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THURSDAY DEEP DIVE: THE STRENGTH MOVE
Sunday’s issue introduced the Eccentric Wrist Extension protocol. Today we provide three progression levels and the specific criteria for advancing from one to the next.
The cardinal rule of tendon loading protocols: increase load only when the current level produces no more than a 3 out of 10 discomfort during exercise, and when post-exercise discomfort resolves completely within 24 hours. Advancing too quickly is the most common reason tendon loading programs fail.
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PROGRESSION 1: ISOMETRIC WRIST EXTENSION HOLD (BEGINNER, ACUTE PHASE)
Best for: People with significant pain during the eccentric protocol, or during the first 1 to 2 weeks when the tendon is most irritable.
How to do it:
Forearm resting on table, palm down, wrist in neutral position
Place the opposite hand on the back of the wrist hand and apply gentle downward pressure
Resist the pressure by attempting to extend the wrist upward — the wrist does not actually move, this is a pure isometric contraction
Hold 30 seconds — maintain 5 to 7 out of 10 effort
5 holds per session, 3 sessions per day, for the first 1 to 2 weeks
Isometric loading has been shown to produce immediate pain reduction in tendinopathy through a mechanism involving cortical pain inhibition. People often report a 30 to 50 percent reduction in pain lasting 30 to 45 minutes after a set of isometric holds. This makes it an excellent pre-play strategy during the treatment period.
PROGRESSION 2: ECCENTRIC WRIST EXTENSION (INTERMEDIATE)
Sunday’s featured exercise. Advance to this from the isometric protocol when post-exercise discomfort is 3 out of 10 or less and resolves within 24 hours.
Begin at the lightest possible load — 1 lb or even a filled water bottle
Progress weight every 2 weeks when the 24-hour rule is consistently met
Continue for a full 8 to 12 weeks regardless of when symptoms resolve — pain resolution does not indicate tendon remodeling is complete
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PROGRESSION 3: CONCENTRIC AND ECCENTRIC WRIST EXTENSION (RETURN TO FULL LOAD)
Best for: People who have completed 8 weeks of the eccentric protocol and are returning to full racket sport participation.
How to do it:
Hold a light to moderate dumbbell (2 to 5 lbs), forearm on table, palm down
Extend the wrist upward with the affected hand alone — the concentric phase is now performed without assistance
Lower the wrist slowly over 4 seconds — the eccentric phase continues
10 reps, 3 sets, three times per week as maintenance
Return-to-play criteria: able to perform 3 sets of 10 concentric-eccentric wrist extensions at 5 lbs without more than 2 out of 10 discomfort during or after. Grip strength within 20 percent of the unaffected side. No rest pain or morning stiffness.
COMING UP
Saturday closes out Issue #44 with the equipment toolkit for racket sport elbow health and the specific equipment adjustments that reduce elbow load independently of any exercise program.
Still moving forward,
— The SIM60 Team
SIM60 content is for educational and motivational purposes only and is not medical advice. Please consult your own healthcare provider before starting any new stretch, strength move, or exercise routine. Any equipment mentioned is for illustration only — SIM60 receives no commissions or affiliate fees.
— The SIM60 Team
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