Why Do My Eccentric Exercises Help for a While and Then Make My Elbow Worse?

Eccentric exercises can genuinely help tennis elbow, but a tendon's capacity to tolerate loading changes depending on what stage of healing it is in. A program that was appropriately dosed early on can become too aggressive as the tendon's condition shifts, and pushing through that flare without adjusting the dose can set recovery back rather than advance it.

Being handed the same exercise sheet regardless of how your elbow has changed over the months is a common experience, and it is reasonable to wonder why something that used to help now makes things worse.

The Mechanism

Tendon healing is not a single linear process with one correct exercise dose throughout. The most widely used framework for understanding this, the continuum model of tendon pathology developed by Cook and Purdam, describes tendon problems as existing along stages: a reactive stage following a sudden increase in load, a dysrepair stage with more significant matrix breakdown, and a degenerative stage with extensive, often irreversible disorganization. A tendon can also move backward and forward along this continuum depending on how it is loaded.

This staging matters directly for exercise dosing. In the reactive stage, the tendon has thickened as a short-term protective response, and heavy eccentric loading at this point can be highly provocative, worsening the reactive response rather than helping it. In more established dysrepair or degenerative stages, graded loading is what stimulates collagen remodeling and is genuinely the right tool, but the dose, how much load, how fast, and how often, has to match the tissue's current capacity. The same exercise program that was well-tolerated and effective at one stage can overload a tendon that has become more reactive again, whether from a flare-up, a change in activity, or a new source of strain such as cervical nerve root irritation increasing mechanical demand on the muscle.

This explains a pattern many people experience without understanding why: initial improvement with a loading program, followed by a plateau or a flare when the same program continues unchanged. The tendon's needs shifted, and the program did not shift with it.

When It's Something More Serious

Pain that is sharply worsening rather than fluctuating, new swelling, or a sudden change in your ability to use the arm needs evaluation. Numbness, tingling, or weakness that develops or worsens alongside exercise also warrants an exam, since it may indicate a nerve contributor that a tendon-only program cannot address.

How This Gets Addressed

Rather than a fixed exercise sheet, treatment needs to track where your tendon actually is.

Physical therapy stages the loading program to your tendon's current state, scaling back during reactive flares and progressing once the tissue is ready, rather than applying the same protocol throughout.

Dry needling can calm an overly reactive tendon while continuing to stimulate repair in degenerated tissue, and chiropractic care addresses the cervical and shoulder contributors that can be adding mechanical demand beyond what the exercise program accounts for.

Naturopathic medicine evaluates whether systemic inflammation or nutrient status is limiting the tendon's capacity to adapt to loading at all.

You can learn more about our full approach to elbow pain here.

Most patients find steadier, more sustained progress once their loading program is adjusted to match their tendon's current stage rather than followed as a fixed protocol, although occasional flares during an aggressive week are a normal part of the process and do not necessarily mean the program has failed.

Written By:

Dr. Jason Winkelmann

Naturopathic doctor, Chiropractor, Chronic Pain Specialist, and Educator

Frequently Asked Questions

Should I stop doing my exercises if they start to hurt more?

Some discomfort during loading is expected, but pain that is sharply worse, lingers well past the exercise session, or is accompanied by swelling suggests the dose has outpaced your tendon's current tolerance. Reducing the load rather than abandoning exercise entirely, with guidance on how much to reduce it, is usually the better path.

How do I know what stage my tendon is in?

There is no single home test for this. A clinical exam considers how the pain responds to loading, how long symptoms have been present, and the pattern of flares and improvement, and uses that to estimate where on the continuum the tendon currently sits and how to dose exercise accordingly.

Is it normal for tennis elbow recovery to go up and down instead of steadily improving?

Yes, to a point. Tendon healing is not perfectly linear, and minor fluctuations are common. A pattern of real, sustained flares that keep undoing progress usually means the loading dose needs to be reassessed rather than simply continued through.