Any athlete that trains hard for their sport may encounter some inner elbow pain at some point. The most common advice is to just stop lifting. But if you want to be a competitive athlete, you can’t afford to not keep up your strength and conditioning. It’s what gives you an edge. If you are a high school wrestler competing for the state title, you are not going to let a little elbow pain stop you from training and competing. Continue reading to learn how to continue training and reduce inner elbow pain at the same time.

What is Medial Epicondylitis?

inner elbow pain

Lift long enough and hard enough and you will probably get pain on the inside of your elbow, and this is most likely a condition called Medial Epicondylitis (ME), often referred to as Golfer’s Elbow. Athletic activities that increase risk for developing ME are: golfing, tennis, rock climbing, weight training, and throwing a football, baseball, or javelin. ME is a form of tendonitis that happens when the tendinous sheath located at the medial epicondyle of the elbow becomes inflamed. This sheath is the attachment point for multiple muscles that flex the fingers and wrist and pronate the forearm.

What causes Medial Epicondylitis?

ME can come from overuse, imbalanced training, improper technique, poor nutrition (eg. food intolerances and alcohol), and even some medications such as the antibiotic Cipro. The key to getting better faster is first to stop any activities that trigger and contribute to the pain, and then to strengthen and stretch the muscles involved.

What weight room exercises may contribute to Medial Epicondylitis?

The weight room can be both a cause and a solution to ME. The first step to getting better is to identify what movements may be contributing to the inner elbow pain and to then either stop these activities or perform them in a way that is not injurious.

Certain exercises will be red flags. Watch out for:

  • Exercises where you bend the elbow against resistance
  • Exercises where you flex the fingers or wrist against resistance
  • Exercises that create resisted pronation.
  • Exercises that requires a strong grip utilizing the forearm flexors

Here is a list of specific red flag movements that could be contributing to your elbow pain.

Upper Body Exercises

  1. Wrist Curls
  2. Bicep Curls
    1. A supinated grip will be the worst offender
    1. A narrower grip will usually be worse
  3. Upper Body Multi-Joint Pulling Exercises: Lat pulldowns, all forms of pullups and lat rows
    1. A supinated grip will be the worst offender
    1. A narrower grip will usually be worse
  4. Dumbell and Barbell Shrugs

Lower Body Exercises

  1. Step-ups with Dumbbells
  2. Dumbell Lunges or Split Squats
  3. Dumbell or Barbell Deadlifts and Deadlift Variations

This means lower body exercises that involve grip may be triggers.  Keep in mind that some exercises that are “triggers” can also be “fixers” such as wrist curls when integrated at the right time in the right dose may also fix the issue as they will make the muscle and tendon stronger.

How do you organize a workout so you can train hard and fix your elbow pain?

Now that you know the possible weight room triggers, you can organize your training in a way that not only lets you keep training hard but train either pain-free or with less pain. Follow this sequence for your exercises.

A1) Stretch the forearm flexors and pronators.

This is simple to do. Simply straighten your arm, extend your wrist and fingers, and supinate your hand. It works best to push against a flat surface such as a wall or a chair. You may also use your other hand. Hold for 30 seconds. Stretch prior to exercise or paired when training upper body red flag exercises to diminish the pain.

A2) Train wrist extension.  

Often tendonitis is due to a muscle imbalance. In this case, training the opposite muscles is one of the ways to restore balance and possibly eliminate the pain. Start with 15-25 reps and go no lower than 10-15 reps.

A3) Train a chest, anterior deltoid, or tricep exercise before attempting a bicep or back exercise in A4.

This will use muscles that are the antagonists to the muscles that attach to the medial epicondyle and will help to relax the tissue through a process called reciprocal inhibition. To increase your training capacity, start your program with some wrist extension, or when you want to train any upper body pull red flag exercise, pair this with a wrist flexion exercise.

A4) Try adding an exercise that involves the forearm flexors or forearm pronators.

Usually the best place to start is a row, pulldown, or pullup all with a pronated grip. The pronated grip will be better tolerated than a supinated or semi-supinated grip. Also, always use wrist straps to spare your grip. This will reduce the pain tremendously. Be sure to use straps on lower body red flag exercises.

Adding in wrist flexion for high reps is the next progression. (15-25 reps). Isolated pronation training is also a great place to start. When adding in bicep work, a hammer grip seems to work best. We have seen the most success with low pulley cable bicep curls from a preacher curl using a hammer grip on a rope (see video demo). This seems to be the least strenuous to ME.

Pro Tips:

  1. Spare your grip. Be sure to always use straps on upper body pulling exercises and any of the lower body red flag exercises
  2. Get some soft tissue therapy such as Active Release Therapy or try massaging and rolling out the tissue.
  3. Your nutrition really makes a difference. Eating and drinking bad calories takes away from your capacity to heal. Key in on water, protein, and plant foods to accelerate healing. There are many anti-inflammatory nutrients that can accelerate healing as well such as proteolytic enzymes and curcumin or turmeric.
  4. Not fully straightening the arm on curls, rows, pulldowns and pull-ups is one of the possible contributors to ME. Also, too much fat grip training or pulling exercises without enough pushing exercises can be a cause.
  5. If you are not getting better, seek medical advice.