How to Train Smart and Prevent Pain

Twingy and tweaky elbows are never desirable. But much like with shoulder pain, if you’ve been lifting for any appreciable amount of time, you’ve probably experienced (or currently have) elbow pain. But all is not lost if you already have pain.

This article offers some tips to avoid elbow pain through preventive work. I’ll also explain a few ways to reduce pain and work around it. Not only that, but there’s a little bit of anatomy thrown in so you can show off at parties.

Note: First and foremost, if your elbow is persistently cranky, you should seek professional help for a diagnosis. The pathology of elbow pain varies widely and can be tricky to self-assess.

Let’s Talk Anatomy

The medial (inside of elbow) and lateral (outside of elbow) epicondyles are critical attachment points for ligaments and tendons.

The olecranon process sits in the olecranon fossa of the humerus. This is the “hinge” of the elbow. It also prevents hyperextension.

The humeroulnar joint (humerus and ulna) is a hinge joint. The humeroradial joint is a pivot joint.This is how we can supinate (palm up) and pronate (palm down) our hands.

Common Sources of Elbow Problems

Soft tissue restrictions (i.e. “tightness,” “knots,” or, the super-scientific term, “gunk”) often occur when there is friction between muscles/tendons. Myofascial researcher Luigi Stecco coined the term “zones of convergence” to describe areas where multiple muscles share a common tendon attachment. This creates a zone where forces are generated by multiple muscles, which means there is a high concentration of force in a very small area.

In the elbow there are at least three major zones of convergence:

  1. Four of the wrist flexor muscles attach to the medial epicondyle via common tendon.
  2. Five wrist extensors attach to the lateral epicondyle via common tendon.
  3. The three heads of the triceps all converge on the olecranon process.

Overall, there are sixteen muscles that cross the elbow joint. That is a lot of tendons. Not only that, but you have ligaments, nerves, arteries, and veins all vying for space within the joint, too. It’s more crowded than a New York subway car at rush hour.

Your main take-away is that the elbow contains lots of things in a very small space. When friction is introduced, the tendons, muscles, and ligaments stick together to form dense, fibrotic tissue- that is, “gunk.” This gunk can impact everything to include nerve function, ligament integrity, and the health of the tendons.

Why Lifting Makes It Worse

Typically, lifters experience medial elbow pain. This is because we go through repetitive elbow and wrist motions while under load (just think of a standard upper-body training day). We grip heavy barbells, dumbbells, and kettlebells. The muscles we use to grip – the flexors of the forearm – attach to the medial epicondyle, so it’s no surprise we can get gunky on the inside of our elbows. And it’s not just gripping the bar on a row or deadlift that produces tension. Take a gander at the elbow position on a back squat.

Holding the bar on your back creates a lot of valgus (medial or inside the elbow) stress. Do you ever get tingling in your pinky and ring finger after a heavy or extended squat set? The ulnar nerve can get pinched when the elbow undergoes valgus stress.

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