Elbow pain can be a real bitch for serious weightlifters. The pain can be so debilitating that basic exercises such as pull ups are impossible, and in some cases, the pain lingers for months. I once battled golfer’s elbow (medial epicondylitis) for over 6 months. I tried everything. I started using grip aids during my workouts. I iced. I rested. I massaged. Nothing helped… until I found the magic combination that fixed my elbow pain once and for all.
Elbow pain sucks
Imbalance, the root of the problem
Elbow pain is caused by a combination of overuse and dysfunction. Most athletes, (including my former self), pay no attention to making sure the hands and forearms are conditioned and balanced. We grip barbells and dumb bells and we assume all this gripping is enough. Often, the flexors are overworked in a very narrow load range and the extensors are underworked completely. This is a recipe for nasty imbalance and a good dose of tendon pain.
Tennis elbow and Golfer’s elbow are usually called epicondylitis since the tendons involved attach to the medial and lateral epicondyles. Many people refer to this condition as tendonitis. However, pain in these areas that lasts for more than a few weeks is more likely tendonosis, which is more problematic than simple and acute inflammation. Tendonosis is characterized by damaged to the tendon at the cellular level caused by repeated microtears in the connective tissue that do not heal properly. (In short, tendonosis happens when tendonitis sticks around too long.)
Tendonosis is especially nasty because it leads to vascularization of the tendon tissue. Where blood vessels grow, so do nerves. As the tendons become increasingly innervated, guess what? Surprise!!! They hurt more! Trust me, when this lasts for 6 months, it really sucks.
Want to get rid of your pain quickly? Blitzkrieg is the only way.
Epicondylitis can be devilishly stubborn. It’s one of those nagging pains that often lasts for months. Sometimes it will fade away or disappear for a week only to rear it’s ugly head again on arm day. To make matters worse, once you’ve had epicondylitis once, you are more likely to get it again. Worse still, if left untreated, it can become chronic. Often, single tactics aren’t effective. This is why it’s best to attack the problem swiftly and from multiple angles. The following tactics, applied in sum and with the full force of a war offensive, WILL fix your elbow pain. Seriously, none of these tactics alone will help if you have a bad case. You must do them all.
1. Voodoo Floss Bands
Voodoo flossing works…um…like voodoo. This combination of extreme compression of the elbow during full range of motion has truly magical effects on pissed off tissue. Flossing may work due to any or all of the following: Source
- Neurophysiological mechanisms
- Temporarily reduced blood flow
- The sponge effect of the compression
- The “breaking ” of crosslinks (fascial impact)
- Reduced muscle tension
- A decrease in edema following an increase in lymphatic and venous drainage
2. Tack and Floss (See the below video for a demonstration)
Tack verb Definition: to apply targeted pressure to a specific area of muscle tissue or facsia tissue.
Floss verb Definition: to move a joint or limb through a specific range of motion.
3. Ice: The Right (and wrong) Way to Use it.
For years, whenever I had joint pain, I wrapped up some ice in a towel or a plastic bag and held it on the pain for 15 to 20 minutes. I later learned this is a stupid way to ice for elbow pain. While it is true that icing reduces inflammation, this is not the mechanism of healing that we are looking for. (Inflammation is good for healing.) The real goal of icing areas with painful tendinosis is to increase blood flow. When we supercool the skin over a problem area to the point of numbness, we are stimulating a massive increase in blood flow to the area as the nervous system calls for increased circulation to the tissues involved.
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4. Dry Needling
Dry needling is intensely painful not only during, but also immediately after the treatment. However, if you are serious about solving your problems, suck it up and endure because it works. “…Dry needling has been shown to positively influence tendon healing by increasing blood flow via local vasodilation and collagen proliferation.” Source
My first experience with dry needling was to treat my own tennis elbow. The session lasted about 20 minutes, during which time the PT stuck my forearm arm in about 10 different locations. I barely felt some of them, but a few of them had me squirming and sweating all over the exam table. Surprisingly, my entire forearm was completely sore before I even walked out of the office. It felt like the worst case of muscle soreness multiplied by about 10. This gradually faded over the next 48 hours, after which time, the elbow pain was significantly reduced.
5. Eccentric training.
Eccentric (aka “negative”) strength training stimulates a more effective tendon repair response and facilitates tendon remodeling by increasing the number of collagen cross-linkages. Source
Flex Bar by Theraband
My favorite tool for eccentric loading is the Flex Bar by Theraband. It’s easy to use and is available in different strengths. Another great method is a wood dowel with a rope and a 5 or 10 pound plate tied to the bottom. Wrap the rope around the dowel and let it down slowly and deliberately with the affected muscle group.
6. Rest
Nobody wants to hear this, but a damaged tendon cannot properly repair itself if you keep tearing it apart during every workout. You can plow through the pain because you can’t bare to miss arm day, or you can listen to your body and get better. Don’t be a dummy. I tried the dummy path and it didn’t work out. Using fat grips (see below) is one way to mitigate the ongoing damage. Modifying your workouts to utilize fewer free weights will also help.
Prevention: Never get elbow pain again.
Weightlifters and other strength athletes often neglect the hands and forearms, but to avoid elbow tendon problems, they should be trained religiously. Fortunately, the muscles of the hands and forearms recover quickly and it requires little time to incorporate some maintenance exercises into a regular workout. Here are my favorites:
- Extensor specific exercises using bands and dowels
- Fat grips to vary the load range of the flexors. This ads zero time to a regular workout. Just snap the fat grips onto your barbell or dumb bell and do your workout as normal. Fat grips have the added bonus of relieving active elbow pain (both golfers elbow and tennis elbow) because it changes the load range of both the flexors and extensors.
- Grip specific and extensor specific training protocols See this article on grip strength
Dude I have this!! I have golfers elbow and am 10 weeks out of surgery from my distal bicep tendon repair. What all can I do at this point? I’d love to talk to you about all this!
Hi DJ. This is pretty common for people who have bicep tendon injuries because the normal balance of musculature and fascial tissue has been altered by the injury. The surrounding tissues are called upon to perform more work and they often get over use injuries. I think if you are 10 weeks post surgery, you can probably do all of the therapy exercises for golfers elbow. Just obey any pain signals from your biceps tendon.
Thanks Jacob! I’m a tennis player who ends up with “golfers’ elbow” pain!! Go figure!? 😆
You have given me very good pointers that I will include into my recovery…. I have done rehabs and rest, but still can’t get rid of the pain… so I have to attack this full on…
This full blown attack has worked wonders for me. Good Luck! Let me know how it goes.
Enjoyed your article question I have is I am right handed and I have originating painbehind the elbow it is intense had distal bicep surgery along with ulnar nerve decompression on right arm that has post op numbness 3 months out now Dr is worthless do you think I have something more concerning. Thank you
PHilip,
I would recommend that you see a physical therapist as well as a soft tissue worker (such as a rolfer) about this. Surgery can be very disruptive to the nerves and fascia surrounding the injury. I am not surprised that you still have pain and numbness 3 months post op as this is somewhat common. Don’t panic. Do the PT and the soft tissue work.
Jacob, I have been dealing with golfer’s elbow for almost a year now. Like you, when it first happened I thought it was no big deal. I kept playing golf and lifting weights and doing yoga for a few months, taking ibuprofen whenever I had pain. Then, 7 months ago, I shut everything down. No weights, no yoga, no golf, and trying to use my right hand as little as possible around the house and with my kids.
I did PT, didn’t work. Did PRP, and while it has shown some improvement in the four months since, I still can’t seem to get over the hump. While it feels much better today than it did months ago, it still is nowhere close to back. I’ve played golf a few times in the last few weeks, but still can’t go “all out” when I swing and the pain comes and goes in the week after a round.
I started your program seven days ago and it has been great thus far. While the pain isn’t completely gone, I can almost feel it getting better each time. Thank you for posting this!
Two questions:
1. I hear you on the “4-5 times per day” mentality and attacking it, but should I be doing this every day? Any off days to let things recover?? For example I finally found “the spot” on the tack and floss exercise last night and as a result it was pretty tender today. Should I keep going, or give it a day off?
2. How long should this take to heal? I realize tendonosis can never truly “heal”, but when should I see significant results using your program? Two weeks? A month? I first found out about my partial tear(s) to the common flexor tendon via a MRI in November… should I get another one to see what type of progress has been made?
Golf is a big part of my life, and 7 months off has been brutal for me, mentally. I am worried that coming up to a year of this issue means it’s chronic and that I may need to get surgery to try to fix it for good.
Thanks for the help here!
Derek,
In answer to your questions, if it is tender from the soft tissue work, then give it a day of rest. There is a point of diminishing returns with these tactics, and it’s different for everyone. You must be the judge of this. In general this tissue is very quick to recover from soft tissue work. I have had to lay off for as much as 3 days when I’ve overdone it with the tack and floss.
Regarding time frame, this is also different for everyone. But typically, if you attack this full on, you should begin to feel improvement after 2 to 4 weeks. The eccentric exercises are important for remodeling the disorganized scar tissue. This process can take 6 weeks in healthy tissue. My recommendation is to wait until you are pain free for at least 2 weeks before you return to a full golf swing. Patience is the key to recovering fully. If you keep blowing it, you will end up under the knife.
You should also try cross sectional massage, which is essentially self massaging the injured tissue but only against the grain of the muscle belly. This helps to break up the scar tissue that is malformed and helps to align the collagen fibers along the proper axis. You can find lots of videos online that demonstrate cross sectional massage.
Please check back in 2 weeks and let me know how it feels!
Update here:
I did almost 3 weeks of the “game plan” you laid out and what I noted above (everything except Dry Needling, which is hard to find in CA). The elbow felt much better at that point, but definitely not cured.
Then, towards the end of the three weeks, I over-did the tack and floss to the point where I got tingling/numbness in the left side of my right hand and my pinky finger. So, I shut everything down for a few days. Over the next week, I only did a little massaging, Flexbar, and ice cup, trying to give things a rest to get the tingling/numbness down. Interestingly, the elbow has improved substantially since I backed off. However, the tingling/numbness has gone from the pinky to the pinky + ring finger to now my entire hand. It comes and goes throughout the day with no rhyme or reason. I’m sure I pissed off the Ulnar Nerve.
Any thoughts would be greatly appreciated!
Derek, Sorry for the late reply. I have heard of some folks having success with “nerve flossing” techniques. I would definitely lay off any more tack and flossing until you get the nerve problem resolved. Many body workers are skilled at alleviating these types of nerve problems, but you need to seek someone with many years of experience. How is it now?