Elbow Pain in Strength Sports
Elbow pain is a very common complaint among fitness and strength athletes. It is most common among weightlifters and powerlifters who grip barbells, as well as those who perform activities with loaded elbow flexion such as bench press, dumbbell lifts, push-ups, and more. Although pain in this region is common, it is an area of the body that many well-educated professionals find difficult to diagnose and to treat. Let’s dive in to the structure and kinematics of the elbow joint, and what Physical Therapy can do to assist with elbow pain treatment!
The elbow is a hinge joint composed of three major bony structures: the humerus (specifically the medial and lateral epicondyles), the ulna (specifically the olecranon), and radius (specifically the head of the radius). However, although it may be classified as a simple hinge joint, these 3 structures move in more ways than just opening and closing, or bending and straightening. Muscle actions work to rotate the forearm for positions necessary for ALL arm functions, which requires a combination of straightening, bending, and rotating. These movements are directly influenced by movement at the shoulder and the wrists, especially when a loaded apparatus is involved. Additionally, with 16 muscles and 3 major nerves that cross the joint, while the elbow may SEEM like a simple hinge joint, it actually is quite complex. It’s not as simple as just using blanket statements like tennis elbow or golfers elbow!
So, let’s simplify it! As the elbow joint relates to strength sports, let’s consider one very important topic, and break it down into 4 easy-to-swallow concepts.
The goal of this article is to SIMPLIFY the causes of elbow pain in strength sports, and to outline what Physical Therapy can do to help with treating the elbow!
Impaired Loading Strategies
Overuse: Most injuries are not catastrophic, such as dislocating or fracturing your elbow. The most common injuries to the elbow structures involve wear and tear stresses that accumulate over time. When gripping a barbell, dumbbell, kettlebell, or other medium, we expose our elbow and surrounding muscles to load, to which it adapts. This requires constant exposure to load, but paired with adequate rest and recovery. Problems usually arise in cases of insufficient recovery and repetitive overuse, where inflammation can arise in associated muscles involved with gripping. This can arise in different locations of the elbow depending on the activity, with the most common being the medial and lateral elbow regions.
Imbalance through Kinetic Chain: Impaired loading can occur when there is an imbalance through the kinetic chain; this involves the mobility, stability, and motor control from your shoulder all the way down to your hand. When treating the elbow, it is important we don’t narrow our focus to the elbow alone, but consider these other contributing factors within the kinetic chain. For example, I once worked with a patient with severe forearm pain with pull ups; our care focused on addressing the weakness of his scapular muscles and lats during initiation of the pull, to reduce the excessive use of his forearm muscles during the pulling movement. In another example, I personally used to experience medial elbow pain on my right side when I would receive a snatch; this was due to weakness in the stability of my LEFT shoulder in the catching position, which led to me using excessive strain in my grip on my RIGHT side to accommodate. It’s important to have an assessment of your overall mechanics and strength, as impairments in your movement pattern such as shoulder mobility, stability, or motor control through the whole kinetic chain can lead to excessive stress in unwanted areas.
Movement Pattern Considerations: As stated before, the elbow bends and extends, but it also rotates. The rotational movements are called supination (“palm up” position) and pronation (“palm down” position). These movements, in combination with movements at the shoulder, will determine where the load is distributed across the upper extremity. For example, in the front rack position, the elbow is in front of the body at 90deg with the elbow flexed and the forearm pronated (palm is away from you as you grip the barbell). When gripping the barbell when setting up for a snatch or clean, your elbow is extended and pronated, but there is some rotation at the shoulder when building tension for the lift… The fine details don’t matter as much when generating this concept — the important thing to take away from this is that the movements we do in strength sports demands mobility and movement in certain patterns of the elbow that can be influenced by the shoulder. Restrictions in mobility can impair how we load and result in pain.
Nerve Compression: the three important nerves to talk about are the Radial, Ulnar, and Median nerves as they cross the elbow. While most cases of elbow pain in strength athletes are related to load impairments and overuse, this can lead to nerve irritation as well. Excessive muscle strain in the sites of the nerves can lead to nerve compression and lead to pain, such as generalized burning, numbness, and tingling. It’s important to screen the neck to ensure this isn’t coming from higher up.
So, what can Physical Therapy do to treat elbow pain?
First, in pursuit of pain management, If there is soft tissue irritation and inflammation, we have great modalities to help address this. But our treatment doesn’t stop there — we need to fix what is causing this pain in the first place.
We’d address any relevant restrictions in the muscle and joint movement of the elbow. For example, limitations to elbow extension, flexion, pronation, or supination should be addressed to restore normalized mobility through the joint.
Then, we will LOAD the new established ranges of the joint in associated movement patterns. Not only that, but we will do so by prioritizing stability and motor control through the WHOLE kinetic chain. Pressing, rows, kettlebell windmills, kettlebell screwdrivers, are just a few of some of my favorite ways to do this. This is where our physical therapist team in the twin cities thrives!
Get you back to moving pain free!
The elbow is complex — but the treatment doesn’t have to be!! Let’s work together at our Minneapolis physical therapy clinic to find the best solutions for you to get rid of that elbow pain and return to lifting pain free! Call or email us to connect on how we can best help you.
We would be happy to discuss further how Loon State Physical Therapy can be a teammate in getting you back to moving and feeling your best! Our convenient Minneapolis physical therapy, Edina physical therapy, and Stillwater physical therapy locations will happily welcome you to get you back to moving at your best. Call us at (612) 405-8503 or book with us online at www.loonstatephysicaltherapy.com for an in-person or virtual appointment.
We look forward to being your teammate through this journey!
Dr. Jessie Parrish
jparrish@loonstatephysicaltherapy.com
612-200-2962
