elbow pain during squats

Elbow Pain While Lifting Weights: Tendinitis and the Squat

Many lifters experience elbow tendinitis—a pain in the elbow caused by inflammation of the tendon that connects the medial forearm muscles to the humerus. An error in the squat rack position often causes this issue, but the pain arises during the upper body lifts. Identify and fix the root cause, adjust programming and exercises to reduce pain during training, and understand that it takes time to heal.

Elbow Tendinitis

By: Dan Shell, BLOC Staff Coach

Elbow tendinitis is a real, well…pain in the elbow. This common malady afflicts many lifters at some point in their lifting career. It often occurs toward the end of the novice linear progression or the beginning of intermediate programming, when heavier weights cause form issues or the increased stress from the load accumulates into tendinitis. The pain normally occurs in the inside of the elbow, and lifters often complain about pain during the press and bench press. The squat, however, not the upper body presses, usually causes this pain.

Common Indicators of Elbow Tendinitis

Elbow tendinitis presents with localized pain where the tendons of your forearm muscles attach to your elbow on either side—indicating medial or lateral epicondylitis. Some people also experience a lingering dull ache, stiffness at the elbow and forearm, and weakness in the hands or wrists. Golfer’s elbow, or pain on the inside of the elbow, is most common with lifting-related pain. Because the pain shows up in the upper extremities, lifters tend to think their upper body lifts are the cause. It may come as a surprise when coaches look at their squat.

Besides pain, certain form-related indicators suggest to the coach that the squat is causing the tendinitis:

  • Bar above or beneath the rear deltoid “meat shelf”
  • High elbows, almost horizontal to the ground
  • Elbows rising during the execution of the squat
  • Wrists bending during the squat
  • Rounded upper body at the top of the lift (thoracic flexion)
  • Upper body rounds during the squat movement
  • Bar rolling up or down the back

Many of the above will occur together, boiling down to the importance of maintaining thoracic extension, starting with the bar in the correct position, and keeping the arms out of the movement:

If the lifter has a rounded upper back, the elbows will rise or begin high.

If the bar begins in the wrong position, it will want to roll up or down the back, and the lifter may lift the elbows to keep the bar in place.

The arms hold the bar in place during the squat; they should not bear weight. The arms should not have to fight against the bar rolling up or down the back. When the arms repeatedly raise to fight the movement of the bar or begin high, the tendons that connect the forearm muscles at the medial epicondyle of the elbow can become inflamed. This comes from a misunderstanding of how the arms contribute to pinning the bar into position or an incorrect upper body position.

Identify and Fix the Root Cause

A correctly-set upper back and rack position help keep the bar in place without stressing the tendons. Here are some things to look for in the correct low bar position:

  • Bar beneath the ridge of the scapulae sitting on the “meat shelf”
  • More vertical forearms, close to parallel to the back angle
  • Elbows stay still throughout the squat
  • Thoracic extension
  • Bar is secure throughout the movement

Ensure the bar is in the correct position on your upper back. It should sit beneath the bony ridge of your scapulae on top of the “meat shelf” of your rear deltoids. One way to identify this position is to roll the bar down your upper back and feel it roll over the bony ridge of the shoulder blade. The bar goes right beneath the bony ridge. Feel for that “meat shelf.” Squeezing your shoulder blades together and bringing your grip in close helps make the spot the rear deltoids create more pronounced.

Ensure that you maintain thoracic extension during the squat. Especially as the weight gets heavy, lifters may lose thoracic extension as they unrack the bar or during the movement of the squat. They may misunderstand that the “lean over” cue does not mean a rounding of the upper back. The rounding may also occur as they drive the bar up and feel the bar oppressively driving down on their back, feeling as if their back will collapse—that sensation that only a really heavy squat can deliver.

Certain cues can help prevent the rounding of the back. “Proud chest” is a common one. “Puff up your chest” is another. If you have an in-person coach, they can tactilely cue the chest up by putting their hand above your chest and trying to get you to touch it. They can also tell you in real-time whether you have thoracic extension or not.

Reduce Pain During Training

There are some things you can do to potentially alleviate stress to the elbows if the squat rack position is causing the tendinitis.

  • Thumbs-around grip on the squat
  • Upper body lifts before the squat
  • Remove unnecessary volume
  • Doctor-approved over the counter pain relievers

Using a thumbs-around grip may temporarily alleviate stress on the tendon. It is critical, however, that the rack position is fixed first. If the bar is not secure in the right position with thoracic extension, the weight of the bar will be felt by the wrists. This can cause pain and issues in the wrists.

You could adjust your workouts to put your upper body lifts before squats. If the squat is still inflaming the tendon, the upper body lifts will be completed before this stress causes pain. This means that if your squats continue to bother your elbows, you’re getting the upper body lifts—where pain likely pops up—done prior to the squats.

Eliminate any additional volume besides the big four lifts—the squat, deadlift, bench press, and press. Additional stress from accessory work is likely not warranted, especially if it has to be completed with pain or causes pain.

Some people find relief with NSAIDs, as the “itis” in “tendinitis” or “medial epicondylitis” means inflammation, and NSAIDs help reduce inflammation. Understand, however, that drugs come with risks, so do so understanding the potential risks. If you have questions, ask your physician.

Allow for Healing

Fixing the cause removes the underlying stress causing the inflammation. Alleviating pain allows for lifters to continue to train as the tendinitis bothers them. It takes time, however, for the tendons to heal. Understand that the pain will not go away overnight. In the meantime, you can and should continue to train.

For a lifter without a knowledgeable coach, managing training stress from the squat can be difficult. Getting a form check from a knowledgeable coach can help the lifter fix the form errors with confidence and ensure old form errors do not return. A coach can also help lifters deal with the frustration of continued pain without ending all training—it can be difficult to know whether form errors are continuing to stress the tendons or the tendon has simply not had enough time to heal.

Elbow tendinitis during squats can be painful and frustrating. Lifters who looked forward to training may lack the desire to go into the gym. Those who already struggle to get themselves into the gym have another obstacle they must overcome. With correct form and some simple changes, tendons can heal, and pain can be reduced or eliminated.

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