Home Baseball Content Understanding Elbow Pain – Part 6: Elbow Pain in Lifters

Understanding Elbow Pain – Part 6: Elbow Pain in Lifters

Written on June 2, 2010 at 6:26 am, by Eric Cressey

Today, I’m going to wrap up this six-part series entirely devoted to the elbow.  In case you missed the first five, check them out:

Part 1: Functional Anatomy
Part 2: Pathology
Part 3: Throwing Injuries
Part 4: Protecting Pitchers
Part 5: The Truth About Tennis Elbow

In this final installment, I’m going to discuss elbow issues as they pertain to a strength training population.  Even though some of the treatments for these injuries/conditioning may be very similar or even identical to what we see in a throwing population, I separate lifters because their problems are almost always soft tissue in nature.  While we may see stress fractures, ulnar nerve issues, and ulnar collateral ligament tears in throwers, we are virtually always dealing with problems with muscles and tendons in folks who are avid lifters.  What gives?

Well, it’s very simple: they grip stuff a lot more than normal folks, and also perform a ton of repetitive movements at the elbows and wrists.  This difference also makes you appreciate why we often see elbow issues in those who work on factory lines, performing the same task for hours on-end.

Why is it that all these issues present at the elbow?  You see, many of the muscles involved in gripping originate at the superomedial aspect of the forearm, particularly on the medial epicondyle:

medialepicondyle

When these structures get overused, they shorten – and as we discussed in Part 1, the zones of convergence (where tendons bunch up and create friction with one another) are where we develop some nasty soft tissue adhesions.

However, this doesn’t just happen from gripping.  Think about what happens when you put the bar in this position to back squat:

hammer-back-squat2

That bar wants to roll off his back, and while the majority of the weight is compressive loading, a good chunk of it becomes valgus stress that must be resisted by the flexors and pronators that attach at the medial aspect of the forearm/elbow. It’s not a whole lot different than the stress we see here; we just trade off the velocity and extreme range of motion in the throwing motion for prolonged loading in the lifting example:

wagner2

As a general rule of thumb, the narrower the squatting grip, the more stress on the elbow.  Unfortunately, the wider the grip, the more shoulder problems we tend to see, as this position can chew up the biceps tendon.  The solution is to maintain as much specificity as possible with respect to one’s chosen endeavor, but find breaks from the repetition of these squatting positions by plugging in options like front squats, giant cambered bar squats, and safety squat bar squats.

For these reasons, I also look at soft tissue work on the forearms – and particularly the medial aspect – as a form of preventative maintenance.  Regardless of the soft tissue modality you select, get some work done every few months and stay on top of your stretching in the area to maintain adequate length of these tissues.

We’ll also see a fair amount of “underside” elbow pain in lifters, in most cases where the three heads of the triceps join up as a common tendon (another zone of convergence; does anyone see a pattern here?) to attach to the olecranon process.  The smaller anconeus – a weak elbow extensor – also comes in here.

Almost universally, the lifters who present with overuse injuries posteriorly are the ones who use loads of elbow-only extension movements like skullcrushers/nosebreakers/French presses/triceps extensions.  As a random aside to this, how can these movements have four different names, and not one of them begins with some Eastern European nationality?  “French” just doesn’t get it done when we have Russian good mornings, Bulgarian split squats, Romanian Deadlifts.

lying_triceps_extension_5314_7

Anyway, we vilify leg extensions and leg curls as being non-functional and overly stressful at the knee.  The knee is the joint most similar to the elbow, yet it’s much bigger than the elbow, yet nobody contraindicates 4-5 elbow extension-only exercises per week in many routines as being inappropriate – or even excessive.  If you want to build big legs, you squat, deadlift, and lunge.  If you want to build big triceps, you bench, do weighted push-ups, overhead press, and do dips.  The absolute load is higher, but the stress is shared over multiple joints.

In just about every instance, when you drop the direct elbow extension work from someone’s program, their elbow issues resolve very quickly and they don’t miss a beat with training.

So, as you probably inferred, it’s very rarely a lack of strength that causes elbow pain in lifters.  Rather, it’s generally poor tissue quality, a lack of flexibility, and overuse of a collection of muscles that have “congested” insertion points.  Simply changing the program around, getting some soft tissue work done, and following it up with some stretching can go a long way to both prevent and address these issues.  That said, there will be cases where elbow pain may originate further up at the cervical spine or shoulder or – as I learned from a reader in the comments section of Part 5 – from an abducted ulna.  So, there is definitely no one-size-fits-all approach.

That wraps up this series.  Hopefully, you’ve gained insights into some of what’s rattling around inside my brain with respect to elbows.  Thanks for putting up with me for all six installments!


Please enter your email below to sign up for our FREE newsletter.

Name
Email
  • Gareth

    French IS a European nationality? 🙂
    Thanks for the article. I’ve had some elbow/forearm issues from low bar squatting a lot, and find that the only thing to stop the pain is to stay away from the low bar position for 4 weeks or more and cycle the low bars in when peaking for a competition.

  • Eric Lpine

    Gareth, “Eastern European” is what the man was asking for 😉 Sounds way tougher than anything starting with “French”!!!! I’d be in favor of Ukrainian Skullcrushers for some added toughness!

  • Ceaze

    Do you have any opinion on this device for at-home soft tissue work?

    http://armaid.com

  • Eric,

    Great series. A large part of the personal training cleintele participate in tennis and golf, and experience these types of overuse and degenerative issues. Have you read anything on the research they have done recently with eccentric training at Nicholas Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital in New York City. The New York Times wrote an article last summer on Dr. Timothy Tyler’s work with eccentric wrist flexion using rubber bars. very interesting. http://well.blogs.nytimes.com/2009/08/25/phys-ed-an-easy-fix-for-tennis-elbow/?scp=1&sq=eccentric%20elbow&st=cse

  • Ken O’Neill

    Wonderful series.
    In my case, some months ago de Quervain’s syndrome came on without forewarning. After several months of ART/Graston, it became better for a while only to worsen. At that point I took over as project manager with my practitioner, mandating upstream functional analysis. Turned out to find entrapment of my radial nerve above the elbow compounded with lack of full extension of that elbow. My physician did x-rays, finding some calcification he believes is reversible. BTW, I’m 65 with 52 years of training – some of it the functional training that used to be called Old Time Strong Man feats!
    This series has been very insightfully helpful. About to be loaned a therapeutic pulsed electromagnetic frequency resonating device to treat both elbow and wrist.
    Thanks again, amigo

  • My elbow problems came as a result of letting cleans get out in front of me and looking more like a “power reverse curl”. Once I got the hang of tracking the bar closer to my body, the elbows were happier.

  • Benjamin Kusin

    FWIW Rippetoe states that elbow pain can be caused by gripping the bar incorrectly in the squat. He advocates a basically neutral wrist, so that you don’t attempt to “hold the bar up.” I admit I don’t (usually) grip the bar his way but here is a video of one of his trainees so you can see what I mean.

    btw this guy is a case study in what happens when a novice trains hard linearly with total body workouts and eats harder.
    http://www.startingstrength.com/resources/forum/showthread.php?t=15386&highlight=zach

    how’s that for some motivation?


LEARN HOW TO DEADLIFT
  • Avoid the most common deadlifting mistakes
  • 9 - minute instructional video
  • 3 part follow up series