getting better. I want to thank also wanted to let people know there is hope even for a newbie with a 65 year old body. God bless and thank you…….bill

  51. Hi Chad,

    Not a shooter, but I’ve been struggling with tennis elbow in both arms for over 6 months now, probably due to a combination of too many weighted pull-ups and computer work.

    Been doing a lot of research on it myself, but the problem is that I feel like there is just too much conflicting advice. The general consensus seems to be that wrist curls are the way to go (although the frequency seems to be debated, some say 3x/week, others 7x/week, my PT says twice a day 7x/week).

    I tried your program a while back, and although I noticed a great improvement at first, if I remember correctly it became more painful when I started adding other exercises such as barbell rows, pull ups etc. with higher intensity. So currently I am able to workout pretty intensively, but some days the elbows flare up, but not as bad as it used to be initially. The pain is manageable, but I’m afraid that this could worsen the condition over time.

    Anyway, I’ve been reading this article by a guy who seems pretty respected in the calisthenics community: And while it seems that you agree on a lot of things, I feel like the difference is that you recommend to just continue working out full intensity in addition to the exercises, while he recommends more or less the same but with removing any aggravating exercises. Also he recommends doing the rehab 3x/week for 3×10 reps. Anyway, would be interesting to get your take on his approach versus yours, and specifically if continuing heavy lifting can in any way worsen the condition.

    • Hi Joakim,

      If you have the tennis elbow variety you’re definitely going to want to emphasis reverse wrist curls over wrist curls, but I expect that’s what you meant.

      Optimal frequency is still unknown. 3x/week has been shown to work, as has twice a day 7x/week. In my experience 3x/week was too slow and every time I did the exercises it was somewhat irritating. If I did the exercises once daily I felt like I was rapidly progressing and the exercises themselves quickly became painless. 2x per day felt like too much of a good thing, and definitely diminishing returns. Some of my experience has since been vindicated in the research study I later found where 6 days per week of treatment for tennis elbow was found superior to 3 days per week. They didn’t test twice per day vs once per day, and as far as I know they still haven’t.

      Your experience sounds normal. My program should rapidly decrease your pain, but if you stress the tendon in a different way before you are fully healed you will often feel that sharp pain. I would expect heavy rows could do that. If you did the rows (with higher reps) everyday, they would probably stop hurting around day 3. I’m imagining that you are doing a some type of split routine or training on alternate days, where everyday performance of that exercise would not be optimal. In such case, if it were me, I would do some combination of the following:

      a) Use straps.
      b) Keep your reps higher (15s) making your offending exercises into a form of rehab exercises.
      c) Do your rows and pullups after doing your wrist curls/reverse wrist curls, thus making sure those tendons are warmed up before you stress them.
      d) Not sweat it. The number of people who have torn their forearm muscles when back training is so low that I have honestly never heard of it happening, ever.

      The Steven Low article starts ok, but then devolves into him recommending supplements and gadgets very unlikely to help because he gets a percentage of your money per referral marketing. So immediately I lose respect (not because of the money, but because of the poor recommendations).

      If you remove any aggravating exercises, then you don’t know if you are truly better, and you can’t even tell if you’re improving. And you’re probably setting yourself up for a very unpleasant surprise when you think you’re better, try you previously aggravating exercise, and realize you’re not really better. He’s doing less reps but he’s doing longer reps where you count several seconds on the way up and down. Actually in his case I think the way down? I think he’s still recommending eccentric only exercise but sometimes “heavy slow resistance.” I get the impression he knows much of the research, but doesn’t see through the research to the underlying truth that you want some optimal combination of frequency of exercise, intensity of exercise, and duration of exercise. Thus he’s seeing/reporting contradiction and flip flopping between recommendations.

      I’m sure there’s some amount of heavy lifting that could/would make you worse in spite of doing even my program but if you’re training at all sensibly it’s unlikely you’re there. Especially if you have been improving overall like you say, but just feel some pain when going hard on back day.

      I hope all that helps/makes sense.

  52. I have extremely painful tendonitis in my left wrist,weak hand ,i dry fire 5 times a week and have tried massage therpy and acupuncture with no help,would these same exercises be good for me?

    • Hi Jay!

      That’s difficult to say. Tendinitis in the wrist is fairly rare. More frequently, in my experience, wrist pain comes from ligament strains. However, unlike tennis and golfer’s elbow I don’t have an easy way to tell you how to self diagnose a ligament strain. If however, it’s a ligament strain the exercises I teach for shooter’s elbow would likely make you feel worse rather than better, so that would be a clue. If it’s a ligament strain, usually taping the wrist or wearing a tight leather weightlifter’s style wrist brace works wonders. So that would be another clue and perhaps a treatment of choice as the tape/wrist would hold the wrist ligaments tight while you shoot, hopefully allowing them to heal.

      If the pain is on the thumb side of the wrist that could indicate a condition called De Quervain syndrome, which is a form of tendinopathy. In that case the exercises here would probably help a little bit but not truly target the painful tendon. However, if that’s the case I could recommend a couple extra exercises that would. Very likely if you look up in the comments I already have. I hope that helps!

  53. Hi Chad.

    In addition to tennis elbow, I have been diagnosed with distal biceps tendinitis. Rotational strength is compromised and pain manifests on the outside of the elbow similar to tennis elbow, per the ortho. Are there any exercises you would add or remove from the above routine if dealing with both issues at the same time?

    • Hi Thomas,

      Distal biceps tendinitis isn’t very common so I’m not sure how much I would trust the diagnosis, particularly if the pain is on the outside of the elbow and not, you know, in the biceps tendon. It could be a strain of the supinator muscle however. I’m not sure enough that it’s that to add anything, but if I thought it was that, I would maybe add something like this. You make it harder or easier by choking up on, or moving back further on the grip. See that belly in my video? Apparently 2012 was before I started intermittent fasting, lol.

      If it is the biceps tendon then the first exercise in my program, the curls should strengthen it and allow it to heal. It might be sharply painful to start out with however. One of the reasons I have people with tennis elbow start with biceps and triceps is to warm the joint before they do their main exercise, that way it doesn’t hurt so much. If it’s biceps tendinitis you have it might be worth doing 1-3 sets of pushups to warm up your arms before starting the curls. Let me know how it goes.

      • Thank you. The tenderness at the lateral epicondyle is absolutely decreasing. The MRI showed distal biceps tendinitis/osis/opathy/whatever, per my ortho. The best way to describe what I am feeling is if we shook hands and you tried to rotate my palm up against my resistance, I would experience pain on the outside of the elbow.. but different than what I have experienced with the tennis elbow. I also have a fairly constant aching pain in the elbow that is worst at full extension (and exceptionally awful after periods of immobility). The ortho swears it is the biceps tendon. I notice that my brachoradialis on the problem arm is knotted up to twice the size as the one on the “good” arm… and I can’t think that it isn’t part of the problem. So I have been working the trigger points via massage and dry needling. I have been doing the pronation/suppination exercises for a couple weeks now. They are painful in both directions with a 4# sledge. As far as I know, it could be just a different manifestation of the same tennis elbow. I am growing quite frustrated with it. I’ll add in pushups on the front end of the rehab and see if that changes the proposition any. Thanks again!

  54. Hi Chad,

    Just wanted you give you a quick update on how your program has been working out for me. I was travelling a lot for work so wasn’t able to jump into it straight away, but I’ve been pretty consistent the last 3 weeks.

    Had some initial pain the first few days, which made me question if this was truly the right choice, but worked through it and continued with the exercises. I’m happy to say that the pain is almost non-existent now 3 weeks in, and I am able to hit the gym with pretty intense upper-body exercises 3-4 days/week. The only thing I’ve been a bit hesitant of is returning to pull-ups/very heavy rows/hanging leg raises, but my plan is to incorporate these next week if the pain stays away.

    I might add that I’ve only been doing 2 sets of the arm exercises lately (easy-medium) to avoid fatiguing before moving on to the “real” work-out, but I still stick with all sets for the elbow-specific ones.

    Anyway, just a small update on how this went for me individually. Can’t believe I spent so many hours trying different treatments (acupuncture, ESWT, stretching etc. etc.) with different therapists when I should’ve stuck to this program from the get-go (one even suggested cortisol, glad I dodged that bullet).

    Thanks a lot for both your program and previous reply!

    • Hi again,

      I’m happy my program helped! The only thing I would think to add, is not to worry about it too much if you have some pain when you move back to pull-ups, rows, etc. Often “something different” still hurts even though you think your better. The trick I’ve found is to stay with that something different and pretty soon you’ll be used to it and it won’t hurt either. Doing higher reps as you start those exercises might make the transition easier, and you could then gradually work to heavier weights/lower reps over a few weeks. Straps will probably help too, but I might have said all this already.

  55. Hi Chad,
    I am a shooter, and I get this in both elbows. The pain migrates in to the radial tunnel area, but it stems from the top of the Brachioradialis. It’s been called radial tunnel by my doctor, but I’m not sure I agree. I’ve started your program a few different times, but it generally aggravates the condition enough that I stop doing the exercises. For example, I started last week, and am doing 10 lb. weights only. 3 reps of 15 a day. Both types of wrist curls. A week later I have pain holding a cup that I did not have when I started. Is this normal? Should I push through?

    • Hi Greg,

      Sorry for the late reply, I was unplugged in Mexico for a while. About your arm. I would tell you NOT to push thru that pain. Your doctor might be right, about it being radial tunnel. At least it’s not acting like tennis elbow. Tennis elbow, and pretty much all tendinopathy feels somewhat better almost immediately after doing my exercise program. It’s such a reliable finding that if it doesn’t turn out that way with someone I’m working with I’ll question my diagnosis. It could also be they are going to light for the weights to do any good, but that should do nothing, not make it worse. So the fact that you are telling me the exercises are aggravating your arm makes me think it’s something else. If it’s radial tunnel I’d expect more muscle weakness of the muscles opening the hand, and I would expect tenderness in the region wrist extensor muscles, while tennis elbow should be more localized and sharply tender right at the lateral epicondyle.

      Unfortunately if it’s radial tunnel, I don’t have a bang up way to fix it, but I have had people get better by having them avoid twisting the forearm and too much bending and extending the elbow. From what I know it’s more of a friction over the nerve thing, so that if you lessen the friction of those movements the nerve should heal.

      If I were you I would look at your neck posture as well because the same nerves can also be pinched, or half pinched as they come out of the neck if posture isn’t good. A lot of shooters get neck pain from that turtle stance with a pistol, creeping forward on gun stocks, and just looking down a lot to reload ammo or work on guns. Tricks for the latter are to raise the level of what you are working on, or lower your head by sitting, and/or develop the habit of looking down with your eyes rather than you neck. I hope some of that helps!

  56. I came across this on the Practical Shooting Training Group forums ( It was posted on a topic of elbow pain. At the time, I was pain free but developed a bit of tendinitis more recently (It didn’t bother me during training, and after training/on an off day the pain would be like a 4 if I had to estimate it). At the time I was doing your program once a week as a maintenance sort of thing. I dryfire 4-5 times a week for about an hour and a half per session, along with a live fire training session of a few hundred rounds every week, and USPSA/Steel Challenge Comps twice a month.

    I upped the frequency to 3x a week, and within 3-4 weeks the pain is 95% gone! I’m gonna continue it for a while more to make sure everything is pain free, but I haven’t decreased my training frequency at all and feel even better! It’s funny, this weekend I dryfired 4 sessions at 1.5 hours each, shot 600 rounds on Saturday during training and shot a 250 round match Sunday, and now on Monday I have basically zero pain, which was definitely unexpected haha. I appreciate you taking the time to write this up for us shooters!

    I wanted to ask you as well – do you have any shoulder protocols that would benefit high volume shooters as well? This is more of a maintenance/preventative thing for me but I would imagine shoulder health is pretty important to shooters as well and figured you might just have something for it. I already do things like various types of bench press, OHP and such, as well as Yoga 2-3x per week if that is relevant. Thanks for your advice in advance!

  57. Chad, thank you for the wonderful information. I also listed to your interview with Steve Anderson. I have been struggling with this for sometime. I had a couple questions. Based on the interview with Steve I take it your not real big on the grip strengthening devices? Is that correct? Also, I know anti-inflammatory supplements don’t really help tendinitis, but I read that higher doses of vitamin C have been shown to help along with protein. Can you offer any input on that? Lastly, what’s your thoughts on KT tape to help through a match? Or maybe a compression sleeve? Thank you

    • Hi Jason,

      A short answer but no, I don’t think KT tape, the elbow braces make any difference whatsoever. Here’s a blog I did on kinesio tape, in short I hold it in very low regard.

      As for Vitamins or diet, I haven’t seen any research to suggest either help. I would bet money against vitamin C unless you have a deficiency and even then I would bet against it. Protein I have my doubts as well, though in theory it sounds like a good idea to have enough high quality protein to be healthy. I do take a multi-vitamin and drink whey protein daily and I don’t have any tendinopathy, so there’s that. Mostly what’s coming out with regards to diet and tendinopathy is that you just don’t want to be fat, particularly around the waistline. There is a lot of evidence coming out showing that being overweight leads to fatty deposits within the tendons, making them weaker. For that it’s not so much what you eat, but what you don’t. Here’s my first blog on intermittent fasting. I know of at least one world champion shooter who does IF. I hope that helps.

  58. Question.

    Is wrist tendinitis basically the same or similar as elbow? Are the exercises the same or similar? Is rest and ice just as worthless with wrist tendinitis as it is with elbow?

    My wrist has been bothering me and I’m unsure how to approach it, I’m semi confident RICE will be worthless. This morning I did the wrist exercises shown in the video (I have done this routine off and on for years now) but I went slower and went with a bit less weight than normal, sets of 10 at 5-10-15 pounds, generally I would do 10-20-30 pounds for the wrist stuff.

    Thanks! Your stuff on shooters elbow is the only thing that worked and wasn’t a huge waste of my time and money.

    • Hi Drew,

      In theory wrist tendinitis would be the same as the elbow, exercises would be mostly the same depending on which of the many tendons connecting too, or crossing the wrist were effective. However, in my experience the wrist rarely gets tendinitis and more often suffers from ligament strains, often from a fall onto the wrist or something like that. If that’s the latter is the case, then the exercises would likely hurt the wrist. You could usually tell if this is so, as with a wrist sprain you’ll usually feel worse both during and after the exercise, while with tendinitis you usually feel better afterwards. Often with a ligament strain the best thing you can do is tape the wrist circumferentially with athletic tape (not so tight that your hand turns blue) thus unloading the ligaments by holding the bone in the wrist tight with the tape. If that works Rogue Fitness makes some good old-school leather wrist straps that do much the same thing as the tape, but they last a lot longer. In either case I would agree ice doesn’t make much of a difference.

      And thank you, I’m glad my exercises helped!

  59. Chad,

    Thanks for your previous input on my “shooter’s hand” condition. I’m now experiencing patellar tendonopathy (aka jumper’s/runner’s knee). Can you give me any input on this condition and direct me to any recommended exercises other than what I’ve researched below? Also, are there any supplement or dietary recommendations for these tendon issues?

    This is what has been recommended so far:
    – Foam rolling
    – Stretching
    > Quads
    – Couch stretch
    – Standing quad stretch
    > Seated hamstring stretch
    > Calf stretch
    – Band exercises (glute medias strengthening)
    > Terminal knee extensions (TKEs)
    > Glute bridges with knee extensions outward
    > Clams
    > Monster walks
    > Lateral sides steps
    – Abductor exercises
    – Other exercises (loading the tendons)
    > Single leg decline squats (using both legs to push up)
    > Bulgarian single leg split squats
    > Box squats
    – Bicycling


    • Hi Steve,

      The short answer is 100 alternate lunges, done daily, in as few sets to finish the 100 reps as it takes, has never failed to cure the condition since I have started recommending it. 100 reps sounds like a lot but if you have basic fitness it should be doable in one set, taking less than 3 minutes to finish. If you can’t do that, then that’s what you are wanting to work up too. Since you are alternating legs, right and left it works out to 50 reps each, which is almost exactly the same as the total of the total of 45 reps you get with the three sets of 15 reps I recommend for the elbow.

      Since you mentioned diet supplements there isn’t so much I can think of that you can take that can, help, but if you are at all overweight (or skinny fat) there is lot you can stop taking (that being food) that will help immensely. Newer research is showing fat deposits within tendons making them prone to tendinopathy, plus increased weight puts more strain on the knee tendons especially. So if you have trouble doing 100 lunges in 3 minutes time that would be a big clue that either your muscles aren’t strong enough, or your body weights too much. If it’s the latter, I love, Love, LOVE intermittent fasting.

      Of the ideas you were able to research up on the web, some of it is good, but most looks next to worthless at best. Clam shells, foam rolling? Really? But there is something to be said for strengthening the hips either with side outs or the “lebris” I just added I’ve been teaching as part of SpinalFlowYoga (which is all about strength and hardly at all about stretch) if it’s a home program, or heavy Romanian Deadlifts if you have weights to work with. The way I teach my lunges is in Spinal Flow also, for which the one’s you would want to do probably being the Level-2 lunges, which are pretty standard, partial lunges (Level-1) if you are remedial, up to Jump Lunges, Level-3. I would expect your knees tendons would be well healed before wanting to progress to Level-3. I hope that helps!

  60. Hi,

    I recently subscribed to your spinal flow program and also found the workout videos on Shooter’s elbow. I’m also a competitive shooter in USPSA, with a bad shooter’s elbow. How do I incorporate the elbow workouts into the spinal flow workouts? Just do it after the spinal flow but do it everyday? Can I still dry fire 4-5 days a week, after all the workouts? or would that be too much?

    Thank you

    • Hi June,
      That’s a good question that I hadn’t really thought through until now. The shooter’s elbow treatment was designed as a stand-alone thing before I even had the idea for Spinal Flow. However, the shooter’s elbow exercises takes about 10 minutes, while total body SF5 is only 5 minutes, so (to us at least) it’s a no-brainer to incorporate the two.

      I would do SF5 first, and in doing so I think you can absolutely get away with skipping the biceps curls and triceps extensions in the shooter’s elbow program and just do the 3 sets of 15 reps (easy-medium-hard) of the wrist curls and reverse wrist curls. The pushups every third day in SF5 would more than make up for the triceps extensions and if you do the bonus set of curls on day-2 of SF5, you have your biceps covered. I definitely would not double up.

      As for dryfire, so long as it’s within reason (maybe an hour a day or less) I would keep it up. You’ll know soon if that’s a wise choice or not as the shooter’s elbow exercises should start lessening elbow pain within a few days, often lessening pain immediately. If things aren’t getting better I would still do the dryfire 4-5 days a week, 7 days might even be better, but do it for less minutes per day. When I had my shooter’s elbow years ago, taking time off from shooting didn’t help at all and if anything made things worse when I came back. I hope that helps!

  61. Hi Chad, I’m a USPSA shooter and I have shooters elbow. I was looking at your exercise plan for the condition and was wondering about working out 7 days per week. I have heard one should not work out the same muscle group daily but give it rest between days. Is there a need for rest? Thanks ahead of time.

    • Al,
      The “rest thing” is a good question. The short answer is, “no, you don’t need more rest.”

      However, the long answer is more interesting and hopefully gives more confidence that you can believe the short answer. The 48 hours, or more, rest thing is more of a bodybuilding concept, where if you tear muscles down you want to give them time to repair and grow bigger and stronger. However, amongst olympic weightlifters, the best ones train the same exercises every single day, and sometimes more than once in a day. Literally, they do squats day in and day out. I’ve competed in both bodybuilding and weightlifting, trained both ways, and both ways work. For me, I prefer at least 48 hours recovery, and in Spinal Flow’s F5 program, I found I got my best gains (muscle strength and mass) with 72 hours recovery. So I have F5 set up so you rehit the same exercises after a two day recovery. However, on those “recovery” days you’re not resting, but rather working other body parts of equally hard (100%) intensity inside a total of 5 minutes workout time.

      All the above is all for muscle, but I’m sure it helps tendons too. However, if I am trying to target tendons specifically there is research that daily stress makes tendinopathy heal faster, I even blogged on it a few years back. Absolutely, my experience both on myself and the people I have worked with is that daily exercise is better, and rest days only make the tendon hurt more when you start exercising again.

      So you have some options. Absolutely you want to do either the wrist curl (if you have the golfer’s elbow type of pain) every day, or the reverse wrist curl (if you have the tennis elbow type) every day for tendon healing, while the other three exercises could be done every 1-3 days. However, the other exercises help to warm up the elbow before you hit the painful tendon with it’s targeted exercise, so I usually tell people to do all the exercises at least until they have fully recovered their strength and have pain 90% gone, at which point they can drop all the exercises back to every other, or every third day. That will work, with a success rate of about 99% as close as I can tell.

      However, now that I have F5 (which didn’t exist when I developed my shooter’s elbow treatment) if it were me, I would skip the curls and the triceps extensions and do F5 instead. Curls are in F5 already (as my sole non-bodyweight option), and triceps are worked in F5 with pushups. The benefit of F5 over the regular dumbbell is you are working your entire body in the time you were otherwise just training your arms. I would then follow up F5 with just the wrist curls and reverse wrist curls exactly as taught in my shooter’s elbow videos. I’m currently working on some bodyweight forearm exercises for Spinal Flow, but if you have dumbbells already I would just use those.

      I hope that helps!

  62. Chad, I am a 30+ (off and on) USPSA shooter and retired law enforcement officer and firearms instructor who has struggled with elbow pain in my strong side elbow for the past 20 years. I stumbled upon your shooters elbow exercises about a year ago and they have helped tremendously! Thank you! I am also now doing your Spinalflow Yoga and am wondering your thoughts on the value of doing something similar with the elbow exercises, such as 1 minute of wrist rolls with a moderate or heavy weight rather than 3 sets of 15, light medium heavy? Thanks for what you are doing

    • Greg,

      Sorry for belatedly getting back to you. I was in Alaska! I’m back but planning on moving there so life is a bit hectic. It’s almost perfect timing that you mention that as I’m working on a couple new bodyweight exercises that I will work with shooter’s elbow. I’m not entirely sure what I think of them yet, and one of them the wrist press is so hard that I still can’t demo it properly. However, I’m nearly there I think. I learned them from a handstand specialists when I was doing my yoga teacher training in India, and I asked one of them what she called and she didn’t have a name. So I’m calling them wrist presses and reverse wrist presses. The idea is that you get in a pushup position (off the wall first) pressing off flat hands, up onto just your fingers as you flex your wrist. For the reverse wrist press you do the same but off the back of your hands, flat, then pressing up onto the back of your knuckles. The latter one feels fairly uncomfortable on the wrist ligaments but it seems like I’m getting used to it. I’m doing one set of 50 to 100 reps each, trying to get it done in 60 seconds each way. For rehab of shooter’s elbow, I still think the wrist curls, 3 sets of 15 reps (easy-medium-hard) with the dumbbells is easier, more controllable, and all around better.

      If you have dumbbells already and you want to be super efficient with them, and use them in a manner consistent with the rest of Spinal Flow (which is considerably newer than my Shooter’s elbow advice) I would maybe try one set of wrist curls as many as you can in a minute, and one set of reverse wrist curls as many as you can in a minute. I would expect that to work for shooter’s elbow and all around strength, though I can’t say I’ve tested it.

  63. Hey Chad, thanks for all your great info. Just a quick question. I know that you recommend continuing with dry fire while doing the exercises but how about live fire? When I do live fire, my elbow hurts. 2 weeks ago I couldn’t finish a match due to the pain. As my elbow gets better and the pain lessens, will doing live fire cause a reversal in the healing process or damage? I have a couple of big matches coming up and was just wondering.

    Thanks, Debby

    • Hi Debbie,

      Live fire should be fine too. The importance is that you are gripping your gun and keeping your tendons used to the stress. Most people can’t live fire everyday, but if you can that’s great, if not, the dryfire keeps the tendons used to the specific stress of gripping the gun, so that live fire should be ok, not a shock to you, and so that you know better when your elbows are fully healed. If it were me I would probably shoot minor with 147s, or at least 124s, so recoil is not too snappy. Shooting open I would expect to be fine also, but I have less experience there. But I would push the strength fairly hard with the shooters elbow exercises. That should both heal you faster, and give you more confidence that even if your elbows are painful that they aren’t weak. I hope that helps!

  64. Hi your blog has a wealth of information. Thank you. I do bullseye shooting and practice 2 to 3 hrs a day, mostly dry fireing. I think I’m gripping to tight and I think I am putting to much pressure on my elbow keeping it locked. The result is I believe I have developed triceps tendoniitis. Pain in the middle of the rear of my elbow. I would like to start doing the exercises you recommend, but am not sure it is appropriate for this condition. Everything I read on the net says rest, ice and ibuprofen. Wich is exactly opposite of your recommendation. I would prefer to continue to shoot and just do the exercises.
    Thank you, Tom

    • Thomas,

      Yes, if it’s triceps tendinitis I would expect the same four exercises above would fix it. Maybe move triceps extensions to last in the exercise order, so the elbow would me more warmed up by the time you get there. And yes, I’m very aware, that what I’m teaching is the opposite of what everyone says, which is why what everyone says just doesn’t work. If you read through my tendinopathy blogs, the research is very much on my side.

      I would caution that triceps tendinopathy is a rarer condition than tennis or golfers elbow, so you would want to be sure about the diagnosis to know that the exercises will work. If it’s something else, like arthritis, a bone spur, or a loose body in the elbow then they may or may not help. It’s hard for me to say much without having seen your elbow, but if the exercises make you feel worse over the near term (days to a couple weeks) that’s a sign you should abort mission and get it looked at. I hope that helps!

  65. Hi Chad, about a year ago I asked you about doing live fire with tennis elbow and you responded that it should be all right. I’m here to say that you were right, it didn’t cause any problems. I started out with only about 1 lb as the pain was so bad but gradually increased it til I was using 10-12 lb weights. The heavier the weights, the quicker it got better. I have been able to continue with my competition shooting since then and the pain is gone. If I feel a twinge, I immediately begin the exercises again and it goes away. Thanks so much for sharing this great technique in controlling tennis elbow.

    I do have a new question for you. My left thumb joint has been experiencing a lot of pain and the doctor says its tendonitis. She gave me some stretching exercises for “De Quervain’s Disease” but they don’t seem to do anything. I can’t think of any exercises with weights for my thumb. They want to give me cortisone shots but I have held off after reading what you say about that. Do you have any advice on this?

    Thanks, Debby

    • Hi Debby, thanks for the feedback on the elbow.

      As for De Quervain syndrome, scroll up and read my response to Nick who had the same condition. Try those exercises and let me know what you think. I would avoid the steroid shots myself for the same reasons as with shooter’s elbow. I think I mention in my response to Nick that I suspect the Finkelstein’s stretch (it should hurt real bad, at least at first) will heal it by itself, without the other exercises, but I’ve always shotgunned the tendon when treating others. So if you wanted, try just the stretch at first and see if that cures it, I would love to hear how it goes.

      If it’s not remarkably better in a couple weeks add the resistance work and I would expect a better than 90% chance of curing it.

  66. Thanks again for the advice. I have been trying just the stretches and then added the elbow exercises but none of that seemed to do a lot of good. I am going to go all out and try all of the above and see if I can get recovery kickstarted. I will let you know how I’m doing after a couple of weeks.


    • Debbie, all the above includes the “thumb hook radial deviation” exercise correct? That’s what should be the money exercise if the stretching alone doesn’t get it. Definitely I’m interested in hearing what happens. As with tennis and golfer’s elbow, I think most people error towards too little, rather than too much weight so don’t be afraid to make it intense.

      • Hi Chad…just an update. I tried the exercises as best I could but it didn’t seem to help like it did with my elbow. I had an MRI done just to make sure there wasn’t something else going on and it came back tendonitis. After struggling with this for about 3 months, I saw another doctor. I was told that the elbow tendons are muscle activated and exercise definitely helps. However, she said the thumb tendon is in a sheath and if inflamed, exercise can make the inflammation worse. I finally gave up and had a cortisone shot to try to get the inflammation down. It has been 2 1/2 weeks and it finally is feeling pretty normal. I haven’t done any dry or live fire to make sure the inflammation goes down. My question is this…is she correct in saying the only way to get to the tendon inflammation is with the cortisone because of the sheath? I’ve tried to find cross section pictures but have been unsuccessful. I would appreciate your input. Thanks again

        • Debby

          Ok, I got some good news. I just found my “heavy hammer.” Looks like price has doubled (now since I bought mine, probably decades ago, so it’s a bit of a ripoff, but it’s exactly what I used to treat people with De Quervain’s. At $60 it’s still cheaper than a doctors visit.

          New doctor is incorrect. When I read the research on De Quervain’s syndrome, like tendinopathy there was NO inflammation present, but rather the same disordered collagen degeneration. It is true however that those tendons are in a sheath (basically a tube) with my recollection of said literature showing the addition of adhesions between the tendon and the inner surface of the sheath, which is why I expect that stretching is more painful than with tennis or golfer’s elbow.

          Statistically cortisone is fools gold for tendinopathy, with people (on average) feeling better in the near term only to (on average) feel worse in the long term. So I would tell you to ask your doctor how long to wait before you return to shooting, and exercise, and to do what she says, so that if the pain comes back you can blame her. And if it doesn’t come back, you got lucky. Know that a lot of people do in fact get lucky, which is why you hear so many reports of people and doctors saying cortisone works. Delaying your return to shooting until your doctor says so, at this point is unlikely to cost you much additional time.

          However, if it were me, I would maybe start the exercises immediately knowing the research (we’re relying on my recollection here because I just to Alaska and my papers still packed away) has shown exercise, when combined with cortisone can somewhat offset the atrophy that the cortisone imparts. But research shows cortisone plus exercise (in the long term), while better than cortisone alone, is not as good as exercise alone. If it were me, and I did this, and the pain came back I would suck it up, keep doing the exercises, and definitely not get a second shot.

          That said, thinking as I write, with the shot already being done, even if it were me, I’d probably wait till my doctor said, to begin exercises and shooting. Then if the pain returned I could confirm my bias, and blame the shot. Then suck it up, continue with the exercises and shooting.

          Also, I would consider my F5 exercise routine. Having had a couple of wrist and arm exercises with shooting I would start wondering if my hands and arms weren’t being overworked because of relative weakness of the rest of my body. F5 will make all the rest of those muscles hella strong.

          But let me see if I can get a video with that heavy hammer uploaded in the next few days.

  67. Can I check my understanding of this …..

    I noticed a general discomfort in the elbow region(i.e. cant ascertain if golfers or tennis elbow, though did note wrist extensors felt more discomfort than flexors and definitely something going on at the posterior side of the elbow…triceps tendon related possibly?). Are you saying to continue with my activity of choice (weights at gym and some calisthenics such as push-ups and pull ups) AND introduce your suggested routine ? i.e. don’t stop my other activities , rather continue with them so long as I am doing the suggested exercises you have provided ?

    • More pain with wrist extension would seem to indicate lateral epicondylitis or tennis elbow. However, there should be sharp pain with palpation (firm finger pressure) over the lateral epicondyle. If the pain is not over the epicondyle, but is over the triceps that would indicate something different, and my protocol would likely not work. In such case it might be good to see a doctor or physical therapist who can, hopefully, properly diagnose you. And if it is tennis or golfer’s elbow then almost certainly ignore what they have to say about treatment (rest, ice, arm band, massage, dry needling, cortisone shot…) and do what I say instead.

      If it is tennis/golfer’s elbow then yes, both research on athletes and my experience on myself, and a lot of others, indicates that resting the tendon doesn’t really help. While progressively strengthening the tendon with exercises like mine, does. That said, I wouldn’t go crazy with anything that seems to be actively worsening pain from day to day and week to week. Pushups I would think would be fine, but pullups (if you have golfer’s elbow specifically) may be on the edge of what it can handle, depending on your bodyweight and what reps you are doing. Wrist straps might help lessen the load and still let you train.

      But yes, in general, you don’t need or want to stop other activities as you falsely think you are better only to have the pain come back with a fury when you resume that which you had stopped. I hope that helps!

  68. Hello Chad. I’ve had golfer’s elbow for about a year and a half now. I mainly injured myself through heavy weightlifting every day without rest, to then let my friends use 2 arms against me in an arm wrestle to carrying my 40kg cousin holding hands in a neutral position strictly using forearms only. I went to a physical therapist 4 months ago and he gave me a light-resistant band which I put under my foot and did 3 x 30 both extensor and flexor slow reps with a moderate squeeze at the top. After I did this again 2 days later I was feeling excruciating pain that night 3 and a half fingers from my medial epicondyle in my pronator teres area which I suspected was medial nerve compression. I could barely have a shower, can’t even play games on a controller anymore, sleep at night properly, and felt extreme pain for a while even at rest. I went to another physiotherapist and he said my medial nerve was slightly compressed but had no entrapment. Even typing this my elbows are in pain. My right is worse at about a 6/10 pain right now my left is at about a 2/10 pain right now. I want to do these exercises but I’m scared that nerve pain will start again. Also, my pronator teres is always in a lot more pain than my other flexor tendons. My other flexor tendons are nowhere near the pain level as my pronator teres What should I do? Do you recommend these exercises? Thanks, from Mirac

  69. Also, I forgot to mention that my elbow experiences a sharp pain when I bend my elbows past 90 degrees. I don’t know but it might be my ulnar nerve being compressed. Do you recommend getting an MRI to confirm nerve compression? Thanks


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