How to avoid and eliminate elbow pain for good

Disclaimer: I’m not a clinician, nor do I play to be one.  My advice is for educational and informational purposes only; and is not intended to be a substitute for a physician’s advice or diagnose an issue. This information, as effective as it had been for me, and as it might be to you, is based on my own scientific research and experience. Please consult your physician about the suitability of any opinions or recommendations as they relate to your own symptoms or medical conditions.

In this article I will lay out for you useful and practical information about how to prevent and eliminate medial and lateral elbow pain. Being a hardcore lifter all my life, I had suffered a number of times both injuries back in the days when I first started training. I learned the hard way and with my own research how to end and avoid, for good, both medial and lateral epicondylitis and epicondylosis while getting massive and stronger.  

Here is a video of me doing pull ups with  a 28 kg kettlebell (61.6 lbs) plus a 5 lb dumbbell = 66.6 lbs at body weight of 115 lbs with pain free elbows:

Anti-inflammatory drugs, bracing the elbow, local cortisone injections, supportive straps, and even orthopedic surgical repair will take care of the symptom but not the root of the symptom. None of these approaches are substitutes for rehab exercises and the corrective strategies to get rid off of the true cause of the pain which is nothing but muscular imbalances due to training errors such as high volume, high intensity  training, and dysfunctions throughout the body.

In any kind of an acute inflammatory response, such as epicondylitis, your first goal is to work on reducing the inflammation. So the best thing to do is to ice the affected area right away for ten minutes twice a day and lay off for a while from any activity that might cause the pain. Once inflammation had subsided considerably, you need to start incorporating some joint mobility drills to wig out the tension and stretching exercises to re-establish balance between the hand extensors and the hand flexors.  

If the issue is epicondylosis, which refers to the chronic inflammation and degeneration of these tissues, in addition to icing and resting the elbow, you need to emphasize strengthening exercises with full mobility drills: and  increase blood flow to the area with manual therapy as well as the corrective strategies necessary to re-establish proper movement patterns throughout the body.  Keep in mind that in order to know what corrective strategies to practice based on your body dysfunctions, you need to hire a qualified physical therapist or a certified FMS instructor. 

 Tennis Elbow or Lateral Epicondylitis/Epicondylosis:

Tennis elbow is the colloquial name for lateral epicondylitis (LE) which refers to an acute inflammation of the periosteum (connective tissue covering the bone) as well as the tendons and muscles of the forearm that originates from the lateral epicondyle right outside of the elbow.

Lateral epicondylosis refers to the chronic inflammation and degeneration of these tissues. It is the breakdown of these tissues, which causes the pain and weakness at the elbow.  Causes are excessive repetitive strain from the wrist extensors, forcing the wrist extensors to suddenly perform a task they are not prepared to perform, and over training. Another cause might be deeper movement dysfunctions related with lack of proper movement elsewhere in the body. For instance, the repetitive tennis stroke coming from a player with a lack of hip mobility who compensats by extending the wrist and forcing the forearm musculature to work too hard to drive power into the ball. This compensation besides making the stroke less powerful and accurate is also creating the so called tennis elbow or lateral epicodilitis/epicondilosis.

Therapy solutions for lateral epicondylosis:

1) Start your therapeutic approach with soft tissue mobilization or self myofascia release. You may use your hands and/or a lacrosse ball or TP ball on the affected area for about five minutes. It is also a very good idea to apply some arnica oil while massaging the affected area.

 2) After you are done with your soft tissue mobilization, perform a few joint mobility drills for the elbow, hands, and shoulders for about five minutes.  Pavel has a great DVD of joint mobility drills for the entire body (not just the hands and elbows), which I highly recommend here

3) Do eccentrics of wrist extension to strengthen the tendons of the forearm with a homemade 18” uneven dumbbell handle. Eccentric means lengthening of the muscle in response to external resistance.

At your local sports store get a 1lb plate weight and a pair of spring collars to hold the plate in place. Additionally, get an 18“stick at your local hardware store that can fit perfectly into your 1lb plate. Load one end of the handle with the weight placed towards the far end. 

Grip the handle holding the weight at one end with your forearm on top of your thigh and the handle pointing straight up. Turn the handle lowering the weight slowly until your palm is facing downwards, and then bring it back up to vertical with your other hand. Continue for the prescribed amount of reps.

Perform with one pound (or more depending on your injury and level of strength) 2-3 sets of 10 to 15 reps two to three times a day.

If you find the 18” handle too painful or challenging to control, simply slide your hand closer to the weight. As you get stronger slide the hand further away from the weight and decrease the amount of reps.

4) After you are done with your therapeutic strengthening exercises, ice the affected area for 10 minutes to reduce and/or prevent inflammation.

Once your wrist extensors are healed with these therapeutic approaches, add this killer exercise to your arsenal to continue to strengthen your wrist and forearm muscles and to reduce the risk of further injury:

Kettlebell Bottom Up Cleans: This is a fantastic exercise that requires balance and patience. It strengthens the wrist stabilizers and develops forearm muscular endurance; which increases the necessary forearm strength for combat applications, rock climbing, and tennis performance.

Place the kettlebell between your feet. Hook the handle with your fingers and clean it to shoulder height. Hold the bell for about 10 seconds. Perform 3 to 5 sets.

Golfer’s Elbow or Medial Epicondylitis/Epicondylosys :

Golfers elbow is the colloquial name for medial epicondilitis (ME) which refers to an acute inflammation of the medial humeral periosteum (connective tissue covering the bone) as well as the tendons and muscles of the forearm that originates from the medial epicondyle right inside of the elbow at the origin of the flexor tendons of the forearm. Lateral epicondylosis refers to the chronic inflammation and degeneration of these tissues.

Causes are excessive repetitive strain from the wrist flexors as well as muscular imbalances without exercising the opposite muscle groups in the forearm.  Also carrying heavy suitcases or heavy groceries bags with weak shoulders and weak wrist muscles may lead to ME.

Sports activities that involve a lot of gripping and excessive pulling such as bodybuilding, grappling, rock climbing, heavy odd object lifting, bar and nail bending must counterbalance the demands placed on the wrist flexors by strengthening the wrist extensors and lengthening the wrist flexors.

Another culprit of ME might be deeper movement dysfunctions related with lack of proper movement elsewhere in the body. For instance, a rock climber with ME might be gripping way too much instead of allowing the back, shoulders and chest to help to do the work due to lack of proper structure, function, and motion in the shoulder girdle.

Therapy solutions for medial epicondylosis:

1) Start your therapeutic approach with soft tissue mobilization. You may use your hands and/or a lacrosse ball or TP ball on the affected area for about five minutes. It is also a very good idea to apply some arnica oil while massaging the affected area.

2)  Perform joint mobility drills for the hands and elbows to wig out the tension and to lengthen the flexors for about five minutes or so.

 3) Eccentrics of wrist flexion to strengthen the tendons with the home made uneven dumbbell handle.

Grip the handle holding the weight at one end with your forearm on top of your thigh and the handle pointing straight up. Turn the handle lowering the weight slowly until your palm is facing upwards and then bring it back up to vertical with your other hand. Repeat.

Perform 2-3 sets of 10 to 15 reps.

If you find the 18” handle too painful or challenging to control simply slide your hand closer to the weight. As you get stronger, slide the hand further away from the weight and decrease the amount of reps.

4) Wrist extensions with a rubber band: Expand  the wrist bands from Ironmind.com are by far my favorite bands on the market. They come in a pair of five progressive resistances and the quality is good. You may also use the rubber bands that come with the broccoli, carrots, or asparagus at your local market but the resistance might not be ideal for your therapeutic and strengthening approach.

If you decide to go with the Ironmind bands, start with the white band which is the lightest one. Place the band around your finger nails and extend the fingers opening the band. Perform 2-3 sets of 20 reps. Progress slowly on to higher reps. As your wrist extensors get stronger, move on to the next heavier band and begin with lower reps.

How to prevent elbow pain for good:

Now that I covered effective therapeutic strategies to cure your elbow pain, I will share with you some invaluable tips to prevent both medial and lateral epicondylitis/epicondylosis for life.

1) It is imperative to ALWAYS maintain antagonist balance between the hand extensors and the hand flexors in full mobility strength. Period. Therefore, always do some form of mobility strength work and joint mobility work before and after your pulls and presses exercises. Here is a video of me performing a few mobility drills to develop full mobility strength before and/or after grip and pulling work.

2)Train smart when lifting weights and avoid over training. Varying the volume and the load from workout to workout, besides ensuring steady strength gains, will also tremendously reduce the risk of injuries. For instance, some days you may go with a high load/low volume; other days low volume/low intensity for active recovery; other days medium load/medium intensity; and sometimes you may go balls on walls with a high volume/high intensity approach.

3) When doing pulls and presses together, it is a good idea to go from an exercise that requires a gripping position (or flexion of the hands) to an exercise that requires a position of extension of the hands, to counterbalance the grip work. For instance, if you are super setting or alternating pull ups with presses, chose an exercise that requires an open hand position after your pulls. In this case either pike presses or head stand push-ups (depending on your level of pressing strength) requires an open hand (wrist extension). You may also alternate pull ups with dive bombers push-ups or one-arm dumbbell rows with two hands or one-arm push ups. This approach is a great way to counter balance wrist flexion with wrist extension while strengthening the pulling and pressing muscles.

4)Strengthen your grip, wrist and forearm muscles, once to twice a week. Grip work when done in moderation and with variation will not only prevent pain at the elbows, but it will also bring phenomenal strength gains to your whole body and enhance the link between the brain and the entire kinetic chain. Choose two exercises to strengthen your grip and forearms at the end of your work out. Perform two sets and vary the reps.

5)Lastly, make sure to do some tissue mobilization work with your hands, a foam roller, a lacrosse ball or T.P. ball either on your active recovery days or before and after your training.

How to prevent Lateral Epicondilitis (LE):

1) Avoid ‘skull crush presses’. This exercise puts a lot of unnecessary stress in the olecranon process (process of the ulna that forms the outer bump of the elbow). Compound exercises such as dips on parallel bars or gymnastic rings, close grip bench presses, Hindu push-ups, and kettlebell crush floor presses are much better to strengthen all the pressing muscles with a lower risk of injuries to the elbow.

2) Avoid high volume of isolated triceps work.

3)  Keep your wrist straight when doing presses while gripping a bar, a kettlebell, or a handle.

4)  Vary your pressing exercises.

5)   Vary your grips.

6)    Always do some joint mobility work before and after your training.

How to avoid Medial Epicondilitis (ME):

1) Avoid lifting straps when doing heavy pull ups and deadlifts. Lifting straps create muscular imbalances making the forearm and the wrist weak. Don’t be stupid (like many gym members). Strengthen the grip and forearms at the same time that you are strengthening the pulling muscles.

2) Avoid doing pull ups on a straight bar or perform them sporadically. Straight bars offer a mechanical disadvantage to the elbow and recruit less pulling muscles. Gymnastic rings are awesome for pull ups and chin ups; besides recruiting more pulling muscles and stabilizer muscles alike, they are a lot kinder to the elbows.

3) Vary your grip position when doing your pulls. Perform reverse grip pulls, close grip pulls, parallel grip chins, and thumb less underhand grip pulls. If you train at home and only have a straight pull bar, you may want to make your own inexpensive pair of handles with a chain and a PVC pipe. Hang them from your pull up bar and perform your parallel grip chins and/or close grip pulls with your cool handles.

4)  Avoid barbell curls on a straight bar. Again, pulling work on straight bars is bad news for the elbows. Dumbbells are the best choice. The second choice would be the EZ bars.

5) Vary your pulling exercises

6) Avoid high volume of isolated  bicep curl work

7) Always do your joint mobility work after you are done with your pulls and grip work

You will find immediate relief for your elbow pain using these therapeutic approaches. Once your elbows are completely healed, train smart and apply all the tips I am sharing with you -at not charge- to avoid elbow issues from happening again. I give you my word that you too will grow strong with pain free elbows like me and with full mobility strength.

Applied knowledge is power!

~Marty Covault~