Weight training makes you stronger and more resistant to injury, but it’s also not uncommon to develop pain and soreness in the body parts you work, especially if you over-train or use sloppy weight training form. For example, you could end up with shoulder pain, back pain, knee pain – but also pain in the elbows if you train improperly or too often. Needless to say, sore elbows are an annoyance when you’re trying to do exercises like bench press, biceps curls, or triceps dips. Elbow pain is not uncommon among people who weight train – but why does elbow soreness happen?
Anatomy of the Elbow
Overuse injuries of the elbow are frequent, especially among athletes that throw or play racquet sports. However, pro and novice weight trainers alike can end up with sore elbows. The elbow is a simple hinge joint. It’s composed of the space where the humerus in the upper arm connects with the radius and ulna in the forearm. Surrounding this region is a joint capsule made up of cartilage and synovial fluid that bathes the elbow joint and reduces friction. That’s important since you use your elbows a lot. Think about how many times you flex and extend your arm over the course of a day. The elbow joint also aids in pronation and supination of the forearm and wrist at the elbow, allowing you to turn your hand outward (supination) and inward (pronation).
Connecting bone to bone within the elbow joint are ligaments that help to keep it stable both at rest and when you flex and extend your arms. You also have tough, fibrous connective tissue called tendons in the elbow that attach muscle to bone and help move the arm. It’s the ligaments and tendons of the elbow that are most susceptible to injury. Of course, you can break your elbow or dislocate it but this usually happens after an acute injury, not from overuse. Most elbow pain that happens due to weight training is gradual in onset and due to overuse or using poor form when lifting.
Causes of Elbow Pain Due to Weight Training
Although you should always get persistent elbow pain evaluated, the most common reason for sore elbows is an injury to the tendons that connect muscle to bone in your elbow. If you take your hands and squeeze both sides of your elbow, you’ll feel two firm bumps, one on the inside of your elbow and one on the outside. The one on the inside is called the medial epicondyle while the one on the outside is the lateral epicondyle. The tendons that flex your arm (flexor tendons) attach to the medial epicondyle. As you might expect, the tendons that extend the arm (extensor tendons) join to the lateral epicondyle.
Elbow pain related to weight training is usually due to injury to either the extensor or flexor tendons in the elbow. The former is called tennis elbow and the latter golfer’s elbow. How do you know which it is? If you feel discomfort when doing exercises where you flex your arms, for example, biceps curls, it’s likely the flexor tendons are injured. In contrast, if your elbows feel sore when you do triceps extensions, the extensor tendons are more likely involved. Although injury to the extensor tendons, lateral epicondylitis, is called tennis elbow, only about 5% of cases are actually due to playing tennis.
What Causes Elbow Pain Related to Weight Training?
You’ve probably heard that the underlying cause of lateral and medial epicondylitis is inflammation related to overuse. In reality, both are a type of tendinosis, a degeneration of the tendons rather than an acute inflammatory process. In some cases, the tendons actually have microscopic tears. Nevertheless, both forms of epicondylitis are usually brought on by overuse.
Exercises that place lots of stress on the elbows and commonly trigger elbow pain are pull-ups and chin-ups, exercises that not everyone does. However, overdoing the biceps training can do it too. Performing biceps curls using a straight bar places more stress on the elbows than the EZ bar does. Therefore, using the EZ bar, if you use barbells, is one way to lower your risk of epicondylitis. In addition, using a barbell restricts the movement of your biceps to one path. You have more freedom to change the path when you curl with dumbbells. So, dumbbells or an EZ bar are a better choice if you’re prone towards elbow tendinosis. In fact, it’s best to alternate between dumbbells, the EZ bar, and resistance bands when you do curls so you’re not doing the same repetitive movements over and over.
Overdoing biceps training, in general, can irritate the tendons surrounding your elbows. Remember, you’re working your biceps when you do other compound exercises, like rows. So, you don’t need to focus too much on biceps training to build muscle and strength, as long as you’re doing other compound exercises. It’s also a good idea to vary the weight and reps you do. Do high resistance, low rep sets some days and high reps, low resistance other days.
Biceps curls aren’t the only exercise that can irritate the tendons in your elbow, especially if you overdo them or do them with poor form. Triceps extensions and shoulder flies can too. The take-home message? Don’t overemphasize the upper body isolation movements as they place more stress on the tendons in the elbow as well as the joint itself. Doing upper body isolation exercises in moderation is one thing you can do to lower the risk of elbow soreness related to weight training.
What if You Already Have Elbow Pain?
Medial and lateral epicondylitis aren’t the only causes of elbow pain related to weight training but they are the most common. If you have a sudden onset of elbow pain or persistent elbow pain that doesn’t respond to changing your training style, get your elbow evaluated. If it turns out to be epicondylitis, scaling back your upper body training or even taking a 7 to 10-day break may be best to reduce the stress on the tendons. Instead, do cross-training to maintain your fitness gains.
For conservative therapy, orthopedists usually recommend ice to the sore areas and stretching exercises. If persistent, they might recommend an injection of prednisone into the joint, physical therapy, or, less commonly, surgery. Fortunately, most elbow tendinosis subsides with rest. To avoid getting it again, modify your training a bit to take some of the stress off of the tendons.
References:
Medscape.com. “Lateral Epicondylitis”
J Pharmacopuncture. 2014 Dec; 17(4): 22–26.
ACE Fitness. “How to Train a Client with Chronic Injuries”
