After lower back and shoulder issues, I’d say that “elbows” definitely round out the “Big 3” of annoying joints that affect our training.
If you are old enough and have trained long enough then your elbows have probably flared up on you. I keep using “elbows” in air-quotes because “elbow pain” is an oversimplification. Most elbow pain originates from inflammation where the muscles from either the biceps, forearms, or triceps attach around the joint. It’s a good idea to try and pin-point where the pain is originating from so you have a better idea of how to deal with it. Although in many circumstances the “fixes” will be applied the same, regardless of which attachment point is the source of your troubles.
Below are what I hope to be a series of helpful, practical, and useful tips and tricks to alleviate elbow pain and keep you from losing training time. These 12 tips are in no particular order of importance;
Change Squat Grip. Squats probably cause as many issues as any other exercises as it relates to the elbow. Particularly low bar squats. The issue is often that in the low bar carry, the weight of the barbell tends to work itself down into your hands, rather than solely across your back. Now your elbows are under a huge amout of pressure trying to carry a heavy load (or a big portion of it) while also in a compressed, acute angle. Done repeatedly and they don’t like it. As a preventative, make sure that your Low-Bar Squat is not TOO LOW. Too low and you are forced to carry some of the bar weight in your hands. Make sure as close to 100% of the bar weight is supported and absorbed across the back. This is why many of us teach a low bar squat with a thumbless grip……if you have the flexibility to do so, the thumbless grip goes a long way in preventing you from carrying the bar too low and holding too much weight in your hands.
If you have been making this mistake for a while, and the elbow inflammation has set in…then don’t expect a change to the “correct” grip to fix things all of a sudden. You may have to ditch the low bar squat for a period of time and let the elbows calm down. A High Bar Squat is a simple solution but even better might be the switch to a Safety Squat Bar where the elbows can more or less be completely relaxed during the movement. A Rackable 14″ Cambered Bar is also a good alternative.
If you are an intermediate or advanced trainee there really is no reason that you need to low-bar squat multiple times per week. High Low Bar Squat frequency is a problem for many athletes, especially as we get older and stronger. Don’t get married to the idea that you must continue to low-bar squat 2-3 times per week in perpetuity just because you did so as a novice.
For most people, squatting 2x/week is sufficient on any good strength or hypertrophy programs. Use low-bars 1x/weeks as your main squat stimulus and then use another variation later in the week – Safety Squat Bar, Cambered Squat Bar, High Bar Squats, or even Front Squats. This will give you plenty of squat frequency without beating up your elbow and shoulder joints over time.
Change Workout Split. Many lifters find that their elbow pain “shows up” when they Bench Press, but that the Bench isn’t the real causative factor – it’s the Squat. But the way in which their split is arranged they are either Benching immediately after Squatting (commonly done with fully body splits) or they are Benching the day after squatting. Try and figure out a way to adjust your schedule so this isn’t happening. The best way to do things is usually just to train upper body on Monday and Thursday and train lower body on Tuesday and Friday rather than the other way around. This always gives the elbows and shoulders a chance to heal up after squatting, before you put them to work again on the Bench. If you are going to stay with full body workouts, there is no law that says you must squat first in the session. No reason you cannot bench or press first, then squat, then do your pulling movements.
Wear Straps. If you are doing a lot of pulling movements involving loads of grip strength (deadlifts, cleans, farmers walks, etc) and/or dynamic elbow flexion/extension (pull ups, chin ups, rows, curls) that can take a toll on the forearms and their attachment points. You aren’t a super hero for avoiding straps on every exercises. Leave them off on your main deadlift movement to make sure your grip is keeping pace with your pulling strength, but there is no reason not to throw them on for things like Pull ups, shrugs, and rows. The straps will lessen the tension across the forearms and allow you mitigate some of that inflammation that keeps popping up.
Ditch Repeatedly Harmful Exercises. If you are a Power Lifter, then you have to Squat, Bench, and Deadlift. There are literally no other lifts that you HAVE to do. If you are a non-competitor just training for general strength, then there are ZERO exercises that you have to do. None. If something keeps giving you grief, especially if it’s impacting other lifts, then ditch it. No one will know, and no one will care. I promise. I’m not saying to drop an important movement the first time you have a flare up. But many of you guys have been battling the same exercises over and over and over again for years and you’ve made very little progress. It’s just been a series of recurring battles against inflammation. Stop doing this. Your wasting time and making yourself hate the process. There is no law that says you must low bar squat. You can high bar. You can use a Safety Squat Bar. There is no law that says you must do Lying Tricep Extensions to get big strong triceps. You can do them overhead. You can use dumbbells. You can use cables.
Warm Up Better. A very very thorough warm up will likely be necessarily if you are doing a direct Arm Day, but even if it’s a more generic upper body workout or even if it’s a lower body workout……you might consider doing a quick but extremely thorough warm up for the elbows. For the biceps, forearms, and triceps. Don’t overthink this. The idea is to push a ton of blood into the elbow area, get a good pump, but avoid unnecessary fatigue. My advice is to use cables and/or bands for the warm up work. My favorite protocol usually is something like this:
Tricep Rope Pressdowns x 50
Bicep Curls with Bands x 50
I do this before every upper body workout and also before some lower body workouts if I intend to start with squats and if my elbows are flaring up on me. If they’re not, then I’ll skip them before lower body workout, but they get done before upper body sessions regardless.
Then once I get through the direct bicep/tricep warm up, then I do a bunch of reps with whatever my first exercise is going to be for that day. If I’m Bench Pressing, Pressing, or Inclining then I’ll do around 50 total reps with the empty bar. Again, I don’t exhaust myself, but I just do a ton of reps so the entire elbow area (and shoulder) is full of blood and totally warm. If I’m starting with Pull Ups then I always warm up with perhaps 2 x 20 on the Pulldown machine first.
You get the idea. Spend more time and do more reps during the warm up.
Pre-Exhaust. (see previous articles on Pre-Exhaust Technique for more in-depth explanation). This is almost like an extension of the idea from above, pre-exhaust can almost be thought of as a “super warm up”. But this has become a very important part of my hypertrophy specific training routine as I’ve gotten older. This strategy may or may not be useful to you based on your overall training split and your goals. Pre-exhaust can be really useful when training on a “bro-split” where you have multiple days per week committed to the upper body. Where the volume and frequency start to stack up, you need to find ways to bring overall intensity down. Pre-exhaustion helps fulfil that role. As it relates to the Elbows, I use pre-exhaustion techniques mainly on my tricep training day. For compound movements I really like weighted dips and I really like close grip presses and close grip floor presses. So I usually pick one of those exercises on my arm day and I train it second……the first movement is always a cable tricep pressdown done for higher reps and pushed to failure or beyond. This greatly reduces the loads I can use on the heavy compound lift. I still get the benefit of the movement but the reduced load keeps the pressure on the muscles rather than the joints.
Cables & Bands. This applies to both biceps and triceps training. Something about the continuous tension provided by the cables and bands that the joints really like. I definitely like them for the initial warm up sets, but I’d say at least 50% (or more) of my direct bicep and/or tricep training is done with cables or bands. It’s great as a warm up, as a pre-exhaustion movement, or as the primary exercise that day. If you’re currently eating your elbows up doing a ton of barbell curls and skull crushers, try working in more cable curls and cable pressdowns. You won’t lose any size (you may actually gain some) and your elbows will thank you!!!
Reduce Frequency. Frequency reduction could mean a lot of things. In this context it mainly means reducing the frequency of the source of the inflammation. So if squats are the main culprit, and you’re squatting 3 days per week, switch to 1 or 2. If it’s tricep related (ie. pressing movements, and extensions) then limit your pressing to 2x/week and limit your isolation/extension type work to just 1x/week. That might mean Bench Pressing on Monday and Overhead Pressing + Triceps on Thursday. In the past, I’ve recommended some lifters train their Back up to 4 days per week. The Back can handle it but sometimes the elbows cannot. Consolidate your back volume into a single session and give more time to rest. The idea that “as long as volume is equated, then frequency doesn’t matter” is wrong. You might be able to handle the same amount of volume, but recovery might mean consolidating more of that work into less sessions with more days off in between.
More Exercise Variety, More Often. Overall, I think that lack of variety in a program is more of a cause of overuse and injury than are load or volume prescriptions. The common denominator amongst guys who seems to be “always” battling this kind of thing is not the volume they operate of, or their average % of 1RM……its the fact that their exercises selection is too narrow. 4-5 exercises only is fine for a novice, but a few years in and you’re going to need to diversify the source of the stress a little more. This is especially true with elbows. If you train triceps 1x/week I would rotate different movements in there as often as every session. At a minimum every 3-4 weeks I’d be rotating new exercises in and out. And I would suggest to NEVER do the same tricep extension movement 2 times within the same week. You can do extensions lying, standing, seated, at an incline or decline. You can use straight bars, ez curl bars, neutral grip bars, dumbbells, kettlebells, bands, cables, or use a machine. Take advantage of the variety. You don’t need 20 different variants but no reason you can’t rotate through 8-12 of them. Same with biceps. Use variety and use it often. Your elbows will thank you.
Strengthen The Muscles. If you’re a guy who tends to avoid isolation work in favor of only compound movements, I’m fine with that in principle. However if you keep battling issues with the elbows, give some consideration to strengthening the muscles around the elbow joint more directly with some isolation work. You don’t have to get carried away with it…..start with once per week for each. 3 to 5 sets of 10-20 reps for triceps and 3 to 5 sets of 8-12 reps for biceps. Put it into your current routine where ever it makes sense for recovery. You can do the bicep/tricep work together or on different days. It doesn’t matter. If you have access, my recommendation is cable pressdowns for the triceps and cable curls for the biceps. Again – that continuous tension does some magical healing stuff.
Auto-Regulate and Be Flexible. Many of you guys make your injuries worse with stubbornness and rigidity, even in places where it doesn’t make sense. You wrote down “Lying Tricep Extension” in your log book but that first set is killing your elbows. Instead of moving on to a different movement……you just knock out another 2 sets and make them even worse. Why? Be smart. Call an audible. Move to a different exercise. Cut the load down and aim for sets of 15-20 rather than 8-10. Do something, but don’t be pig headed and just keep making the problem worse. There are too many potential “fixes” to keep doing something that obviously isn’t working.
Use Ibuprofen. No I don’t want you to live on this stuff. But there are a whole lot of you who have checked yourselves into weeks and months of absolutely useless physical therapy when 2-3 days worth of Ibuprofen would have done the trick. Seriously. The pills aren’t going to eat a giant gaping hole through your stomach. I promise. If your elbows get really inflamed, try 2400mg per day for 3-4 days and watch what happens. Taking 1 or 2 pills here or there isn’t gonna do the trick. You need to hit it hard with a high dose for a few days. Works almost every time. If it doesn’t work, then we go to plan B. And if you find yourself needing to do the Ibuprofen Regimen all the time…..then you need to adjust your training program. Ibuprofen is a wonder-drug but again, it’s not meant to just stay in your system 24/7. While you are doing the 3-4 day Ibuprofen regimen – stop doing the things that are hurting your elbows. Let them rest a few days while you hit them with the NSAIDs.
