Elbow Pain: All in the Wrist?
Joseph M. Horrigan
Elbow pain is common in weight training and often occurs on the inner side of the elbow, usually during triceps training. Triceps tendons, though, may not be the source of the pain.
Triceps-tendon injuries are not common, nor is triceps tendinitis. The cause of much elbow pain that occurs during triceps training is another group of tendons located very close to the triceps tendon. The site of the pain is the smaller bony prominence of the elbow known as the medial epicondyle, where the forearm muscles come together.
The forearm muscles you use to perform a wrist curl are collectively known as the wrist flexors and are involved in triceps training. They bend, or flex, the wrist, as when you perform a wrist curl.
When you perform triceps pushdowns with a straight or V bar, the palms usually face the floor at the bottom of the pushdown; the elbows are straight. That position bends the wrists back and stretches the wrist flexors, which can pull on the origin, or attachment, of the muscles at the medial epicondyle. The pull is magnified when you try to force an extra rep and whip the bar down ballistically, putting much more stress on the wrist flexor tendons.
The same problem can occur during lying triceps extensions, especially when you achieve extra reps by letting the bar drop down behind your head and then use speed to try to throw it up. It happens with standing triceps extensions as well.
The added stress is quite evident when a patient reports to our office with a complaint of elbow pain associated with triceps training. Usually the pain occurs with triceps exercises, becomes worse the longer the workout takes and gets worse over weeks. The patients rarely experience elbow pain when they do the bench press, military press or dip, which is inconsistent with true triceps tendinitis or a partial tear. When we examine their elbows, we rarely find the triceps tendon tender to the touch. When we apply pressure to that bony prominence, however, the patients usually flinch from pain.
The long-term answer is to change your wrist position during triceps training. Instead of allowing your palms to face the floor at the bottom of pushdowns, you should keep your wrists straight throughout the motion—your palms will face your thighs at the bottom. That modified wrist position will decrease the stretch and ballistic overload of the wrist flexor tendons at the elbow. You’ll initially have to reduce the weight slightly on these exercises, but you’ll be back up to the same weights within a few weeks—without pain or with much less pain.
Also try to keep your wrists straight on lying and standing triceps extensions. It will feel a little strange at first, but you’ll quickly acclimate.
There are other forms of elbow pain. If it feels as if it’s deep inside the joint and if the joint feels rough in its movement, you may have what’s known as loose bodies—fragments of cartilage or bone—inside the joint. The loose bodies can erode the cartilage lining the elbow. That type of pain needs to be followed up by either an orthopedic surgeon or a chiropractor with sportsmedicine or orthopedic training.
Editor’s note: Visit www.softtissuecenter.com for reprints of Horrigan’s past Sportsmedicine columns that have appeared in IRON MAN. You can order the books, Strength, Conditioning and Injury Prevention for Hockey by Joseph Horrigan, D.C., and E.J. “Doc” Kreis, D.A., and the 7-Minute Rotator Cuff Solution by Horrigan and Jerry Robinson from Home Gym Warehouse, (800) 447-0008 or at www.home-gym.com.
Your wrist position on certain exercises can inflame elbow tendons—giving you tennis elbow without your ever playing tennis