Elbow Pain and Strength Building Ergonomics

As way of a disclaimer, I’m not a doctor, nor do I play one on television. My advice is for informational purposes only and isn’t intended to be a substitute for a physician’s advice or diagnose an issue. Please consult your physician or health care provider about the suitability of any opinions or recommendations as they relate to your own symptoms or medical conditions.

With that out of the way, below are some links to some common issues that affect the elbow. Take the time to educate yourself.

Now…elbow pain sucks! No, seriously. It does. On a bright note, it’s also fairly easy to get rid of. All you need to do is follow the less is more principle. Meaning, the less you do, the more it heals. Unfortunately, for the majority of us, that’s much easier said than done.

First of all, let me clarify something. I’ve worked primarily acute care as an occupational therapist, so my “outpatient” experience with various musculoskeletal conditions is limited. I’m by no means an elbow tendinitis guru. Much of what I learned regarding this condition, I attribute to my clinicals at a hand clinic, my own studies into the matter, and some postings by Evan R. Peck, MD who’s a physical medicine and rehabilitation physician. On a side note, Evan, where the hell have ya been lately?

If we’re to look at the various treatment protocols for conditions affecting the elbow, many treatments, depending on where you lie in the acute to chronic spectrum, consist of some of the following:

  • Rest, ice, compression, and elevation (RICE) for a couple weeks or so.
  • Provided you’ve been pain free for several days, begin a solid stretching regimen focusing on the shoulder, biceps, triceps, forearm, and wrist. Also, cross friction massage, ultrasound, or iontophoresis may be used as well.
  • After a week or two of stretching, strengthening exercises should begin. Strengthening exercises will generally focus not only on the elbow but the joints above and below the area of injury. This is because the mechanism of injury may not necessarily be the elbow itself.

For example, you can do scapular retractors/rhomboids (think rows…lots and lots of rows), but avoid locking out the elbows! You can do lower trap work (think straight arm shrugs on a lat pull-down). Still continue to avoid full lockout of the elbows. Or you can do serratus anterior work (push-up pluses are helpful). Again, avoid full lockout for now.
Continue to stretch the upper traps, levator scapula, pec major, and pec minor (think doorway stretches with the hands up higher and the one with the hands lower). Here’s the catch—this will take time and generally involves quite a lay off regarding your weightlifting activities.

Upon hearing this, most are thinking blasphemy! I understand. This is why I fight this condition rather frequently. I have access to many great minds—physical therapists and occupational therapists as well as many physicians. The unfortunate thing is (unfortunate for rehabilitative purposes) I’m also a competitive powerlifter. This means I share the same perspective of many of the people who read this site. By this, I mean that a break from the activities we love to do and the lifts we perform usually isn’t an option. So what do you do? Is an extended lay off the best solution? Probably. No, let me rephrase that. Yes! Definitely yes! But…

We all know how that works. Six days pass, you carry in a big ass bag of dog food, and you think “Wow, that was heavier than I remember it being.” One thing leads to another and bam! You’re back out in the gym maxing out your deadlift, board pressing, rack pulling, caber tossing, log pressing, and farmer walking. Truth is we are hardwired to push past the pain, work around it, do whatever we have to do to meet the goals of our sport or support the athletic lifestyle we’re accustomed. Therefore, the obvious answer is work around it. So why not just work around it?

Well…if you’ve had the issue for quite awhile, you’ve probably already been doing that. So now it’s six months later…how’s that been working for ya? You’ve bitched, moaned, tweeted, posted on forums, and whined to your friends and family to the point that they’ve all quit coming to your weekly Dancing with the Stars wine and cheese soirée. Yet, still the issue exists! Why?

Truth is it isn’t easy to not involve the scapula, shoulders (glenohumeral joint in this instance), elbows, forearms, wrist, and hands in most exercises. So what do ya do? Modify! Yes, face it. You’re too damn stubborn to take time off and recuperate. You’re going to do what you always do and that’s lift weights and give the finger to good, sound advice. So the second best answer is damage control.

Here’s a caveat—this will take a long time. For some, a long, long time. For others, never. However, it can ease the pain some and allow you to work around the issue a bit. At least it may allow you to finish competing until the season ends when you can focus some actual time on fixing the problem.

In the meantime, for those of us who are challenged by the trials and tribulations presented to us by elbow tendinitis, we still need to train! There’s a multitude of ways to train around the issue, but you’re limited. This doesn’t mean you can’t train! It just means you need to make some modifications and be aware of what perpetuates the problem.

Some of the problems that exacerbate the issue are:

  • Locking out the elbows (think top portion of dips, benching, overhead pressing, or bottom of chin-ups/pull ups, triceps push-downs)
  • Gripping
  • Elbow flexor work (dumbbell or barbell curls, hammer curls)
  • Forearm rotation
  • Repetitive movements, especially ones related to the above (also don’t forget daily activities related to the type of work you do including the use of a computer mouse)
  • Jerky movements or movements with impact can also worsen the issue (Olympic lifts and “drop and give me twenty” isn’t a good idea in your case)

To work around the issue…

Avoid locking out: Don’t lock out the elbows in any movement. I wouldn’t even do the “soft lockout” thing. Think bodybuilders and the constant tension on the muscle concept. Keep everything an inch or two short of full elbow extension. This is especially important to remember for dynamic effort bench work. For some, the lockout is a weak point in the bench, but now isn’t the time to work on it. If you absolutely must, limit it to only a couple times every two weeks.

Decrease or eliminate gripping: Use of a fat bar will help take the stress off the elbow and forearms. Because not all exercises can be modified to take out the gripping portion, the use of Fat Gripz or something similar can help. The wider grip will stress the elbow/forearm muscles much less. In Strongman, they do a fair share of fat bar work already. I would utilize that concept throughout all training for awhile to decrease the elbow stress. Another interesting concept would be to vary grip widths and/or hand  positioning throughout sets.

For example:
Set 1: T-bar row with wide grip/pronated using fat grips
Set 2: T-bar row with shoulder-width grip/supinated using fat grips
Set 3: T-bar row close/neutral grip using an extra thick towel
(Need I say it yet again—don’t lockout your elbows at the bottom of the movement.)

Here are some other ways to decrease the need for gripping:

Use abdominal slings: Those slings you see hanging off chin-up bars that people use to do hanging knee/leg raises can be used for something besides comedy purposes and watching your friends twist around in mid-air to hit their “abs and ‘bliques.” These can come in handy for multiple lat pull-downs or seated row movements. Just attach them to the cable and wrap the slings around your elbows and pull. This will still allow you to work your upper back as chin-ups and pull-ups should take a backseat for awhile.

There’s a device out there with cuffs that attach to your wrists or elbows and can be used for cable machine exercises as well. I’m not sure what it’s called or where you can find it. I’ve just seen it at the Arnold Classic this past year. What I do know is it’s a bit pricey and something similar could probably be made at home. Bands wrapped around your arms are another option, but this may be uncomfortable for some. The take home message is the less gripping you have to do, the better.

Cut down on forearm rotation: Minimize rotation at the wrist/forearm. In other words, unless it’s supporting your livelihood, quit wrenching on your car six hours a day with that new socket set your Aunt Beatrice got you for Christmas. Also, quit repping out on those kewl pipe wrench wrist rotations  and wrist rollers you use to get your Popeye’s all swole. Continue on this path and simple things like twisting a door knob will start to hurt. There’s a time for them in the rehabilitative process but not in the modification process.

Cut out repetition of movements: High reps of anything that exacerbate the issue isn’t a good idea. This also includes daily activities that involve bending and straightening of the wrist, palm up/down movements, and static positions with the hand bent back. Look at the above and modify your work and leisure activities as much as your weight room ones. A great place to start is the use of your mouse. You may wish to consider using a track ball instead, especially for all those late night marathons of forum posting and visits to the no-no sites. In other words, everyone is so quick to point out what they do in the weight room as the cause of their injury, but they neglect the other 22 hours or so they spend outside the gym, which could actually be doing the most damage.

One of the things that actually worked for me was one of those neoprene forearm straps. Yeah, I know. I was skeptical as well. But here’s the thing—all the counterforce bracing hoopla aside, I think the magic was that it worked similarly to those goofy ass back support braces that factory/warehouse workers tend to wear. It doesn’t do jack on its own, but it at least acts as a cue to remind you of your lifting mechanics, which in turn can decrease certain movements that exacerbate the issue.

Quit cha jerkin’: Aside from making you blind, hard, jerky movements at the elbow can really bring on the damage. For shits n’ grins, I wanted to learn the Olympic lifts. I took a class at the local YMCA and worked at them for the next several weeks. By no means a contender for the next Olympics, I did at least get the basics down and performed them frequently. Shortly thereafter, I got perhaps the worst case of tennis elbow I’ve ever experienced.

Do I think the Olympic lifts caused this? Doubtful. Do I think I was already well on the path to tendinitis and these were just what pushed me over the edge? Quite probable. The bottom line is quick, snapping movements in combination with locking out the elbows won’t help if you have an elbow issue. Nor will high impact movements like sledgehammers on tires or dropping to the ground abruptly to perform burpees or push-ups. The list goes on.

Here’s some stuff I’ve heard may help, but I don’t have any personal experience with them:

So for the hardcore lifters out there, these few things may help in decreasing the pain and letting you continue to lift and get stronger when time off isn’t an option. Give them a try and remember the quote often attributed to Bruce Lee (yes, I know it’s been quoted to death but for a good reason): “Absorb what is useful; reject what is useless.”

Copied from www.elitefts.com

About the Author

Ron Reeder is an occupational therapist and competitive Masters powerlifter with a 485-lb deadlift, a paltry 285-lb bench, and a squat he refuses to discuss in the 148-lb weight class. He is driven to help people of all ages meet their goals whether it is to get strong, get big, lift the most weight, or improve their independence with their activities of daily living. He lives near Lansing, Michigan with his beautiful wife and three dogs Maggie, Sam, and Ruto.