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.
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.
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
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.
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