Tendonitis & Weight Training - Elbow Pain and Swelling Treatment

Elbow Pain

Train & Exercise Smart to Avoid Injuries

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I hope you're not like me and so many other long-term lifters who have worn down their elbow tendons and experience chronic inflammation of the tendon to which all three heads of the triceps link-the dreaded tendinitis. Bad form and use of overly heavy weights can cause it, or it may simply be caused by overuse. If you're afflicted, please allow me to pass on some of the things I've learned about how to train effectively and with as little pain as possible.

Don't skimp on warmups. Forget about doing one or two warmup sets before getting into heavy weights for chest, shoulder or triceps movements (in some severe cases the outer elbows are tender even during back and triceps exercises). With a bad elbow you need at least three, possibly four, warmups. The reps should start high, about 20, then go down to 15, 12 and 10. That should get the area adequately pumped, attracting blood and heat, and the joints should become lubricated with synovial fluid. Never skip or even cut back on your warmups, even if you're in a hurry that day. Doing fewer work sets is a small price to pay for not exacerbating an injured area.

Use cables for triceps extensions. Any triceps extension movement performed with a barbell or dumbbell is absolutely the most painful thing I can do to my elbow. Something about getting the resistance through the sticking point puts an undue amount of pressure on the tendon. I've found cable movements to be smoother and virtually pain-free so long as I do warmups and perform the reps slowly and in perfect form. I know it looks a lot cooler to lie on a bench with a loaded EZ-curl bar and grind out skull crushers (even the name sounds rough and tough), but you can get just as good a workout with cable pushdowns if you hit them intensely.

Preexhaust chest and shoulder presses. Other lifters suffer the worst elbow pain when pressing for the chest or shoulders. An easy solution is to reduce the weight while still making the chest or shoulders work just as hard. Preexhausting either with an isolation movement immediately prior to the press will accomplish that. Say your normal bench press is 300 pounds for 10 reps but it makes your elbow throb with agony. Try doing a set of machine or dumbbell flys or cable crossovers to failure. Then, without any rest, lie down and press 225. That 225 will feel just as heavy as 300 normally does, but the stress you subject your elbows to is greatly reduced-hence less pain and risk of further damage.

See your doctor. You may be living needlessly with that nagging pain when your doctor could have the ticket to relief. He or she may refer you to an orthopedic specialist, and your treatment could be as simple as a prescription for anti-inflammatory medication. While you may think it's macho to tolerate pain, I say it's just plain stupid and unnecessary.

Use joint-building supplements. I've been using glucosamine-and-chondroitin-sulfate supplements religiously for a couple of years now, and they've helped decrease my elbow pain significantly. Give them a fair try.


As a bodybuilder, you're probably not playing golf four days a week, or regularly whacking 100 serves on the tennis court, but guys who do, have something in common with you. You may have heard the terms tennis elbow Qateral epicondylitis) and golfer's elbow (medial epicondylitis). These injuries do not discriminate between bodybuilders and other athletes. They're the result of frequent repetitive stresses placed on specific anatomical structures.

The similarities among avid body-builders, tennis players and golfers certainly don't lie in body composition, flexibility, speed, agility, strength and core control. However, improvement in bodybuilding, tennis or golf all require repetition of specific exercises or movement patterns. Because of this repetition, microscopic tears and damage in the tendons may cause inflammation. In time, chronic damage leads to degenerative changes, including calcifications, loss of blood flow, inflammation and pain.

All these sports are repetitive in nature, but medial and lateral epicondylitis among weight trainers usually result from several factors. According to Asghar Husain, MD, sports medicine orthopedic surgeon in Rancho Cucamonga, California, and clinical assistant professor of orthopedic surgery at the University of Southern California in Los Angeles, these factors include "excessive tension on the tendon from extreme lifting intensity, high frequency, poor form (particularly in the eccentric phase of the movements) and improper lifting rhythm (jerky reps)."

Dr. Husain stresses that going heavy alone won't necessarily lead to injury, but combining heavy weights with poor form and jerky movements can cause problems. Regulating the frequency and intensity of training is also critical to staying healthy. This is where the concept of implementing a periodized training program (where training variables such as volume, intensity, frequency, rest periods and exercise selection are changed regularly) can not only contribute to greater improvements in your physique, but also aid in injury prevention. (See "Elbow Pain Among Bodybuilders.")

Medial epicondylitis is usually described as pain on the inside of the elbow just below the funny bone. (Actually it's not a bone at all - it's the ulnar nerve, and it's anything but funny.) Athletes with more chronic pain may also complain of grip weakness. According to an article published in Clinical Sports Medicine, "up to 20% of patients with medial epicondyilits report ulnar nerve symptoms - a tingling/numbing sensation from the inside elbow into the pinky and ring finger."

The anatomical structures involved with this injury are the pronator teres muscle and the origin of the flexor carpi ulnaris. Since the injury occurs in these structures, bodybuilders usually have pain with resisted wrist flexion, for example, a wrist curl bringing the palm and fingers toward the inside forearm, and resisted pronation going from palms up to palms down toward the floor. Dr. Husain says that among bodybuilders in his practice, medial epicondylitis is more prominent than lateral epicondylitis.

Lateral epicondylitis usually causes pain on top of the forearm and outside the elbow. The primary anatomical structures involved with this injury are the extensor carpi radialis brevis (ECRB) muscle and the extensor carpi radialis longus (ECRL) muscle. Pain is typically heightened with wrist extension and/or supination. Other exercises where gripping is involved such as lat pulldowns or bent-over rows may also increase lateral elbow pain.

The treatment for both medial and lateral epicondylitis is similar. In the initial stages of the injury a short period of rest (three to five days) is advised during which the tissue can repair itself through a natural inflammatory process. Doctors usually recommend nonsteroidal anti-inflammatory drugs (NSAIDs) at this stage, but Dr. Husain notes more recent research suggests the initial natural inflammatory response actually assists in the healing process. In those first three days a patient can use acetaminophen (i.e., Tylenol) for pain control in conjunction with cold therapy several times a day for 15-20 minutes per application. (See "Home Treatment Protocol for Elbow Pain" for basic home treatment of medial and lateral epicondylitis through each stage of healing as suggested by Dr. Husain.) Remember that if pain persists, you should seek the help of a physician (preferably a doctor trained in sports medicine), physical therapist or certified athletic trainer.

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