Before we even get to the rehab, it's worth considering the differential diagnosis. While extensor carpi tendinopathy is likely, you might also be looking at something like a radial nerve entrapment or an extensor carpi ulnaris (ECU) tendinopathy. The treatment principles are often similar, but the root cause might be different. Here's how I'd approach this: Irritability & Load Management Relative Rest: The goal isn't to stop lifting entirely, but to modify it. Identify and avoid the specific movements and grip positions that cause sharp pain. Pain-Free Isometrics: Start with pain-free wrist extension isometrics. They're excellent for pain modulation and can begin the strengthening process without irritation. Address the Grip: Focus on making every grip feel supported. This might mean using a neutral grip on dumbbell rows or trying wrist wraps for a few sessions. The goal is to offload the irritated tissue. Grip Strength vs. Load: Is their grip strength a limiting factor? Often, lifters have strong deadlifts but a weak grip, forcing the wrist extensors to work overtime. You might be able to find the source of the problem right there. Training Volume: Is the volume of their training too high? Assess their current program and see if they're doing too much grip-focused work without adequate recovery. Graded Exposure & Return to Sport Start Submaximal: Once isometrics are pain-free, gradually introduce concentric and eccentric loading. Start with light wrist curls and extensions, then move to bodyweight chin-ups with a focus on a controlled, pain-free eccentric phase. Return to Lifting: This is a slow and deliberate process. Begin with pain-free, submaximal weights on their main lifts and build from there, always checking in on how the wrist feels.

Can you provide more context on what you're seeing? For example, is it a specific injury, a recovery challenge, a mobility issue, or something related to a particular lift (squat, bench, or deadlift)?