I’ve been experiencing some tendionpathy in my left elbow for about 2-3 weeks now. I assume it’s an overuse type injury, since the onset of the pain more or less corresponded with an increase in bench volume. The pain has been getting a little worse as time has gone on, but it’s still pretty manageable. Fortunately, it’s at its worst post training, not during, and I’ve been able to train normally without modifying loading. Still, it’s pretty annoying and has started to bother me a bit when I’m doing competition low bar squats.
In other circumstances, I would simply try pulling back a bit on the pressing volume and intensity, and maybe sub in more dumbbell and/or machine work. However, I’m currently 8 weeks out from my first powerlifting meet in almost two years, so I can’t really afford to make a lot of big volume/intensity changes or step too far away from competition specificity. What modifications to my training, if any, would you advise at this point? I recall that Austin has used reverse grip bench to train around elbow tendinopathy before - maybe I could try that or a Swiss bar for some of my assistance benching? Or, I could just continue with my meet prep as planned (as long as the pain continues to not negatively affect performance too much) and address the issue after the meet.
I would love to hear any thoughts you have. Thanks!
I’ll do my best to give you some tips for managing up until your meet and at 8 weeks out I don’t know that I would recommend dramatic changes in your overall plan. Without knowing your full training background and the variables involved it is hard to be too specific but the general heuristic is the same.
From a strictly “rehab” perspective, we tend to start with the heavy slow resistance training to specifically address the issue. So if this is pain on the outside of your elbow it would be dumbbell wrist extension and on the inside of your elbow wrist flexion. I tend to have my athletes do this at the beginning of the workout as it emphasizes the tendinopathy rehab as well as typically serves as a warm-up that let’s people tolerate movements more later in the session. In the normal form of dosing it looks like:
Weeks 1-2: 4 sets of 12 at RPE 9 at 3-0-3 tempo (so 3” up, 3” down)
Weeks 3-4: 4 sets of 10 at RPE 9 at 3-0-3
Weeks 5-6: 4 sets of 8 at RPE 9 at 3-0-3
Weeks 7-8: 4 sets of 6 at RPE 9 at 3-0-3
Weeks 9+: 3 sets of 10 at RPE 9 at 3-0-3
Depending on what your programming looks like, I would recommend keeping your comp lifts in at least 1x/week and just conceding that up until your meet you may have some waxing and waning symptoms. On your supplemental days you can use things like a football bar or straps for pulls to help take some of the load off your elbows while allowing you to accumulate the necessary volume/intensity you will need. As unfortunately ambiguous as this is, it is finding different variations in the interim that allows you to work through the issue.
After competition, I would recommend continuing on with the protocol listed above, but I also often have athletes do some grip specific work via a Captains of Crush or x-bands. Other useful means is to work different grips into training i.e. for pull-ups holding on to towels or doing a farmer’s walk with a pinch/lumbrical grip. Sometimes when we get symptoms like this it is due to getting a little too far into the specificity category and a little variation goes a long way to addressing symptoms.
Thank you so much for your response. I’ll try to provide some additional context if it helps. I’m a 29M, 6’1", ~210, and have have been strength training for about 6 years with 3 of those being powerlifting focused. I hope to hit something in the neighborhood of 460/325/580 at my upcoming meet. I train 4 days/week and my training is split up fairly similarly to how many of the strength/powerlifting specific BBM templates are in terms of placement of comp lifts and specific variations, comp lift frequency, etc.
I’m not exactly sure what reference point you’re referring to regarding the pain being on the “outside” or “inside” of my elbow. The entire elbow is painful when I’m experiencing symptoms, but if I had to specify what is most painful, I would say toward the radius, when the wrist is extended, and when my hand is supinated - so in your 3-0-3 dumbbell wrist protocol, would I be performing wrist extension or possibly both? Also, how often should I do it? I do some form of benching all 4 days/week that I train, so would you recommend I do it every session?
I will take your advice and try to continue “business as usual” (with the addition of the 3-0-3 dumbbell protocol) in terms of my main programming up through the meet, as long as my pain doesn’t significantly worsen and you believe I wouldn’t be risking additional damage in doing so. No apologies needed re: ambiguity of elbow friendly variations - in lieu of something more involved like a consult, I wouldn’t expect any super specific. After the meet is finished, I will tinker with things and find adjustments that work. I will also try implementing some grip specific training and alter the grips used for various pushing and pulling exercises. I agree that the intentional increase in specificity as of late is likely the culprit here, so I will definitely welcome some more variety in my training and movement patterns after the meet is finished.
Thanks again - I really appreciate all that you and the rest of the BBM team do!
Thanks for this, bookmarking it.
So is the general protocol for tendonopathy “heavy slow”? I recall hearing on a BBM podcast that light/high volume is a positive stimulus for healing muscle tears. Is there anything specific to rehab’ing bone “issues” like facet irritation/microfractures or the like?
To your question regarding flexion or extension, from your report I would say both. As a very general statement I don’t think there is anything inherently bad about additional grip work. I don’t know that I would do it all 4 sessions of training but likely shooting for 3. If you have one accessory day that is not as high on the intensity scale I would skip it in front of this one.
RVR-I would say this is close to the general protocol for heavy slow. Sometimes we tweak it contingent upon where and athlete is in season and how flared up symptoms are. We can’t really say with a high degree of certainty that facet issues are “a thing” as there is no good correlation between having facet changes and experiencing symptoms. For a microfracture it would be contingent upon the location and how far out the individual is from surgery. Typically there are pretty big restrictions on WBing in the initial phases post op and the goals for rehab are more retard atrophy versus hypertrophy until a certain healing window has transpired. For muscle injuries tempo tends to be a larger variable than anything else _initially_where you can load a muscle slow and heavy without much issue but when velocity comes into play, especially with a big eccentric deceleration that is where risk goes up.