It’s Monday and if you’re like most testosterone raging males, that means bench press and lots of it.
However, elbow pain can easily put a damper on your pec pumping party.
Here’s how to get your mojo back…
Joint by Joint Approach
The elbow is essentially the knee of the upper body. It’s routinely blamed for being problematic but often it’s merely an accomplice to the crime rather than the main perpetrator.
If we examine the biomechanics of the upper body via the joint-by-joint approach (ala Mike Boyle and Gray Cook), we can see that certain joints need stability, mobility, or perhaps a combination of both:
- Foot - Mobility & Stability
- Ankle - Mobility
- Knee - Stability
- Hip - Mobility & Stability
- Lumbar Spine - Stability
- Thoracic Spine - Mobility
- Scapula - Mobility & Stability
- Shoulder - Mobility & Stability
- Elbow - Mobility
- Wrist - Mobility
In the case of the elbows, they are often forced to bear the brunt of the load from the wrist and shoulder.
For example, if the shoulder lacks mobility and you may have to compensate through the elbow to complete the movement. Now you wind up with elbow pain and get stuck investigating a false positive while the shoulder continues to remain the real issue.
Programming by the Pros
Please keep in mind that pain is not always indicative of musculoskeletal dysfunction at a cellular level. Relax tough guy, just because you wake up with elbow pain doesn’t mean you magically procured ulnar nerve entrapment overnight. As I touched upon in a previous article:
“The human body is an incredibly adaptive organism with multiple degrees of freedom so it is very tough to make declarative statements regarding static or dynamic postures.
If posture and pain were really as simple as folks make them out to be, then why have multiple studies confirmed that 20-70% of patients with “anatomical abnormalities” (i.e. disc bulges/herniations, labral tears, spinal stenosis, meniscal tears, etc.), present with no history of pain?3-5”
So, given that’s the case, we should first look at programming and technique modifications before resorting to soft tissue or even supplemental recommendations to combat inflammation.
1. Utilize a Neutral Grip For Pressing AND Pulling
This is standard practice for elbow pain but folks often forgot about both sides of the equation. Ideally, we want to eliminate fully supinated or pronated movements when possible to limit rotational stress at the elbow.
For example, if you choose to utilize neutral grip DB presses, don’t forget to also incorporate neutral grip chin-ups and DB rows. Here’s just a few suggestions to incorporate into your programming for 6-8 weeks in place of your normal compound movements.
- Safety Bar Squat
- High Bar Squat (Instead of low bar)
- Front squat with straps
- Front squat with arms crossed
- Trap Bar Deadlift
- Trap Bar RDL
- DB RDL
- Neutral Grip DB Press
- Swiss Bar Bench Press
- Pushup Variations
- DB Floor Press
- Trap Bar OHP
- Neutral Grip DB Press
- Neutral Grip DB Row
- V-Bar Cable Row (Wide and Narrow)
- Neutral Grip Chinup
- V-Bar Pulldown (Wide and Narrow)
- Utilize DB or trap bar variations
GUN SHOW (Flexion):
- Swiss Bar Curl
- DB Hammer Curl
- Cable Rope Hammer Curl
- Banded Hammer Curl
GUN SHOW (Extension):
- Swiss Bar Tricep Extension
- DB Tricep Extension
- Cable Rope Extension
- Banded Tricep Extension
If you don’t have access to DBs or a Swiss bar, make sure to situate the bar as low as possible in the palm. This will help to keep the wrist stacked over the elbow and take some of the isometric stress off the forearm flexors. Greg Robins does an excellent job explaining the concept in more depth here:
2. Consider Using Straps or Modify Your Grip
Elbow issues can indeed be indicative of a weak grip but they can also be the result of overcompensation. For example, when performing chin-ups, many folks will end up flexing the wrist to assist in pulling their chin over their bar.
If that’s the case, the forearm is now loaded with the entire weight of the body during the eccentric component of the movement and this can potentially lead to tendinitis (inflammation from micro-tears due to acute overloading) or tendinosis (degeneration of collagen due to chronic overuse).6
If you tend to overuse your forearms during pulling movements, you may want to consider utilizing a thumbless grip. Generally, this can help to clean up technique as the individual is forced to use more of the back musculature rather than driving the movement with the arms. But, this can also add additional stress to the forearm as the wrist flexors bear more of the load.
If you experience more pain on the medial (inner) portion of the elbow then straps are likely your best option. However, if more of the pain is located on the lateral (outer) portion of the elbow then a thumbless grip may be a viable solution.
If you do choose to use straps with any of the pulling variations listed above, ensure that the movement takes place primarily at the elbow and shoulder, not the wrist. On top of that, you may want to consider performing heavy hinge and lunge movements (see above) without straps and adding additional farmers walks to address grip issues.
3. Utilize Irradiation
Irradiation is a big, fancy word which basically means that stability within joints of the upper body is generally governed by how hard you squeeze something.
Dr. Roger Enoka breaks it down in the Neuromechanics of Human Movement as, “the spread of muscle activation that augments postural stability and enables the transfer of power across joints by two-joint muscles.”1 For example, the triceps accomplish this in the shoulder and the elbow as they are a biarticular muscle group.
This flies in the face of point #2 but you may need to experiment a bit and see what works for you. If your elbow issues stem from instability at the shoulder or wrist, some additional irradiation through grip strength and neural drive during the movement (i.e. SQUEEZE!) may prove to be a simple solution.
For others, they may find that straps are a lifesaver for any movement which tractions the wrist (e.g. DB rows). This list isn’t a set of hard and fast rules, as Bruce Lee once said:
“Absorb what is useful, discard what is useless and add what is specifically your own.”
4. Don’t Over Cue
Many lifters like to use the cue, “screw your arms into your sockets” or “bend the bar” for pressing and pulling movements alike. While the idea is a good one, it can be overused. Elbow issues largely stem from one of two issues:
- Flexion/Extension of the Wrist
Given that’s the case, if you have elbow issues, you want to limit both whenever possible. So, in the case of this cue, you may need to regress the movement entirely or perhaps just change your cueing. Limit additional rotational stress at the elbow and focus more on point #3 above (irradiation). Squeeze instead of twist and see how your elbow feels.
5. Ditch Low Bar Squats and Keep Your Grip Loose
I know, I know, all the Starting Strength aficionados are having a mild panic attack after reading that. Listen, put down your gallon of milk for a second and hear me out…
Due to the difference in bar position, many lifters experience elbow issues if they lack the requisite external rotation at the shoulder. Thus, the elbow experiences an exceptionally high amount of torque and this presents as pain at the medial epicondyle.
If you talk to most high bar squatters, you’ll find that many of them never experience any elbow issues. Why? A simple change in bar position and torso angle relative to the elbow. Nothing wrong with either lift but if you’re dealing with elbow pain it may be time to put your ego aside and switch things up.
Not only that, widening and loosening your grip will free up even more stress from the elbow. Use just enough tension to keep the bar in place but nothing more; save that extra tension for when you hit a sticking point.
You’ll find that this not only helps to improve stability through the trunk (ala irradiation which we discussed above), it also aids in force transfer from the lower body.
6. Soft Tissue Work
Remember, this should be your last-ditch effort. Programming modifications first and foremost, then consider soft tissue solutions.
As I mentioned above, the elbow is often caught in a tug of war between the wrist and shoulder. Given that’s the case, we need to address the musculoskeletal structures present both above and below the offending joint.
Here are some ideas to get you started:
“My elbow has been hurting for a while, can’t I just pop some Aleve and get back under the bar?”
I mean yeah, you could, but you’d be doing more harm than good in the long run. I’ve touched on NSAIDs in the past but I’ll quote it here for those who may have missed it:
“NSAIDs can profoundly alter the basic model of tissue repair by reducing the production of prostaglandins.2 This essentially shortcuts step #1 in the process (inflammation > proliferation > remodeling) as prostaglandins are very important for both the promotion and resolution of the inflammation pathway.3
Not only that, there have been a number of studies linking NSAIDs to various issues such as increased joint laxity, non-union fractures, and decreased tendon strength.4,5”
Movement is medicine, don’t simply resort to pharmaceutical “crutches” without addressing the root of the issue. There is no magic bullet or cure all which will magically fix your elbow overnight.
However, if you apply a variety of solutions from this article and give it time, I think you’ll be pleasantly surprised with the results.
- Enoka R. Neuromechanics of Human Movement. 5th ed. Champaign, IL: Human Kinetics; 2015.
- [NSAID and its effect on prostaglandin].
- Prostaglandins and Inflammation
- Nonsteroidal anti-inflammatory drugs' impact on nonunion and infection rates in long-bone fractures.
- NSAID therapy effects on healing of bone, tendon, and the enthesis
- Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters