How do you build a workout plan for a client with wrist or elbow pain?

Lateral elbow tendinopathy, the thing most people call tennis elbow, is provoked by gripping and by resisted wrist extension. The client feels it on the outside of the elbow when they pick something up with the palm down.

Medial complaints sit on the inside of the elbow and are provoked by resisted wrist flexion and by pronation, so the aggravating exercises are different: curls, heavy pulling with a supinated grip, and anything that twists the forearm under load.

Wrist joint pain is a third pattern, usually provoked by loading the wrist in extension, which is what happens the moment the hands go flat on the floor. Carpal tunnel syndrome is a fourth and different animal: that is a nerve, not a tendon.

Those four ask for different substitutions, which is why the intake question is what provokes it rather than what it is called. A client who can tell you which movement hurts has already narrowed the exercise list for you.

The first group is full bodyweight resting on flat, extended wrists. Push-ups, planks on the hands, pike push-ups, dips and mountain climbers all put the whole body's load through a wrist that is bent back as far as it goes.

The second is hanging. Pull-ups, chin-ups and hanging knee raises suspend the client's entire weight from their hands, so grip and wrist are the limiting tissue rather than the back.

The third is direct loading of the wrist and the elbow tendon: wrist curls in both directions, reverse curls with a pronated grip, skullcrushers, and preacher curls that take the arm to near-full extension under load.

The fourth is a long, heavy grip. A barbell deadlift, heavy shrugs, loaded carries and kettlebell swings all ask the forearm to hold on hard for a long time, which is the exact demand an irritated elbow tendon objects to.

• Push-ups, planks on the hands, dips and mountain climbers
• Pull-ups, chin-ups and hanging core work
• Wrist curls, reverse wrist curls and reverse curls with a pronated grip
• Skullcrushers and preacher curls taken to near-full extension
• Barbell deadlifts, heavy shrugs, loaded carries and kettlebell swings

Pulling survives with straps or hooks, which move the load off the grip and onto the back where it belongs. Machines and neutral grips do the same job for pressing, and a cable with a cuff around the wrist or the ankle removes the handle from the equation completely.

Anti-extension trunk work that normally happens on the hands or the forearms can move to a different tool. A standing anti-rotation press, a dead bug or a side-lying variation loads the trunk without asking the wrist to support anything.

The lower body barely changes at all. The exceptions are the leg exercises where the grip, not the leg, is the limiting factor: a barbell deadlift, a heavy dumbbell Romanian deadlift and a loaded carry. A leg press, a hack squat, a machine hip hinge or a supported squat trains the same muscles with nothing held in the hands.

A painful tendon responds to progressive loading, not to rest. The sequence most clinicians use starts with isometric holds, because they load the tendon without moving it and often take the edge off the pain for a while afterwards: around 5 holds of 30 to 45 seconds at a load the client can tolerate.

From there the progression is slow heavy loading through range: 3 sets of 10 to 15 reps with a deliberate 3 second lowering phase, 2 to 3 times per week, adding load across a block of 3 to 6 weeks rather than session by session.

Be honest about how strong that evidence is. Loading programmes clearly beat doing nothing for tendinopathy, but the head-to-head comparisons between eccentric-only, isometric-first and heavy slow resistance protocols do not produce one clear winner. Pick one, dose it properly, and progress it.

Use the tendon pain rule to steer it: pain up to about 4 out of 10 during loading is acceptable if it is back to baseline within 24 hours. Above that, or still raised the next morning, reduce the load rather than deleting the exercise.

Numbness, tingling or pins and needles in the hand or fingers, especially at night, points at a nerve rather than a tendon. Carpal tunnel syndrome is a diagnosis, not a programming variable, and it belongs with a clinician.

Refer as well on pain after a fall onto the hand, because a wrist fracture is easy to miss; on visible swelling, locking, or a hand that gives way; on real loss of grip strength; and on pain that has sat there for months without changing at all.

In RungGym, ticking wrist or elbow complaints for a client removes the exercises the database flags for it from the entire plan: the bodyweight work on extended wrists, the hanging exercises, the direct wrist loading and the exercises that depend on a long heavy grip.

Exercises that only need an adjustment come through with the note attached on the worksheet. A glute bridge with a dumbbell on the hips, for example, carries the instruction to let the weight rest there rather than squeezing it tight, because the grip is the part that matters on that exercise rather than the load.