Injury Notes: Elbow Pain

I recently got a great email from a reader asking about some elbow pain that she had been having, and if I had any advice for her to decrease the pain while still maintaining/increasing strength.

(For the record…I LOVE reader emails!! So keep them coming) 🙂

I thought I’d turn this into a blog post since A)We all have aches and pains now and again, and B)prevention/evaluation/rehabilitation of injuries is actually how I make my living…So I might as well incorporate some of my  knowledge here, right?

What this reader described was a chronic pain at her elbow that is exacerbated by repetitive flexion of the elbow when she does a lot of work with resistance bands and light dumbbells.

So the question is, why is this happening and what are some things than can be done about it?

**Note: This is not meant as a diagnosis or treatment for any specific person or injury, this is just meant as a general guideline. If you have severe pain or inability to perform certain movements, I recommend that you see your own MD, PA, AT or PT for evaluation/treatment.**

What is elbow pain, anyway?

Chronic elbow pain with lifting is typically caused by either lateral or medial epicondylitis (also known as Tennis Elbow and Golfer’s Elbow respectively). In the case of lateral epicondylitis, your wrist extensor muscle group attaches as a common tendon just above your elbow joint, at what is called the lateral epicondyle of the humerus (your upper arm bone). This common tendon and the surrounding tissues can become inflamed due to improper mechanics, repetitive motions, or mobility issues (within the forearm or elsewhere in the body — Yes, mobility restrictions at the shoulder can absolutely cause elbow pain!) With medial epicondylitis, it is very similar, as it is the wrist flexor tendons which attach at the medial epicondyle that are inflamed.

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There are several other structures in the elbow that can become inflamed or injured, so this is by all means not an all-inclusive list. There are other soft tissues structures, ligaments, bones, and bursa that can be involved, especially if your injury was traumatic.

What is going on to cause this pain?

In the case of this specific reader, she complained of pain that was chronic and worsened with repetitive use of resistance bands for training. My first thought when reading this is that while they can be great tools, often times when people use resistance bands for strength training, the wrist can be put at unnatural positions throughout the exercise range of motion. Repeating an exercise involving elbow flexion over and over, with the wrist at an unnatural position can cause increased stresses at either the flexor or extensor group, speficially at their attachments at the epicondyles.

Not only that, but repeatedly performing arm isolation exercises (bicep curls, tricep kick backs, etc.) can place more stress on your elbow because you’re not necessarily utilizing all of your stabilizing muscles correctly when isolating such small muscle groups.

Another thought that comes to mind is high volume training. Many people tend to do high rep volume when they use lighter weights or resistance bands, and this could lead to overuse pain at that specific joint. (If I did 100 leg extensions every day with a resistance band, you’d better believe I’d start to develop some knee pain related to overuse…)

So what can be done?

As I’ve said above, this is not an all inclusive list. Depending on your specific injury or cause of pain, there may be alternative treatments necessary. These are just a few suggestions to get you started:

  • Wrist strengthening – If wrist position is your issue, it will help to strengthen the muscles surrounding your wrists so that you are able to keep them in neutral position when doing upper body exercises. (Neutral position for your wrist is straight in line with your forearm, not flexed or extended). Holding a light dumbbell, support your forearm on a bench, palm facing down. Extend your wrist up, and back to neutral keeping control of the movement the whole time.  Do 3×10. Now palm facing up, “curl” or flex your wrist for 3×10. Also do slow, controlled rotational movements if pain allows for 3×10 each direction. Push ups can be an exception to the “neutral position” rule, but doing them while holding a pair of dumbbells will help to keep a more neutral position.
  • Increase Grip Strength– Similar to above, but worth mentioning on its own. Increasing your grip strength can help with many aspects of lifting, and will also help you to engage your forearm muscles more effectively. You can use a tool used specifically for grip strength, or you can use something called “Fat Gripz”, which you can attach on a pullup bar, dumbbells, etc.
  • Do More Compound Movements – As said above, repetitive isolation of the arm muscles can cause overuse type injuries at the elbow. Try doing more compound upper body movements, such as pushups, pullups, and cable cross-overs to engage more of your larger shoulder and back muscles, which will help to stabilize your shoulder and elbow.
  • Soft Tissue Work – Doing self soft-tissue work on your forearm muscles, shoulder, back, and pectoral muscles can all  help elbow pain. The key is to finding where the culprit lies — do you have shortened pecs from sitting at a desk all day? (probably) This can cause improper movement patterns in your shoulder that add to stresses at your elbow. This topic could be a whole post in itself, so I’ll stop there on that one. Additionally, stretching the forearm muscles can help. To stretch the extensors, hold your arm out straight with your palm facing down, with the other hand push your hand down, bending at the wrist. To stretch the flexors, start with your arm straight but with palm facing up, use your other hand to push your hand down, again bending at the wrist.
  • Include Other Movement Patterns – Try including more upper body exercises that don’t involve repetitive elbow flexion: anterior raises, lateral raises, landmines, cable cross-overs, etc. The list is endless!
  • NSAIDS: Anti-inflammatories may help if taken correctly. These should be taken on a regular basis (not just once every couple days when you remember). Ibuprofen is the most common, take as directed.
  • Active Rest: If your pain is of a sudden onset or recently increased, you may want to take a break from the exercises that cause you the most pain. You don’t necessarily have to stop lifting all together, but figure out what seems to increase the pain, and back off of those for a little while.
  • Avoid repetitive ADLs – The cause of your pain may actually have nothing at all to do with lifting. Are there any repetitive activities you do at your job? Reaching across your desk, reaching up overhead, simply typing all day? Take stock of your daily life and try to pinpoint any activities that may be making your injury worse.

And there you have it! As I have already said several times, there may be other solutions for you and your specific pain or injury. Be smart and get it checked out if the pain is persistent, severe, or due to a traumatic injury; better safe than sorry right?

Happy lifting, friends, and have a wonderful weekend!

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