It felt like my elbows were about to burst.
Every time I squatted my elbows hurt beyond belief. I couldn't bench press, and I felt as if I couldn't straighten my arms. At age 26.
Luckily, through reading the work of Eric Cressey and Tony Gentilcore, programming, and lifestyle habits, I was able to get rid of the pain forever.
Since then, I've helped many people out of elbow pain.
Tall Andy is one of those people.
I began working with Tall Andy in late 2021.
Weirdly, around 10% of my clientèle are called Andy, so each one has a nickname.
The main character in our story today is Tall Andy. Tall Andy is a long boy. I can hear your gasps at the sheer weight of my creativity.
Tall Andy has been lifting for a few years and wanted to improve his training by working with me, the poor soul.
Andy wanted to get stronger, but didn't want to be banged up and in pain. The main joints in pain were his elbows. Mainly after squats but also around bench press, and overhead press.
Hmm, a burning, horrible, training induced elbow pain? I remember that well. Maybe I could help Tall Andy get out of pain without being diagnostic?
Only time would tell...
[OPENING CREDITS]
Root Causes Of His Pain
As Paul Ingraham of painscience.com will tell you, pain is weird as fuck. On his website, Paul lists 34 UNUSUAL causes of pain, combine that with the common causes of pain and you have a huge list of potential causes.
Judging by his health, age and diet, I saw no reason to refer him to a doctor immediately because the pain was affecting both sides, in the same way, at the same time during a training session.
Andy had being doing a program from Mark Rippetoe's program Starting Strength.
The SS program is simple. Lots of sets of 5 low bar squats, bench press, deadlifts, overhead presses and occasionally pull ups if you want to get wild.
All sessions start with a squat before progressing to other compound lifts. Andy followed the program for over a year, making good progress before hitting a plateau with ever-increasingly sore elbows.
When elbows are sore, the body starts to get funny with barbell pressing exercises and as the soreness progresses the person will either:
A- slow the eccentric/negative/on the way down
Or
B- will drop the bar far faster than usual to avoid the pain
When this happens, strength stops improving and training becomes miserable due to you being in pain.
We noticed Andy was in the most pain after low-bar squatting. Which was required to start EVERY SESSION of the Starting Strength program.
The body recognises and tries to protect painful areas so will stiffen many of the joints around a painful area, resulting in less movement. Less movement at the shoulder makes it more difficult to get into a low-bar position, putting more strain on the elbows creating a vicious circle of pain.
All the exercises on the Starting Strength program use the same grip, increasing the chances of overuse pain.
Combine this with the vibration from every impact with the floor during deadlifts, and you have a recipe for creating elbow pain.
Starting Strength warm ups are largely THE EXERCISES THEMSELVES BUT LIGHTER. I am a big proponent of this approach. It saves time, it works and it isn't complicated, unless it's too much of a particular movement which is causing pain.
If low-bar squats are causing pain, warming up with low bar squats will compound the pain problem.
A picture was beginning to form.
Starting Strength the way Andy was doing it was very elbow heavy
As his elbows took more strain, the area protectively tightened up, restricted movement, and tried to protect the area, causing more difficulty to get into position, causing more stress in the painful areas, or he was already restricted, but needed to repeat the same movements for long and heavy enough to cause pain
Low bar squats were the most pain-provoking so should be addressed first
Warming up by doing more of the problem movements wouldn't be helpful so new warm ups were required.
Reactions 1
When Andy started with me, his elbows were already in pain. We screened his movement and watched him perform various exercises before establishing his shoulders had poor mobility, which was in-turn because his shoulder blades were in all kinds of funny positions as he trained and navigated life, all of which was aggravated by the fact that his elbows hurt all the time.
Addressing an elbow heavy program is relatively simple. You change the exercises until you find variations causing less pain. You repeat these exercises until pain is no longer there. You reintroduce the formerly painful exercises gradually, with a battle plan for if the elbows start to get painful again.
When changing the program of someone who has built significant strength in an exercise, it's a tough sell to expect them to not do a particular movement as they don't want to lose their gains.
The trick is to replace painful movements with the nearest pain-free alternative. Sometimes that's as simple as doing the same thing but lighter, and sometimes you have to change a movement entirely to get the desired reduction in pain.
Here are some changes we made to Andy's training:
Low bar squats changed to high bar squat
Stopped every session beginning with an elbow-aggravating exercise
We found neutral grip incline dumbbell press was pain-free so we did lots of them
Bench press was removed for a while in favour of pain-free dumbbell press variations
Overhead press was removed for a while, with lateral raises and high-incline neutral grip overhead pressing taking it's place
We made sure he used a variety of grips to stop any areas from taking too much punishment
I recommended wrist wraps should be used as often as required to keep pain away
We did lots of exercises to improve and strengthen muscles around/attaching to the shoulder blades
We got Andy to start warming up his shoulders before squatting
These changes slowly reduced stress on the elbows. Pain gradually went away. This was accelerated by us designing new warm-ups for Andy which are included below:
As the pain decreased, his mobility exercises in the warm-ups became easier to do. This improved his positioning in exercises such as low-bar squats. This makes low bar squats less likely to cause pain again.
Whenever you are looking into pain, you have to study the type of person you have in front of you. If it's a NEW PERSONAL BEST OR DIE type of person, you know their fatigue will be higher, their stress will be higher and their chances of being in pain will be higher than someone who possesses maximum chill, because their recovery is compromised.
Andy is the type of person who has pursued strength goals for years and had taken on the attitude that more weight should be added to the barbell every week, which isn't true.
The problem was Andy isn't starting any more. This drive to progress is one of the reasons Andy kept banging his head against the wall, as pain wasn't going to stop him...until it did. He had to learn that maxing out in the pursuit of PBs during every set isn't the best way to make progress.
This is where Andy started working with me.
And when he did, we included exercises to improve the positioning and strength of his shoulders and leave his elbows out of pain.
Exercises Included To Improve Shoulder Strength And Positioning
Upside down kettlebell press variations
Various carries including farmers walk
Rows
Band pull-aparts
Side plank
Press ups
The Picture Becomes More Detailed
5. Because of how Andy trains, more education around recovery and effort management was required
6. If I tell Andy to put in 8/10 effort, he will put in 9.5/10 effort.
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If I need him to do work at a true 8/10, I should be telling him to work at more like 6.5-7/10 by his standards while educating him on the importance of not going BALLS TO THE WALL on every set. I explained how the more sets to failure you do, the more you need to deload and the more beaten up most people feel.
Some other sample lessons for Andy:
Post-PB deadlifts isn't a good time to go balls out on more deadlift
If you train incredibly hard and put high-levels of emotion into a session on a Monday, your session on a Tuesday will often be flatter and generally a shittier session. Learn to pick your battles
Deloads are important and often result in higher performance once they've been completed. Most people hate deloading until they truly need one
The intent of every exercise isn't to go as hard as possible
Archer is good again
The Picture Is Almost Complete
As our picture becomes clearer, we have to consider a 7th option:
7. Eliminate illness-related pain as a factor
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While Andy could be healthier by adding in a little cardio and maybe making a dietary change here and there, I'm fairly certain illness didn't cause his elbow pain.
Into our final stage..
8. Reintroduce the problematic movements with less elbow heavy form
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Once his elbows were feeling significantly better, it was time to reintroduce some movements. We identified low bar squats as our most problematic exercise and decided to work on that first.
Squat Changes
We added wrist wraps to take some of the load
We began chalking his back.
We placed the bar more into the fingers rather than on the palm of the hand, placing less stress on the elbow
Cued pulling down on the bar not back
We widened his grip
Other movements we changed as they were reintroduced:
Overhead Press
Widened his grip
Bench Press
Widened his grip
Changed where touches the bar to his chest
Cued pressing towards the rack
Cued him to get his elbows further under the bar at the bottom of the movement
We started holding the bar with it lower in the palms
The result?
Andy no longer has painful elbows. In fact, most of the time, Andy won't know he has elbows. He's doing all the exercises he wants to, in a way that doesn't aggravate his elbows. He is hitting personal best lifts and is now considering going for his first Strongman competition.
Well done, Sir!
The moral of today's story is lifting induced pain can be fixed, often passes when a few changes are applied, and this knowledge informs you of how to avoid the pain happening again and what to do about it if it does.
By Chris Kershaw
The Heavy Metal Strength Coach
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