Inner or Outer Elbow Pain From Weight Lifting (17 Ways To Fix It)

Whenever I write about injuries, I always like to remind everyone that I am not a doctor nor am I any kind of physical therapist, injury specialist or anything similar.

What I am is a regular person just like you who has been weight lifting since I was about 16 (I’m 31, you do the math) and has, at various points during those years, dealt with a handful of annoying injuries.

Early on it was exclusively issues with one or both of my shoulders. This is something I’ve written about before: 8 Ways To Avoid Common Shoulder Injuries

But then eventually, while my shoulders finally stayed perfect and awesome and wonderful, my elbows decided to become my new pain-in-the-ass body part.

The good news however is that it has currently been about 2 full years since I last had any elbow pain whatsoever. Hooray! Now it’s time to share what I’ve learned.

The (Assumed) Cause Of Your Elbow Pain

elbow-pain

There are a bunch of different injuries that are capable of causing elbow pain, and I’d be lying if I told you I knew tons about every single one of them. I don’t.

What I do know quite a bit about is the specific elbow injury I’ve personally dealt with and the identical (but in reverse) version of that same problem.

In my experience, these tend to be (by far) the two most common types of elbow injuries among people doing any form of weight lifting on a regular basis. They are:

  1. Medial Epicondylitis: Also known as Golfer’s Elbow, this injury affects the flexor tendons that attach at the medial epicondyle (which is the small bony bump on the inside of your elbow… see photo) and causes pain most often on the inner side of your elbow and/or forearm. So if that area tends to hurt most as a result of back and biceps exercises like curls and pull-ups/chin-ups/lat pull-downs… there’s a good chance this is your problem. It was my problem, too.
  2. Lateral Epicondylitis: Also known as Tennis Elbow, this injury affects the extensor tendons that attach at the lateral epicondyle (which is the small bony bump on the outside of your elbow… see photo) and causes pain most often on the outer side of your elbow and/or forearm. So if that area tends to hurt most as a result of chest and triceps exercises like various forms of triceps extensions and chest pressing exercises… there’s a good chance this is your problem.

Again, there are other elbow injuries out there that may cause similar symptoms and similar pain in a similar area. The only way to know for sure is to have your injury properly diagnosed in person by someone truly qualified to do so.

Having said that, these two appear to be the most common, which means they are the ones you are most likely to be dealing with right now or the ones you’ll be most likely to develop in the future and would be wise to try to prevent from this point on.

And as it turns out, they are the two I know the most about preventing. And fixing.

A super comprehensive article about fixing these injuries and explaining in detail exactly what they are (and aren’t), exactly what causes them, the important difference between tendonitis and tendonosis (note those last 4 letters… this difference is why 99% of the information you’ll find/receive about these injuries is completely wrong and useless), and exactly what I did to successfully fix it myself is all definitely on my to-do list.

Today however I want to focus more on preventing these injuries from ever happening in the first place, or just preventing them from becoming worse if you already have them.

Here now are 17 tips for doing just that…

1. Don’t Do Biceps Curls With A Straight Bar

As I mentioned a couple of weeks ago, if you asked me to make a list of the exercises most likely to eventually cause medial epicondylitis/golfer’s elbow (which again is pain on the inner side of the elbow), straight bar biceps curls would probably be #1 on my list (chin-ups would be a close second, more on those in a minute).

In what will become a very noticeable trend throughout this article, the straight bar just tends to suck for a lot of exercises for a lot of people. And this amount of “suck” is MUCH more pronounced when you’re grabbing that straight bar with an underhand grip.

You know, just like you’d grab it if you were doing biceps curls.

It’s just an unnatural position for your wrists and forearms to be in, and most people find that they feel just slightly uncomfortable whenever they do it. That slight discomfort IS the problem.

See, the thing about these two elbow injuries is that they’re less about what your elbows are doing, and more about what your fingers, hands, wrists and forearms are doing along with the tendons that run through them and attach at your elbows.

Which is why that slight misalignment of your wrists caused by the unnatural way the straight bar forces you to grip it will — under heavy repeated loading — be very capable of killing your elbows.

For this reason, I’d highly recommend avoiding straight bar curls. Completely.

Instead, the EZ curl bar will be a much better, safer and wrist/elbow friendly option (full details: EZ Curl Bar vs Straight Bar). And dumbbell curls (which will allow you to put each dumbbell into whatever position your body naturally prefers individually of the other) will be the best and safest option of all.

One other curling tip specifically for those currently dealing with medial epicondylitis: stick with only dumbbell hammer curls for a while. They’ll probably be the only type of curl you’ll be able to do completely pain-free at this point.

2. Avoid Chin-Ups and Underhand Grip Lat Pull-Downs

Take everything I just said about straight bar curls and replace the word “curls” with “chin-ups” or “underhand grip lat pull-downs.”

It’s virtually the exact same scenario (a straight bar being held with an underhand grip) causing the same issues (unnatural wrist/forearm position) with the exact same potential consequences (medial epicondylitis).

The only difference is that you’ll be lifting much more weight on these exercises than you would be with curls, and often doing so with higher intensity and lower rep ranges… all of which only increases the potential for elbow problems.

Instead, I’d highly recommend doing pull-ups (overhand grip), neutral grip pull-ups (palms facing each other) or using rings which will allow you to rotate your wrists naturally as you perform each rep. The same goes for lat pull-downs. Stick with an overhand or neutral grip instead of underhand.

Or, if you absolutely must use an underhand grip on these exercises for whatever reason, at least use some type of angled bar (sort of like an EZ curl bar) so that your wrists aren’t completely supinated.

3. Watch Out For Underhand Grip Rows, Too

Pretty much the same as above. While doing rows with an underhand grip on a straight bar doesn’t seem to be AS problematic for your elbows as vertical pulling movements with an underhand grip are, it can still definitely cause problems.

So, just like before, I’d recommend doing your rows with either an overhand or neutral grip instead. Or, if you’re going to be using an underhand grip, at least go with some kind of angled bar that is somewhere between underhand and neutral rather than completely underhand.

4. Avoid Skull Crushers (Or At Least Do Them Smarter)

Skull crushers are a popular triceps exercise that involves lying on a bench (typically flat, sometimes decline, sometimes incline) with the weight (typically a barbell) held in your hands directly over you similar to the top position of a bench press. It’s then lowered down right over your face/head (hence the name “skull crusher”) by bending at the elbow. You can see an example of it right here.

And skull crushers are popular for a reason… they can be a fantastic triceps exercise. I’ve personally always liked them.

But the bad news is that they have one major downside. They tend to be one of the most common causes of elbow pain on the lateral (outer) side of the elbows. Think of them as the triceps equivalent of the straight barbell biceps curl.

The easiest way to avoid the problems this exercise commonly causes is to simply avoid it completely. For some, this will be the best option. However, it’s not the only option.

You see, there are smarter ways to do skull crushers that will instantly take a significant amount of stress off of the elbows compared to how most people usually do them.

The first step is to NEVER use a straight bar for these. Ever. Not even once. If you must use a barbell, always go with the EZ curl bar. Just like with curls, it allows your wrists to be in a much more natural and comfortable position that will make this exercise a lot more elbow-friendly.

But the most elbow-friendly version of all doesn’t involve any type of barbell. Dumbbell skull crushers (with your palms facing each other) are the safest way to do them.

The second step is to adjust how you lower the bar/dumbbells. The further down on your face you lower the weight to, the more stress it will place on your elbows. So lowering to your chin is a terrible idea. Lowering to your nose is a terrible idea. Lowering to your forehead is a little better, but still not ideal in terms of elbow health.

Instead, the ideal way to lower the weight is by letting your elbows drift back slightly (rather than locking them in place pointing straight up and never letting them move at all) and lowering the weight towards the top of your head or (better yet) just a bit over the top of it.

I cover all of this in more detail here: How To Do Skull Crushers Without Hurting Your Elbows

And also note that some people will have similar problems with overhead triceps exercises as well. More about that here: A Guide To Triceps Exercises

5. Keep An Eye On Pull-Ups

Earlier I mentioned chin-ups being a common cause of elbow injuries on the medial side, and listed pull-ups with an overhand or neutral grip (or rings) as a safer replacement. And it definitely is. By a ton.

Here’s the thing, though. Done long enough and heavy enough, the potential for elbow issues is still there to some extent. Especially for those of us that are either using a lot of volume and/or frequency, or are just going fairly heavy with them (i.e. doing them with additional weight).

For this reason, I have a few recommendations:

  • Don’t do them TOO often. Unless you have some strange pull-up performance goal in mind, I’d recommend doing them just once or twice a week. In fact, since most of us should ideally be training our backs about twice per week, my preference is to do some type of heavier, slightly lower rep pull-up in one workout, and some type of lighter, slightly higher rep lat pull-down during the other workout. The Muscle Building Workout Routine is designed this way.
  • Don’t do TOO many. Similar to push-ups, pull-ups are an exercise I sometimes see people doing tons of volume with. Just set after set after set. Or a few sets as part of their pre workout warm-up. Another random set thrown in while resting between sets of some other exercise. Another couple of sets on other training days. Or doing these never-ending sets of the always entertaining Crossfit-approved “kipping” version which essentially turns pull-ups into what can best be described as cardio for idiots. I’m not sure what it is (the fact that it’s a body weight exercise perhaps?), but people seem to think the volume from it doesn’t count. Well, it does. Just as much if not more so than any other exercise. Especially when it comes to elbow health. For this reason, I’d suggest dropping the unnecessary volume and sticking with 3-4 sets of each pull-up/pull-down exercise you’re doing in a given session (not including warm-up sets). This is really all anyone will truly need or benefit from.
  • Don’t go TOO heavy. I’ve spent a decent amount of time doing weighted pull-ups in the 4-6 rep range (like 5×5 or 4×6), which in hindsight is something that probably wasn’t the greatest idea. I think there are exercises that are suited for lower rep ranges like this, and from an elbow (and shoulder) health standpoint, I wouldn’t consider pull-ups/chin-ups to be those kinds of exercises. Over the last few years, the 6-8 rep range became my official “lower rep range” for these movements, often staying closer to 8. And as for the slightly lighter/higher rep lat pull-downs being done in the other workout (assuming you use my recommendation from before)… the 8-10 or even 8-12 rep range would be perfect. Again, The Muscle Building Workout Routine is designed this way.

6. Keep Biceps And Triceps Exercises Lighter And Higher In Reps

You know how I just mentioned that certain exercises are better suited for being done heavy in lower rep ranges? Yeah… isolation exercises are not exercises I’d put in that group.

This would apply not only to biceps and triceps movements, but to virtually all isolation exercises for all body parts. Calf raises are the only exception that comes to mind.

But stuff like various biceps curls and triceps extensions on the other hand? Nope. The same goes for stuff like lateral raises, leg extensions and dumbbell flyes. These are not your 4-8 rep range movements. These are your 8-15 rep range movements. Maybe even 10-15.

That’s not to say you couldn’t do exercises like these for 4-8 reps. You certainly can. I just wouldn’t consider it an ideal use of these movements or that good of an idea in general. There’s a few reasons for this.

One is just the single-joint “isolated” nature of these exercises, most of which involve your joints, tendons and muscles being put under tension in compromising positions where TOO much tension can so easily be problematic from a safety standpoint.

Not to mention, from a technique standpoint as well. I mean, just try to go heavy enough on these types of exercises to warrant something like 5 reps and let me know how well your proper form remains intact.

Or better yet, look around your gym. You’re bound to see people trying and failing to do this on a daily basis.

Now specifically regarding elbow injuries… think of it like this. When you combine the compromising position isolation exercises put your muscles, joints and tendons in with exercises like barbell curls and skull crushers which already come with their own increased risk of injury, you end up with one hell of an unsafe scenario.

That’s why I’d recommend using your biceps and triceps isolation exercises more as “fatigue” movements rather than “progressive tension” movements.

This is when you want to focus on feeling the muscle working, fatiguing the hell out of it, squeezing hard, lowering slower and getting a good “pump” more so than just getting strong as hell and constantly upping the weight. Save that for the bigger, more important stuff.

I personally don’t go below 10 reps on any type of curl or triceps extension anymore and should have started doing this years ago. The 10-15 rep range is, in my opinion, the sweet spot for arm training. Not just for injury prevention, but for muscle growth as well.

Turns out the biceps and triceps respond quite well to this sort of training, especially when combined with the heavier lower rep work they indirectly get plenty of during all of your compound pressing and pulling exercises.

This combination = better looking arms and healthier elbows.

7. Drop The Excessive Amount Of Biceps/Triceps Work

And speaking of better looking arms… isn’t that something we all want? Probably. And isn’t training biceps and triceps something most people find to be pretty damn fun? Usually.

This combination is probably why it’s so common to see people doing a TON of direct arm work.

Unfortunately, most of that direct arm work is just excessive stress being placed on your elbows that isn’t needed or beneficial to your goal of building pretty looking arms. It’s actually much more likely to be counterproductive to that goal than it is to be useful for it.

The truth is, your biceps and triceps get plenty of indirect volume during all of the compound pressing and pulling exercises that make up the majority of your upper body training.

So much so that after that, very little direct biceps and triceps work will be needed to maximize growth. In fact, some people do just fine with no direct arm training whatsoever (no doubting that) and consider compound exercises to be all anyone needs (though I’d completely disagree with that).

But there is definitely a limit to how much is needed beyond the volume that comes from compound exercises. All biceps/triceps work beyond that amount is just extra stress on your elbows with nothing positive to show for it.

So assuming your overall training program is designed intelligently, the majority of the people reading this will need no more than 4-6 total sets of direct biceps training per week, and 4-6 total sets of direct triceps training per week.

Full details here: The Best Bicep And Tricep Workout Routine

8. Avoid The “Dead Hang” Position On Pull-Ups/Pull-Downs

I know, it doesn’t count as a complete pull-up rep unless your arms are fully extended and you’re starting from a complete dead hang. I always did my pull-ups like that, too.

And with lat pull-downs, if you don’t let that bar go all the way back up until your elbows are fully locked out, you’re not doing full reps either. I always did my lat pull-downs like that, too.

While doing these exercises this way will provide a slightly better stretch in your lats, and it’s great advice for the general population who tends to do pathetic looking half/quarter reps on every exercise including these, this “dead hang” position is the point in each rep where the most stress is being placed on your elbows.

Just like how the most elbow-unfriendly position of a supinated (underhand) barbell curl is at the very bottom when your elbows are fully extended. It’s basically the point when the tendons are being “pulled on” the hardest.

So what does this mean exactly? Well, as long as you don’t fit into that second category (pathetic half reps), you may benefit from stopping ever so slightly before reaching that dead hang/completely locked out position on pull-ups and lat pull-downs, especially if you’re currently dealing with inner elbow pain or have had similar issues in the past.

9. Avoid Thick Bars and Fat Gripz For Back/Biceps Exercises

Good way of improving grip/forearm strength and size? Sure.

Good way of placing a whole lot of additional stress on your grip, forearms and elbows? Yeah, that too.

So if your gym has different barbells that are thicker than others, or different bars for seated cable rows and lat pull-downs that are thicker than others, or various machine rows that have handles that are thicker than others, I’d recommend avoiding those in favor of the thinnest bars/handles you have available.

I’d especially recommend this one to anyone who is currently dealing with medial epicondylitis or has ever dealt with it in the past. There’s a bunch of equipment in my gym that I purposely avoid for this very reason.

10. Stop The Excessive Pressing

There are a few good reasons to stop the infinite amount of pressing exercises the average gym goer/dumbass does on a regular basis.

You know how the typical “chest day” workout goes: 3-5 sets of flat bench press, incline bench press, decline bench press, various dumbbell presses, machine presses and “fly” movements… plus 3 triceps exercises (dips, skull crushers, pushdowns). And don’t forget the 2-4 different types of shoulder presses that same person will be doing on “shoulder day.”

Fantastic!

But besides just being a TERRIBLE way to train (more here: Bodybuilding Workouts Suck), and besides being a damn near guaranteed way to destroy your shoulders… it also happens to be one of the most common reasons people eventually experience pain on the lateral/outer side of their elbows.

11. Training Breaks Are A REQUIREMENT

Even if your training is perfectly designed, and you’re using perfect form on everything, and you’re avoiding all of the exercises that tend to be most problematic, and you’re following all of the advice in this article… there is still one thing that can lead to injuries.

And that’s just the simple fact that your body can only take so much hard training.

I mean, you can’t expect to work your ass off lifting progressively heavier things 3-5 times per week, 52 weeks a year, year after year, without some part of your body (muscles, joints, tendons) giving in somewhere.

You just can’t constantly go at 100% without problems eventually developing.

Which is why in order to prevent injuries, prevent minor injuries from becoming major, stay healthy, stay motivated and actually make progress and get results, you need to occasionally back off a bit and let EVERYTHING get a chance to rest, recover and heal.

It doesn’t even need to be actual time off from training. It certainly can be, but there are other options. I’m of course talking about deloading, which is basically where you take an easy week or two where you continue training, but at a reduced level of intensity (perhaps lifting 80% of your usual weights) or volume (perhaps doing half as many sets as you normally do), or some combination of the two.

And please keep in mind that this isn’t something you should take as a suggestion. It’s not. This is a requirement. Full details here: How To Deload

12. Make Sure Your Hands, Wrists, Forearms And Elbows Stay In Line

Like I keep saying, these elbow injuries are less about what the actual elbow joint itself is doing and more about what’s happening to the tendons and muscles that happen to attach at the elbow as a result of what the hands, wrists and forearms are doing.

For this reason, you want to make sure everything stays in line right behind the other in relation to the line of resistance.

Hand… wrist… forearm… elbow.

Let me show you a few examples of what I’m talking about using screenshots from random YouTube videos with the seated cable row being our example exercise…

bad-cable-row

With the help of my beautifully drawn red line (I have 10+ years of experience with Photoshop, can you tell?), I’d like you to compare the alignment of this dude’s hand, wrist, forearm and elbow to the alignment of the hand/wrist/forearm/elbow of the guy below…

good-cable-row

Can you spot the difference? The second guy has it right.

Now why does what you see in the first picture happen? Sometimes it’s just bad form… a person using a line of pull that doesn’t suit the grip or equipment being used. For example, just compare the angle of the cable itself in both of these pictures. The first guy’s cable is on an angle (he’s pulling to a point too high on his body), while the second guy’s cable is perfectly straight.

But sometimes this sort of thing happens just as a result of using shitty equipment. For example…

high-cable-row

This girl’s hand, wrist, elbow and forearm are similarly out of position like the first guy (her elbow is below her wrist when they should be even), but in this case it’s not her fault. She’s just using a very poorly designed seated cable row machine, at least for the grip she’s trying to use.

My old gym had a few just like this. They suck.

You can see the cable in this case is straight. She’s not pulling it too high like the first guy. The machine she’s using is just designed in a way where the line of pull originates too high, thus forcing her to pull to about chest level when she’s pulling it straight.

The problem of course is that for type of grip being used (narrow neutral grip), she needs to be pulling to her stomach like the second guy from before… not her chest. With this specific machine, she’d need to use a wider overhand grip on a straight bar for everything to line up correctly.

And this misalignment of the hands, wrists, forearms and elbows is definitely not limited to seated cable rows. It can occur due to bad form (an incorrect line of pull/push, using too wide or narrow of a grip, etc.), bad equipment (you could be doing everything right, but the machine you’re using can force you to do things wrong) or both on a variety of exercises.

That includes every kind of row, pull-up and lat pull-down. It also includes every type of pressing exercise. For example, imagine a barbell bench press where, at the bottom position, the person’s wrists are not in line over their elbows (usually happens because the bar path is too far forward or too far back, or because the grip is too wide or too narrow).

It’s a completely different type of movement than something like a seated cable row, but it’s the exact problem.

If you allow this misalignment to take place long enough, elbow injuries are likely to occur. Pay attention.

13. Make Sure Your Wrists Remain Straight

In addition to wanting everything to line up correctly, you also want to make sure your wrists are straight in general and not bent forwards or backwards.

Here’s an example of someone doing a bent over barbell row…

bent-wrist-row

Check out what’s happening inside my pretty red circle. Notice how that guy’s wrist is bent and not straight? Go heavy enough long enough and that’s a flexor tendon injury waiting to happen. (And no, Johnny Tanktop never pointed this out or corrected it in the video.)

And again, this sort of thing can happen on all kinds of exercises, and again it can happen due to bad from or bad equipment. Or both.

So be sure to pay close attention to the position of your wrists during everything from pull-ups/pull-downs and rows, to various types of curls (pay extra attention here… don’t curl with bent wrists) and triceps extensions, to all kinds of chest and shoulder pressing exercises.

14. Don’t “Crimp.”

One thing I learned early on when dealing with my own elbow issues is that medial and lateral epicondylitis are both VERY common rock climbing injuries. So common that golfer’s elbow is sometimes called “climber’s elbow.”

In fact, I’d rank rock climbers at the top of my list of people who truly understand these injuries.

Coincidentally, with medial epicondylitis specifically, it’s often pull-ups/chin-ups that cause pain first (and often cause the most pain), and it just happens to be the closest exercise there is to a rock climbing type of movement.

And in talking with various rock climbers and the one doctor I came across who actually knew a ton about these injuries (he just happened to deal almost exclusively with rock climbers), one thing I kept seeing recommended is to avoid “crimping.”

As someone who knows nothing about rock climbing, I had no idea what that meant. But once I figured it out, it made sense and applied quite well to weight lifting too.

Crimping in the rock climbing world refers to a type of grip where you’re basically grabbing the rock only with your finger tips, thus putting all of your weight on them.

In the weight lifting world, imagine grabbing a pull-up bar, or a lat pull-down bar, or a barbell/dumbbell/machine for some type of row, but holding it more in your fingers than in your palm. Or maybe you started out with the weight more in your palm but as the set progressed it slipped into your fingers. And maybe by the last few reps, you’re basically just hanging on by your finger tips.

That’s what I’d consider to be the weight lifting equivalent of crimping. Don’t do that.

Grab the barbell, dumbbells, handles or whatever other equipment you’re using so that it sits in your palm and lower part of your fingers. And if you’re still having grip issues where the weight is slipping into your finger tips… it’s time for straps.

Speaking of which…

15. Use Straps!

For the 1000th time, everything your hands, fingers, wrists and forearms do affects the tendons that connect at your elbows. Put too much stress on those tendons and elbow pain/injuries will likely follow.

One way to minimize that stress is by minimizing the amount of work your “grip” has to do. You know, like gripping a heavy barbell, dumbbell or machine handle during all forms of rows, deadlifts and shrugs, or gripping the bar during pull-ups and lat pull-downs.

And one of the quickest and simplest ways of doing that is by using straps. In fact, elbow injury prevention is just one reason why I recommend using them. More about that here: Weight Lifting Straps

How often you use them is up to you. Some might only save them for their heaviest sets when their grip is a limiting factor. That’s fine. Some might prefer using them a bit more often. Hey, that’s fine too.

My only advice would be for people currently dealing with an elbow injury or people who have dealt with one before and are looking to prevent it from coming back. In those cases, I’d suggest using straps a bit more often. The less work your grip has to do during these exercises, the healthier your elbows will be.

Also consider using Versa Gripps Pro in place of traditional straps. I do.

16. Pay Attention To Cardio And Leg Training, Too

I know what you’re thinking. What does cardio and leg training have to do with elbow injuries? I mean, that’s an upper body thing, right? Kinda.

With cardio, jogging on a treadmill or sitting on a bike won’t be a problem. But a rowing machine? That has the potential to be more stressful on your elbows than a typical upper body weight training session would. It’s like doing a continuous 30-60 minute set of light straight bar rows.

So if you have a history of golfer’s elbow (or would just prefer to never have a history of it), I’d avoid going anywhere near a rowing machine for cardio.

And what about legs? There’s no elbow extension or flexion during most lower body exercises, so what’s the problem here?

Well, you know those tendons that attach at the elbow? And you know how they’re affected by the stress being placed on your hands/fingers/grip/forearms? Cool. Now let me ask you this. Do deadlifts place any stress on those parts of your body? How about various dumbbell lunges, split squats and step-ups?

Basically, any exercise for any body part that involves holding a heavy weight in your hands is putting some degree of stress on those tendons. Now that alone is unlikely to actually cause these elbow injuries. However, in conjunction with the stress being placed on those tendons during your upper body workouts, it serves as another contributing factor in making it happen.

I’m definitely not suggesting that you to avoid these exercises. I certainly don’t. I’m just suggesting that you take it all into account.

For example, when I was dealing with my own elbow problems a few years ago, there was pain just from holding something as light as 135lbs in my hands for deadlifts. So at that time I stopped deadlifting for almost a full year. I also replaced stuff like dumbbell split squats/lunges with barbell variations or single-leg leg presses.

I have long since brought all of that stuff back into my training, but I’m now extra careful about my programming of it and I consciously design things around minimizing the amount of stress being placed on my grip (and the involved tendons) over the course of the week.

17. Do Forearm Soft Tissue Work/Torture

It’s not fun to do and it can hurt like a bitch. But I’m gonna recommend it anyway.

The ideal way of having soft tissue work done on your forearms is by having someone qualified do it for you on a semi-regular basis. But if that can’t happen, the next best option is to do it yourself. You know, just like foam rolling.

And while the foam roller can be good for many body parts, it sucks for the forearms. You’ll need different tools for this. What kinds of tools, you ask? Anything from a ball to a stick. Let me show you some examples.

Here’s Eric Cressey showing the inner side of his forearm who’s boss using The Stick. I have one of these, and I like it…

And here’s Mike Reinold working on both sides of his forearm using a Thera-Band Roller Massager…

If you want to take it a very expensive step further, there’s this contraption called the Armaid.

Yes, it looks like a cross between a medieval torture device and a sex toy. And sure, there is a bit of an “as-seen-on-TV, only 3 easy payments of $19.95!” sort of vibe to it. And yup, many of the reviews you’ll find for it feel a lot like paid advertisements. And yeah, it probably costs 2-3 times as much as it should.

But I saw a handful of rock climbers swearing by the thing (and again, if any type of athlete knows about dealing with these elbow injuries, it’s rock climbers), so I figured I’d give it a try. And I can tell you that it’s actually pretty good. I just need to remember to hide it when people come over.

Here’s a basic demo…

And here’s Kelly Starrett demonstrating a few forearm soft tissue techniques, including using a ball and the Armaid…

The End

There’s not a doubt in my mind that if I would have followed the guidelines laid out in this article just a few years earlier, I would have completely prevented the elbow issues I eventually had. Bold statement, I know… but I stand by it.

There’s also not a doubt in my mind that following these guidelines right now is what’s kept my elbows at 100% ever since (which is currently 2 years and counting).

And last but not least, there’s not a doubt in my mind that following these guidelines will make you as unlikely as possible to ever develop either of these injuries in the first place.

But that brings us to one final question… what if they’ve already happened? What if you’re already experiencing inner or outer elbow pain? What if you’re past the “preventing” stage and are more than ready for the “fixing/healing” stage?

Well, this article is still a damn fine place to start. But as I mentioned way back at the beginning, fixing the problem when it already exists is a whole other fun and complicated topic of its own. But stay tuned, because I’m definitely going to cover the crap out of it in the near future.

92 thoughts on “Inner or Outer Elbow Pain From Weight Lifting (17 Ways To Fix It)”

92 Comments

  1. Quick comment on #9:

    In the past, there were 2 exercises where I ALWAYS had elbow pain:
    – straight bar biceps curls
    – wide grip incline bench press

    Since I started using Fat Gripz and a narrow grip on these 2 exercises, I have never experienced any elbow pain again.

    • For something like a pressing exercise, a thicker bar can actually help take some stress off of the elbows. So, that makes a little sense.

      But for barbell curls? That makes absolutely no sense whatsoever. I’d wonder what else (if anything) may have changed in your training around that same time.

      EDIT: Also just noticed you said you switched to a narrower grip as well. If your grip was wider than shoulder width on curls before (which is a guaranteed elbow destroyer right there) and you then switched it to something narrower, that alone may have been your solution.

  2. HI Jay,

    In your “Muscle Building Workout” routine Upper Body A recommends an underhand grip lat down as you recommend an overhand grip for the pull ups in Upper Body B. Should I keep them both at overhand?

    As far as the “hand, wrist and elbow line” are concerned, is this also the same recommendation for chest presses as with rows? Elbow should be under the wrist? I see a lot of elbows slightly lower than wrists movement going on at the gym. Also, should I be pressing up in a 90o angle or slightly turning in at the top?

    Thanks in advance….I really trust what you say and these little adjustments can be sooo important.

    And thanks again for the continual great info….it’s priceless, can’t wait for you new work!

    • Actually if you check the notes I include for lat pull-downs, it says: “For lat pull downs, I recommend using an underhand grip (meaning your palms will face you) or a neutral grip (palms face each other… this grip is much less stressful on your elbows/wrists).” I should probably reverse the order of that recommendation, but I’d definitely prefer a neutral grip here. If that’s not possible and you want to avoid underhand, overhand will be just fine.

      And yup, you want your wrists and elbows to stay in line with each other during pressing exercises.

      Not sure what you mean by “should I be pressing up in a 90o angle or slightly turning in at the top” though?

      • Hey just a clarification—on #2 in this write up, you say to avoid underhand for the lat pull down, but in this reply you recommend going underhand. I’ve had tennis elbow in the past so I’m guessing I should go overhand or neutral, not underhand?

        • First, an exercise like lat pulldowns would bother golfer’s elbow (inner side)… not tennis (outer side).

          Second, I’m not really recommending underhand, I’m suggesting it as version of lat pulldowns along with neutral grip and specifying that neutral is the better/safer choice for those with elbows issues or just those looking to avoid elbow issues in the future. So yes… overhand or neutral. Underhand = the worst on the elbows.

  3. Jay,

    What a TEASE ! I thought it was going to be the one on fixing, not preventing !! LOL. I have had two Skype sessions with the aforementioned expert ( super nice guy ) and like you mentioned to me its a SLOW process. The eccentrics he recommends most definitely gets those tendons stronger which is the point of his protocol ( as opposed to getting the flexors/forearm stronger ). I was not improving quite to his liking so I have ( finally ) incorporated the soft tissue work which might be as much as half the battle. I am going on 8 weeks of the work. Slowly but surely.
    And lastly, talk about exercises that shouldn’t annoy your golfer’s elbow but boy does it for me: Back Squats! Oh nelly !!!!!
    Manny

    • Have you been doing both eccentric exercises? For me the pronation movement was by far the more important of the two (though I’m not sure if it’s like that for everyone), as was playing with different elbow angles and trying to purposely seek out the angle that caused the most pain (and then only using that angle until it didn’t hurt as much… and then seeking out the new angle that caused the most pain and using that one). Remember, you WANT to make it hurt when doing this stuff. Every week or two you’ll gradually notice it hurting slightly less.

      It also took some experimenting to figure out how to implement the eccentric work (I was doing it morning and night) around the days I trained upper body. After a while I found I did best when doing the eccentric stuff 3 times per week (only on off days and leg days, never on upper days) while also following all of the guidelines in this article for training upper body (especially only hammer curls for biceps).

      • 100 % exactly what I am going through. Of the two exercises, which I call the dumbbell excentric and the “mallet” protocol, I was not able to elicit any pain on the dumb bell one so he told me to drop it and ONLY do the mallet. My worst pain came in at a flat 180. Once it got “better” I had to search for those sensitive points. Brother I am in the middle of it as I write !

        PS for me much better than even the hammer curls are just doing reverse curls. NO pain whatsoever.
        Thanks again.
        Manny

        • Ha, yeah… I used to call the pronation exercise “pots and pans” because I originally did them while holding various top-heavy pots and pans. Bought an adjustable dumbbell set soon after and only loaded one side, which was perfect for this. I was the same way with the angle. Started out where it hurt the most with my arm completely straight, and by the end I had to bend it to a full 90 degrees to make it hurt.

  4. Talking about heavy pullups, wide overhand grip on causes internal rotation of shoulders, and that’s usually bad for rotator cuffs(like pretty much every exercise where elbows are flared out to the sides). My shoulders can’t take shoulder wide overhand grip either – even if I avoid straight arm dead hangs on reps. And yes, underhand grip is worse on elbows. So it’s a pick your poison situation if you must do heavy pullups/chins(for the competitions of that exercise, for example), but not the end of the world if you build your program wisely. 17 years it has been underhand grip, and I will continue to do them as long as I can(there’s risks in everything – the only way to avoid them is to do nothing).

  5. Great read, couldn’t have come at a better time since I’ve just recently started experiencing outer elbow pain. Could be a combination of some of the things I’ve been doing you mention but also back squats definitely seem to aggravate my elbow. Widening my grip and keeping my hand open definitely have helped but I started using the leg press mainly now to avoid making it worse.

  6. Hey Jay, Great Article as always man!! Like many, I wish I had read this article years ago. I’m 35 yrs old now and had horrible wrist, shoulder, and elbow pains in my early 20s. My elbow hurt most from the skull crushers. I really liked the exercise but not the pain. One day I saw a guy doing them with dumbbells with a neutral grip… and found another favorite triceps exercise. Nowadays I’m battling sciatic nerve issues and disk damage. The funny thing is I hurt my lower back twice once doing deadlifts, and the other time doing barbell row. The thing I dont understand is both times I got injured it was using light weight..I’m thinking I took the weights for granted and went to far on the deep stretch at the bottom causing pain in my lowerback… I wish I could of dodged that bullet lol…… thanks again for all the tips.. my elbow was acting up last week during biceps curls, now I know its cause I used the barbell instead of the ez-bar… Take care man….

    • Thanks dude, hope it helps.

      Also, I’ve noticed “I wish I read this years ago” and “this couldn’t have come at a better time” are like guaranteed responses I get whenever I write anything about injuries. Apparently they are pretty common. 😉

      • Hey mate. About that “fixing pain you already have” article? Any news on that? I have had an injury since last November. Not having medical insurance makes treatments out of the question. And I can’t apply for transfer/ less work because I will get cut. It’s definitely lateral pain. Main symptoms are pain when arm is fully flexed (top of a curl) and fully extended ( like if I’m sitting cross legged leaning back in my hands). Injured it playing football. Got a bad tackle. Any help appreciated. Take care

  7. I’ve been getting a lot of pain in the outer elbow. I find hammer curls and pull-ups are the worst culprits. Anything that hits the Lateral Epicondyle. I’ve begun to use a strap and pay close attention on keeping my wrists in a neutral position. Out of the gym, i’ve been using liberal amounts of anti-inflammatory gels, Traxam is the product. I ice pack it too when I think of it.

    While working out, Chin-ups and a straight bar work best for me, but they mostly hit my inner bicep. I’d like to hit my outer bicep but don’t think it’s possible without engaging the Wrist Extensor Muscles. Any ideas on this?

    My inner elbow is completely fine. Though it’s probably only a matter of time before that goes too… 🙂

    • That sounds a bit backwards. Curls and pull-ups would be exercises that annoy the inner elbow, not outer (although there is definitely overlap, for example my inner elbow used to hurt just from gripping a bar tight to do a press with it even before actually doing any pressing).

      Regarding anti-inflammatories, they may provide some benefit if you’re only in the tendinitis stage, which is just when there is some inflammation around the tendon and can usually heal within a couple of weeks with rest. But if you’re in the tendonosis stage, that’s when there are actually tiny tears in the tendon itself, in which case anti-inflammatories are totally useless and potentially counterproductive (cortisone shots are VERY counterproductive).

    • Oh, and to answer your question, curls will mainly be using your flexor muscles/tendons, not extensor. Though again, you can’t really hold anything heavy in your hand without both sides doing something to some extent.

  8. Sound advice, I never had any elbow pain, but this resonates 100% with what I’ve thought before in terms of safety in exercising.
    Just one thing kind of threw me off though, I realized I do crimp a bit (the bar goes to about the 2nd joint from the fingertip and the knucle, or sometimes between 1st and 2nd joints) during a 10rep bodyweight pullups (never in chinups though…) toward the end. So considering my elbows are about as fresh as they come (very thankful), wouldn’t it make more sense to make my grip stronger by using fatgrips or towel pullups, or anything else that gets a stronger grip, instead of limiting strength and promoting the weakness (..or preventing getting stronger grip) by using straps during DLs and Pullups?
    I understand it makes 100% sense if someone has pain or has a history of elbow problems, but when it comes to people like me..?

    • Actually, just read your strap article, and it made sense. But the thing I’m wondering is, if grip is the thing to give out, would it ‘eventually’ get better since it’s the main thing being trained in whatever exercise (I know it’s stupid to deadlift just for grip, but in theory, would it not get stronger and match your posterior chain strength eventually)?
      And if I’m using straps for say pullups, what should I do for grip strength then, in a beginner routine? What do you think of using fatgrips or towel pullups?
      Lastly, is the stress in general bad for elbows, or is it just overtraining the grip during the exercises that cause the problem, as in, would having a stronger grip eliminate the need for using straps(because the grip is strong enough for the tension, or is this tension bad even for a strong grip)?

      • You’re basically asking your grip to keep up with the strength of your back, biceps, hamstrings, glutes, quads and various combinations of them. So sure, as those muscles get stronger and more weight is lifted, your grip gradually gets stronger along with it. Will it happen just as well and at the exact same rate? As a beginner, usually. After that, rarely. Which is why people use straps. Also keep in mind that using straps doesn’t mean your grip is weak, it just means the rest of your body is strong and straps should be used to ensure it gets trained like it is capable of being trained.

        Hand size plays a big role in this stuff, too. Regardless of grip strength, someone with smaller hands is going to be at a big disadvantage no matter how much they improve their grip. And someone with bigger hands is going to be able to hold quite a bit of weight even if they have terrible overall grip strength in comparison.

        And honestly, assuming you’re training primarily for muscle growth, who even gives a shit about grip strength? Use straps when you need them, don’t when you don’t. If you have some kind of grip specific goal in mind, train it directly as needed. I personally have spent most of the last 14 years doing no direct grip work. Yet, my grip strength is just fine.

        • Thanks!
          Could you touch on the elbow issue as well, am I right in thinking that it’s overloading the grip that is bad for elbows, instead of tension being inherently bad, for ex., for a strong grip and healthy elbows, fatgrips should be fine? Or are they bad for everyone because of increased tension
          And even though I do train a bit for hypertrophy, I’m about 50/50 on strength mass, or even a bit more skewed toward strength/performance. As a martial artist, grip work is very important to me. So is there something I can incorporate into the beginner routine for grip work, like the fatgrips, towel pullups or something else that could be useful, or am I better off as a beginner to do the basic stuff, worry about grip later on when I’m at least intermediate?

          • for a strong grip and healthy elbows, fatgrips should be fine? Or are they bad for everyone because of increased tension

            Mostly the first one, but the potential for the second one can always exist.

            Training specifically to improve grip is not something I have much experience with, so I probably wouldn’t be the best person to ask.

  9. I have had brief elbow issues in the past and they are not fun. There is also a distinct lack of guides on the internet for prehab and rehab advice regarding the elbow. So thanks for the article Jay, it’s greatly appreciated.

  10. On the pullups and lat pull downs or even the seated rows, if you place your thumb over the top of the bar(think of the outside of your thumb as hooking the top of the bar) as opposed to the inside of your thumb hooking underneath the bar, it will help relieve most of the stress from the forearm muscles.

  11. Thanks for this timely (at least for me) article. I’ve been dealing with nagging outside elbow soreness (weird but it’s only my right arm) for a couple weeks now. I’ll try to incorporate your recommendations into my workouts.

  12. Very informative article. I will definitely make some adjustments in my lifting techniques.

    On another subject, will you or have done an article on proper breathing techniques? Do you inhale on contraction and exhale on extraction? I will sometimes catch myself taking one big breath in at the start of the movement then holding my breath for the duration.

    • There are exceptions (that’ll need a full article to cover), but generally you exhale on the concentric (lifting) portion of the rep, and inhale on the eccentric (lowering) portion.

  13. Jay, Im confused, you said that underhand grip is bad on chin-ups AND lat pull downs, but in your muscle building workout routine, you recommended underhand lat pulldowns?

    • Two things about that.

      First, no exercise is universally bad for everyone. It does just happen to be one that increases the potential for “bad” in terms of elbow injuries to a much higher degree than any other vertical pulling movement, which is why many people will be best served to avoid it (or at the very least program it more carefully).

      Second, check the notes for that exercise. It says: “For lat pull downs, I recommend using an underhand grip (meaning your palms will face you) or a neutral grip (palms face each other… this grip is much less stressful on your elbows/wrists).”

  14. I bought your book, love it! A question for you, do you think there will be much of a difference in results from your 3 Day Mass Routine, from your 4 day muscle building routine?

    • Nope, I think most 3 or 4 day programs in that book are pretty close to equally effective.

      However if someone’s schedule better supported a 3 day program, or if a person recovered better with a 3 day program over a 4 day program, that’s when the 3 day program would actually be more effective.

  15. I started lifting serious mode on January this year and since three weeks now i’ve been having elbow pain. Every time i get it my tricep also feels very numb. It always happens some minutes after my workout.

    I also wanted to say that since i started lifting i’ve had several issues with pain in different parts of my body but luckly the’ve all dissapeared by themselves. Pretty weird.

    • Numbness would typically rule out the injuries mentioned in this article, as that would indicate something happening with a nerve (most likely the radial nerve in your case). That would be something to get checked out.

  16. Hi Jay, excellent info as usual.

    I would like to ask:

    1. I’m doing Pendlay row in my routine and i realize my wrist is bent exactly like the guy in your number 13 Make Sure Your Wrists Remain Straight. Does it help to use a pair of wrist WRAP to help keep my wrist straight during the movement?

    2. Should I use wrist wrap all the time to prevent injury even at low weight?

    3. Does it make sense to use both wrist wrap and lifting strap for maximum safety?

    • 1/2. My first suggestion would be to just try to stop bending your wrist like that rather than bring in something like wraps.

      3. If the reason you’re bending your wrist like that is because your grip is slipping and this helps you hold onto the bar better, straps may be worth trying.

  17. Them versa gripps are awesome, been having trouble with grip strength for awhile on my Rdls an as a result of that my technique gas got sloppy (rounding back, shoulders dropping foreword). Used my new versa gripps today for first time an what a difference, form instantly 110% better an no trouble with gripping anymore. Wish I’d got them ages ago

  18. Man, that guy’s wrist is bent so much during the bent over row. His flexor tendon is probably injured by now.

    And he doesn’t even know it’s Johnny Tanktop’s fault…

    🙂

  19. In your book, you say a beginner is someone who has either been training for less than 6 months consistently and intelligently OR someone who stopped for a significant period of time? Define signficant, like can you give an actual time frame?

      • I lift weights throughout the school year, and i had some pretty good numbers (2 plate bench 3 plate squat 155lbs press) but my school gym closes during the summer. If i stopped lifting from June till now (college is starting again), would you consider me a beginner all over again?

        • So it’s been 2-3 months of no lifting? In that case no, I wouldn’t consider you a beginner again (unless you were still a beginner when you left off).

          You will however need to return to lifting slowly and MUCH lighter than you left off, and then gradually work back up.

  20. Hello Jay,

    i have just had a kind of injury on my abs lifting weight, and the doctor says I shall not lift weights until I feel no pain, which she said can take one or two weeks (it will be one for sure).

    I was in half of cutting phase now and this is a really annoying injury and I would like you to give me some advice of how to avoid loosing muscle during this week.

    Thanks a lot

  21. You really should add a search function to your site instead of having people type “site:aworkoutroutine.com _____.” You complain about people leaving the same questions, but if people could search directly i feel this would help a lil. Not trying to be a dick because i really enjoy your site, but for the average person who doesnt know about “site:aworkoutroutine.com” do you know how fucking frustrating it is to have access to a wealth of AMAZING info without being able to thoroughly search it.

    Love your site and keep doing your thing Jay, just want your site to get even better.

    • 3 things dude.

      1. Wasn’t really complaining, just pointing it out and trying to minimize the amount of time wasted answering stuff that is already answered on the site.
      2. I agree that the average person doesn’t know about the Google site-search stuff. That’s exactly why I pointed it out.
      3. Look at the bottom of the right sidebar of every page on this site. There IS and ALWAYS has been a search function. It works well, but Google usually works better.

  22. I had a few questions not at all related to this article but the first one is injury related so I figured what the hell this is as good a place as any.
    1) Do you know anything about trigger finger and is it a common weight lifting injury or is it probably from work (furniture warehouse)?
    2) My main goal is strength but I would also like to build some size just for the aesthetics of it I’m currently doing your beginner program at 4 sets of 6 what rep range would you recommend?

  23. Hi, thank you for your much article, but my current issue is that i did already having an elbow pain which it really pain in ass not only when lifting but also daily work routine.

    May i ask is there any healing steps for it that u recommend?
    Thank you

  24. Excellent article. I am 59 and have been lifting weights for 30 years or so with a goal of maintaining overall fitness. Recently have been experiencing inner elbow pain. I have started using a rope pull machine over the past 3 months, doing about 4 minutes on the heaviest setting. It has become one of my favorite exercises as it uses alot of upper body and core muscles and offers a cardio work out as well. But I am wondering if that is the cause of my right elbow problem. In any event I will be lightening up on the weights over the next 2 weeks to see if that helps.

  25. Hey man, I read the whole article and I truly think it’s a very helpful article. I have recently developed golfer’s elbow due to overdoing it on pullups/chinups (I do calisthenics so these 2 exercises are very common in the routines) . I’ve actually had a lot of pain in both of my elbows and then I decided to take some time off, approx 1 month and a half. I’ve had no pain in my left elbow but still have some pain in the right elbow. I decided it was a good time to go back to the gym and try working out again but after doing just a couple of chinups, not even overdoing it I feel slight/very slight pain in my biceps (maybe upper side of the inside of the elbow but it really feels like it’s on the bottom/inner side of the bicep) and the right elbow is more painful than it was when I first returned. This really makes me feel stressed out cause I want to progress and get back to my training but I really don’t know what to do to recover my elbows fully.. I don’t want to stop doing exercises like pullups/chinups since they are an essential part of my work outs. I’ve been taking fish oil supplements, stretching daily and doing eccentric exercises for the elbow (honestly I feel nothing while doing the eccentric exercises with dumbells, even upping the weight a little bit feels like I could do 100 reps). Can you please advise me what you did to fully recover your golfers elbow injury so I could follow the same thanks , I would be endlessly grateful. Thanks!

  26. Awesome article…Developed medial epicondylitis from i’m guessing waaaay too many chin-ups and variations…Clearly overuse injury. Will try with some straps next

  27. I just ordered some versa gripps pro since I have a bad reoccurring case of golfers elbow. I have not been lifting for well over a year since each time I start again the prob comes back. So with the help of this article and better straps I hope I can start lifting again.

    Also I wonder if its a coincidence the arm with the worst prob is the one that I used for the underhand grip for my alternate grip deadlifts?

  28. Thanks for the well written article, I genuinely appreciate your taking the time to help others out. Of course the reason I’m writing is I am one of the others. I am 54 years old and have been doing the Body Beast DVD program since early February, and really like it, but have recently hurt the outside of both elbows (1st the right then the left a couple weeks later) it is the same exact injury on both sides. I have taken a break from the weights because it got so bad, and have been doing the P90X workout to keep my momentum going and give them a rest. It got so bad I was having trouble using the remote control (holding my arm straight and pushing the buttons was very painful), and that’s when I knew it was getting really bad. The Upright Rows and curls seem to cause me the most pain in my workouts. I wll definitely incorporate some of your tips when I go back at it.

    My question is how do I know when I’m ready to go back (I really miss it), without re-injuring it. I have made up my mind to get them healthy and be patient. I’m in this for the long haul not just a band aid for a reunion or some BS like that. When I do should I use an elbow wrap? Can you recommend a good one?

    Thanks Greg

  29. You know, I have been researching elbow issues as I have been dealing with left tennis elbow for two years, and once it went away right elbow (now) started giving me problems, out of all sites and places you have the most comprehensive article addressing the issues, especially saying that you are not a doctor but a weight lifter as myself 🙂
    very useful info man u make a lot of sense, thank you, really 🙂

  30. Hi – Unfortunately I am in the ‘already broken’ category, and quite recently (8 weeks ago) seriously hurt my right elbow and left to a lesser extent doing chin-ups on a straight bar (too many too quickly after a very long break) I’d really appreciate any help on fixing them, hows that article coming along. Great read, thanks. Jason

  31. Hi Jay!
    many aha moments here – all this makes so much sense – tennis elbow in right arm currently flaring up as I’m doing the no-no’s – will be incorporating all these suggestions. Just have a question regarding straps – I have them but the two loop type. Do you think they are less effective than the one loop straps that allow you to tighten the strap?

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