Medial Elbow Pain

Pain & Rehab Forum [Moderated]
1

I have recently had increased levels of medial elbow pain from low bar squatting that is preventing me from pressing, benching, and squatting. My questions pertain to recovery.

History:
It’s a chronic injury from low bar squatting. I have been training for two years, and very soon into my LP I had elbow pain from low bar squatting. It was on both elbows, on the medial side. Hiring a SSC, we’d alleviate most of it for a little while, then it would come back. But we continued pressing on with low bar position, to my detriment. (I’m no longer working with him.)

Recently, it had been bothering me just on one side and had gotten much worse. I switched to high bar, but it was too late, I can’t tolerate that either now. I tried the NSAID protocol, but I believe in the absence of the pain feedback I pissed it off more by training it heavy. It has deteriorated to the point where I can’t press, and only bench around 85lbs w/o pain (from 240). In addition to pain, there’s also a small pop that developed during the lower part of the descent on bench and press.

I haven’t seen a orthopedic doctor yet, but my symptoms seem to be consistent with a UCL problem, rather than Medial Epicondylitis. My grip is solid, I recently pulled a DL PR, and chins are barely a problem (near @10 sometimes hurts). No pain from poking/pressing fingers around in the area. No pain through normal, unloaded ROM.

Questions:
Is it worth it to have imagining done at this point (at a large expense to me)? I’m thinking what you guys talk about for back injuries, that the only reason would be if I thought surgical intervention is necessary, but I can’t imagine it’s a full rupture of anything.

Which leads me to my next question, if I don’t get it professionally diagnosed: As a chronic, overuse type injury (assuming it isn’t a complete tear), are there differences to rehabbing this whether it’s a tendon or ligament issue?

I’m not sure where the balance is of training around it. Should avoid anything that aggravates it in the least, which basically means not training (even for a short time)? Or does it benefit healing from minor loading from DL/chins, and ridiculously light benching where I leave the workout with minor irritation that calms down a day or two after? I also have a SSB in the mail, which will allow me to squat again.

Grateful for any responses, Thanks!

2

Hey,

Thanks for the questions. I’m skeptical this is a UCL issue if you aren’t noticing instability to the area and/or decreased unloaded range of motion. If you aren’t concerned with surgery then imagining seems unnecessary at this time. Rehab is basically the same regardless (with the added caveat to be conscientious of joint stability if ligament is damaged). If you have full range of motion without issue and only are noticing symptoms with loading then I’d recommend start with the lightest load tolerable and slowly progress loading over time. My preferred method is high volume with low external intensity and would follow an LP like this: 3 x 15, 4 x 12, 4 x 10, 4 x 8, 4 x 6, 4 x 5, 5 x 3……etc. Watch your tempo and control the movement through both eccentric and concentric. For extremity stuff, I typically switch sensitized movements to dumbbell training to ensure appropriate loading of the area without too much compensation elsewhere. I don’t recommend stopping training. Yes, there will be benefit to keep loading the area, provided load is being managed appropriately.

3

Thanks, I appreciate the detailed response.

Is the popping that I mentioned during the eccentric on a bench (above 85lb) or press indicative of the instability you mention? That’s the only time I’ve noticed it. I guess I’m unsure of the symptoms of joint instability - is there further reading you could point me to?

I haven’t heard the term “external” applied to intensity, could you please explain a bit more?

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Hey! I wouldn’t get too hung up on the popping. Nothing you’ve said so far makes me think the elbow joint is at risk of dislocating. Instability is often described as a feeling of laxity to the area and concern by the patient of dislocation. There are low level tests to joints we can do to test out stability that are called stress tests to the area. For elbow it’s usually valgus and varus stress tests. But if you are loading the area during training, my radar for risk of dislocation goes way down. In regards to intensity, there are two ways to track it. External = load on the barbell would be one example and Internal = subjectively how difficult you find an exercise or training session; usually measured via RPE (Rate of Perceived Exertion) or RIR (Reps in Reserve). If you need further guidance, I’d be happy to consult with you. Contact Us | Barbell Medicine

5

Thanks for the added detail Michael. Ah, I was just more used to calling that absolute and relative intensity, respectively. Understood there’s limits to what you can do for free on the forum, appreciate what you’ve done so far.

I was recently was in contact with the crew for programming, which I was eventually planning on doing. But I didn’t think it was cost effective to be paying for that and not being able to effectively train my upper body. But a consult may be a good compromise. Thanks!