In the first half of this post, we talked about five ways to avoid or minimize elbow pain in a strength training program. Wrist straps, thick bars, forearm exercises, gymnast rings and good pressing technique can all help with elbow discomfort.

Here are five more ways to help ailing ‘bows.

6. Pump Up the Triceps

I’ve never been a huge fan of triceps extension exercises like skull crushers, JM presses or anything where you lay down and extend the weight back toward your face. My two reasons for this: I think heavy pressing (like close grip bench presses, board presses or floor presses) is a superior way to build up the triceps, and it’s hard to do extensions with appreciable weight without irritating the elbows.

But we can’t just press all the time. Doing some extension work is really beneficial for elbow health and hits the triceps from a different angle, creating symmetry between the three heads. Unfortunately, I’ve heard more complaints from my athletes about elbow pain while doing lying triceps extensions (either with dumbbells or EZ bars) than any other exercise. The solution? Pump up the guns with standing pushdowns, either with a band or cables.

A really effective approach to developing impressive triceps while circumventing elbow pain is to hit ’em hard and heavy with a pressing movement like a close grip bench and follow up with some high-rep pump work with bands. So an upper body day with a focus on triceps could look something like this:

1A. Close Grip Bench Press 5×5

1B. 1-Arm Dumbbell Rows 5×8/side

2A. Dumbbell Hammer Curls 3×10/side

2B. Triceps Pushdowns with Light Band 3×20-30

This way you build strength and size with a heavy press, then get the restorative effects of a gigantic pump at the end with no elbow irritation. I remember Mike Guadango of DeFranco’s gym and freakstrength.com saying he’d do upwards of 100 band pushdowns to get a huge pump each upper body session and it worked well for elbow health AND size gains. It’s also common to hear powerlifters do daily high-rep band pushdowns to help bring up their bench press.

Pushdowns also have a bit of a different strength curve than extensions. An exercise like a skull crusher is most difficult at the bottom when the triceps are at full stretch, and then deload a bit at the top when the tri’s are full flexed. On the other hand, band pushdowns overload as the band stretches, with peak tension when the tri’s are flexed hard.

7. Improve shoulder mobility

This may be a surprise to some people because it sounds like it’s got nothing to do with the elbow. But what’s happening at the shoulder is inevitably going to affect the elbow and vice versa. Mike Boyle’s “Joint-by-Joint Approach to Training” is really insightful and was one of the first articles that introduced me to the notion that the sight of pain or dysfunction was not always the cause.

This was especially true with my elbow pain during squats. Like I said in the first part of this series, I spent a good 12 weeks ignoring the persistent pain in my right medial epicondyle (inside of the elbow). This was hard to do considering my right arm would be locked into flexion after every set and needed a good 30 seconds to mellow out before I could fully extend my arm again. But after a lot of reading and a lot of talking to other coaches, I concluded that the elbow was not the main culprit of my pain.

I took a proactive approach in improving my shoulder mobility using drills like forearm wall slides, back-to-wall shoulder flexion and all kinds of thoracic spine mobility exercises. I started doing more static stretching like doorway pec stretches. I upped the volume and intensity of my horizontal rowing to strengthen my upper back and improve my posture. And I strengthened and mobilized my forearm muscles to improve movement quality at the other end (see the joint-by-joint approach coming in handy?)

All this allowed me to resume squatting pain free, narrow my grip in on the bar without beating up my elbows AND keep my elbows under the bar, which helped improve upper back tightness while squatting.

8. More Neutral Grip Pushing and Pulling

This goes along with point number four of tucking the elbows, as it helps maintain alignment in all the joints involved in upper body exercises. At Xceleration, the majority of our athletes are baseball or lacrosse players who are notorious for having upper body issues, whether it’s just anterior instability of the shoulder or something as serious as a UCL sprain.

For safety’s sake, we have these athletes do almost 100 percent of their pressing and about 75 percent of their pulling (rows, pulldowns and pullups) with a neutral grip. This helps keep the elbows happy by making it easier to keep the upper arms close to the torso, AND keeps the shoulders happy on pullups by forcing a narrower grip and reducing the chance of shoulder subluxation (dislocation of the “ball” of the ball-and-socket joint of the shoulder).

Neutral grip presses and pulls can be easily done with dumbbells, but if you’re looking to be a badass and load up the weight, a neutral grip bar like the EliteFTS Multigrip Swiss Bar or the Log Press is the way to go. There are few exercises more manly than the log clean and press, which is why it’s a staple in strongman competitions.

On the other side of things, using neutral grip presses and pulls can be conveniently self-limiting if you’re banged up. Barbell bench press hurts your shoulders/elbows? Don’t have access to fancy equipment like a multi-grip bar? Then your options are limited to neutral grip presses and pushup variations (assuming you can do them pain free), which are hard to load too heavy and can keep you from doing something stupid like heavy benching when you’re not ready/healthy.

9. Focus on Eccentric Elbow Flexion

This is just a fancy way of saying emphasize the negative portion of curls. For a long time I thought curls were stupid (mistake #1), and for an even longer time I thought tempo training was stupid (mistake #2). The guys at XST opened my eyes to the importance of both. So if you want to have small, puny arms and cranky elbows forever, ignore this point.

Charles Poliquin is a big advocate of overloading the eccentric portion of flexion exercises like bicep curls and hamstring curls, which seemed silly to me at first. But turns out they’re particularly effective at building up tendon strength. We prescribe light dumbbell curls with a slow eccentric to athletes recovering from biceps tendonitis and it works like a charm. Plus we’re all significantly stronger during the negative phase (up to 150 percent on certain exercises), so you can really load up the weight to enhance overall muscle and tendon development.

Using exercises like dumbbell Zottman curls with a 4-2-1 tempo (one second to curl the weight, a two second squeeze at the top, and four seconds to lower the weight) helped ease my elbow woes. They’re also a great way to add intensity to biceps curls without having to add weight. Progressive overload is tough to do for the arms. Otherwise we’d all be curling 100’s and sporting 25-inch pythons after a few years of training. So to make an exercise tougher and increase the training effect without adding weight, simply lengthen the tempo of the negative phase.

P.S. It was REALLY hard to find a YouTube video of someone doing Zottman curls WITH a shirt on.

10. Soft Tissue Work

We all know the importance of foam rolling and how awesome it feels to hit the roller for 10 minutes before a training session. But what about the areas that we can’t get to with a foam roll, like our elbows?

This is where manual therapy comes in. At XST we’re lucky to have coaches with athletic training background plus two in-house chiropractors, so we can use soft tissue manipulation on our athletes. This is huge for an area like the elbow, which is like a clogged rush hour highway of muscles, tendons and ligaments. A lot can go wrong when you have that much going on in such a small area, and it’s easy to get some nasty adhesions that can limit function and cause pain. Throw the forearm into the mix and you can have some serious scar tissue buildup.

Forms of massage like Active Release Technique (ART) or Graston Technique (a release technique involving aggressive massage with some nasty looking stainless steel tools) can do wonders for breaking up the junk that accumulates around the elbows. The first time I had ART done on my elbows I was blown away by how much crap I had built up
around them. I was also blown away by how I cried like a little baby the whole time. That stuff HURTS! But better to endure 15 minutes of agony than 15 years of aches and pains.

I’d love to get Graston done sometime, but videos like this make me a little scared.

If you don’t know a qualified manual therapist, don’t have the cash to shell out for a Graston treatment, or you’re just a big weeny who’s too scared of the pain (like me), there’s still hope.

Keith Scott of Impact Training and Fitness in New Jersey showed us some really cool soft tissue techniques at Jason Ferruggia’s Renegade Seminar. All you need is a tennis ball or lacrosse ball and you’re good to go. Start with low level stuff like using your hand to roll the ball around your elbows and forearms, applying enough pressure to break up the adhesions. This is great if you’re new to myofascial release because you have a ton of control over the pressure and can back off when it hurts too much. When you’re more comfortable, put the ball up against a wall and roll it over your elbows, triceps and even your pecs, shoulders and traps.

If you’re looking for something a little more intense, the MuscleTrac handheld roller is an awesome tool. My roommate has one and it’s incredible for digging up the elbows and forearms. It’s only slightly less conspicuous than a Shake Weight, but way more useful. People might look at you funny if they see it in your gym bag, but you’re the one with great tissue quality, not them.

Conclusion

Elbow pain or discomfort – no matter how mild – is no laughing matter. If you’re hurt, go see a qualified professional. Physical therapists, athletic trainers and orthopedists are qualified to diagnosis and treat this kind of stuff. I am not. I do have a PhD in tang like Leon Phelps, but I can’t treat your bum elbow.

However, these 10 tips can definitely help you work around elbow discomfort and ward off injuries if you’re already healthy. Try ’em out and let me know how they work.

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