Unlike most of the posts on this site, the following pertains more to athletes than your everyday person. Specifically those who throw a lot e.g. baseball players, dodgeball players (had to throw that in there) and those who get inner elbow pain when lifting.
That’s not to say the information isn’t applicable to everyday people. For example, I’ve seen medial epicondylitis in a person who took a lot of blood pressure readings for work, due to grabbing the blood pressure pump all day. However, I see tennis elbow much more often in everyday people and golfer’s elbow in the athletic oriented.
Typically the cause of medial (inner) elbow pain is grabbing more with the hand/wrist than extending the hand/wrist. The wrist flexors and finger flexors become much stronger than the wrist extensors and finger extensors. If you’re wondering, flexors are on the front of the forearm, palm up side, and extensors are on the back of the forearm. In other words, if you’re looking at your palm, you’re looking at the side of the flexors. If you’re looking at the back of your hand, you’re looking at the extensors.
Lengthen the flexors, strengthen the extensors, and the golfer’s elbow pain typically clears up pretty easily.
I’ve been making a point that the finger flexors are also overworked because I often see people stretching the wrist flexors and not the finger.
Check out the below video. Watch the first few reps when I extend my wrists and you can see the right fingers barely move at all. Meanwhile the fingers on my left hand extend with the wrist. While having the wrist fully extended – which is symmetrical between wrists – I extend my fingers. Found on the third rep:
You can see while I have even flexibility between my wrists I do not have equal flexibility between my fingers. The left fingers extend back much further than the right.
If I’m not cognizant of making sure this imbalance doesn’t become too severe the inside of my right elbow will start to act up, giving myself golfer’s elbow. Some wrist pain can also come about too.
It’s pretty easy to keep something like this in check:
1) Perform the above exercise and try to extend the wrist/fingers further back each rep. This will generate a nice stretch in the forearm as well as help to strengthen the extensors. You can do this with the arm by your side, straight out in front of you, basically whenever. Just make sure the wrist and fingers are moving back and you’re not compensating by moving the elbow or shoulder.
Here’s an example of performing the exercise with the arm straight out in front of you. The opposite hand is on the elbow to help make sure the elbow and shoulder do not rotate. Also, in contrast to the stretching picture above, make sure the hand is pointed down:
Another variation is to use a wall. Keep the hand down, elbow nice and straight, and press the fingers into the wall. Below you can see how I have to press my fingers against the wall to make sure I’m stretching the fingers and not just the wrist. I prefer the above exercise but the wall will help reinforce straight fingers:
Also, performing some manual therapy on the medial epicondyle (inside of elbow) while performing the stretch will help even more and should give you some immediate relief:
3) To elicit more of a challenge throw a rubber band around the fingers as resistance.
-> Issues with the shoulder can contribute to elbow pain but the above typically gets people at least 90% pain free.
Lastly, I’ve seen more than a few people mistake tennis elbow for golfer’s and vice versa. Treatment for golfer’s elbow can make tennis elbow worse. Make sure you know which type you have! Or find someone who can tell you for sure.
Summing up: Take a small break from grabbing and throwing things, perform a crapload of exercise for the wrist/finger extensors, enjoy a pain free elbow.
yui
April 10, 2015
Hi, have a quick question. I play a lot of badminton, but when I extend my arm, i.e. straighten, directly perpendicular to the floor with an empty hand (and therefore not purposely activating any of the wrist/finger flexors/extensors), I feel pain in the medial epicondyle. Do you have any insights on this? Thanks.
reddyb
April 14, 2015
Hey Yui,
Pain with that movement is pretty common in medial elbow pain.
CP
May 5, 2015
Great Article.
I do have a little bit pain in my inner elbow (Golf elbow). I am 42 and do gym regularly. I have started to keep more focus on my exercise form and posture. Also I am trying to smartly choose my exercises. I hope my focus on complete arm exercise (out and inner forearm) and stretching will help me get over this niggle.
I have also started taking Omega3 in my meals.
Do u suggest anything else.
Thanks and regards
CP
reddyb
May 5, 2015
Hey CP,
I’d really give the recommendation in this article of not grabbing as much a significant consideration. Not just stretching and form. Sometimes no matter how good form is, a break from grabbing so much is needed.
There are some different things one can do exercise form wise, such as keep an open grip so you’re not grabbing as much, say during something like a bicep curl. But like I said, it depends on the person whether this ends up being enough.
CTAD
May 31, 2015
Hey Brian, I very recently started a new workout routine, and changed the way I strengthen grip (from farmers walks to grip clamps) and started to get a dull, somewhat throbbing pain in my elbow–definitely medial. I stopped lifting immediately and began ice massages and compression–this was 3 days ago. If I begin these stretches today, roughly how long will I have to take off before I can go back to lifting light weight? A week, two, a month?
reddyb
June 1, 2015
Very hard to say. Some info here though: http://b-reddy.org/2013/08/01/how-long-does-it-take-to-get-rid-of-chronic-pain/
My experience with elbow stuff is the moment something of this nature becomes apparent, that dull ache you mention, drastically cut back on anything grip oriented for a week or two, then reassess. Where you add a little bit of grip work back in at a time and see how things go. You don’t want to take a week off and then go see how heavy you can do farmer’s walks, for instance. If it’s a client of mine, I get rid of all grip stuff for at least a week. If they’re over 30 years old, it’s likely going to be at least two.
This is because elbow stuff takes forever to come back from. The reason for this, I believe, is because it’s so hard to limit grip work during the day. Do you type? That works the forearm and finger flexors enough that it tends to cause things to linger. Even if one takes some time off from grip work in the gym, they’re still going to be gripping during the day. It’s very hard to make activities of daily living elbow friendly nowadays. It’s very hard to give the gripping musculature a true break.
Tangential rant: Now, my experience with what most people actually do- They feel that dull ache. Take a day or two off. Go back to normal gym routine. Ache gets progressively worse. They buy an elbow strap. Ache gets a little better; then gets worse again. Maybe a few months go by. Finally the person is forced to take a break. In that case, it often takes a good few months for things to calm down. I’ve trained a few people who have done this to the point they can’t grip anything for a while. Trying to generate a training effect when you can’t grip anything is my personal definition of creativity.
There are certain things that are a bitch to get to heal. Elbow stuff is one of them. It’s not what to do that’s tough, it’s being able to do it. Because of this, it’s harder to predict timelines for feeling better.
Corshawn
June 17, 2015
I think that it’s golfer’s elbow as I feel pain when I do curls with weight. I’m going to start working on extension exercise with my fingers verses gripping exercises. Thanks for the tips.
reddyb
June 18, 2015
I would double check the pain you feel when curling is medial elbow. You can have tennis elbow symptoms when curling a weight, depending on how you curl it.
One quick check which usually works well is if you curl with your palm down and have pain, that’s typically tennis. If you curl with your palm up and have pain, that’s typically golfer’s.
Joe Bernard
June 26, 2015
Hey Reddy, do you have any experience with using a theraband bar and rotations to help heal elbow pain? I’ve had both medial and lateral tendonitis on and off for over a year and the medial pain just flared up again and I’m thinking about surgery. I took four months off last year to no avail, which is very frustrating. How often should I do the stretches you mention in the article?
reddyb
June 26, 2015
Hey Joe,
I think I know what you mean by rotations with a bar, but feel free to send a video for me to be sure. So, I believe I have experience with that movement, but not to help elbow pain. (Not something I would do.)
If you’re having medial and lateral issues, then just the stretches in this article are probably not enough. A more comprehensive look would be likely be needed.
The stretches here I typically do about 4 sets of 15 reps, every day, or every other day.
Remember, with elbow stuff, activities of daily living are *crucial.*
Joe Bernard
June 26, 2015
Reddy,
These are the two videos I’m referring to using the theraband bar:
https://www.youtube.com/watch?v=9P-QOaCoDWY&index=8&list=PLXw2hCQ7F_HboPAi1NGNLgpJA898QK8Uu
https://www.youtube.com/watch?v=we4UoiKG3Co&index=6&list=PLXw2hCQ7F_HboPAi1NGNLgpJA898QK8Uu
The first one is for golfer’s elbow and the second is for tennis elbow. I agree that the stretches are probably not enough but I’ll give them a shot with the frequency you suggested, I’ve never done it that frequently before. I am used to driving with my left hand (bad elbow side) so I’ll switch to my right and see what else I can switch.
This is an article from the NY times talking about the effectiveness of the theraband bar: http://well.blogs.nytimes.com/2009/08/25/phys-ed-an-easy-fix-for-tennis-elbow/?_r=0
I’m going to visit an orthopedist again soon to see because this has been a long-standing issue. Thanks for the tips.
reddyb
June 30, 2015
With elbow pain, it’s often chronic. At least a few weeks or more. At that point, we’re almost assuredly at tendinosis (things are breaking down and need time to catch up), not tendinitis. This is a distinction that guy doesn’t hit on in the video, which hurts some of the rationale he’s using.
Typically with elbow stuff, the person has been bombarding their elbow with work. Some (probably needs to be gentile) strengthening in the opposite direction can make sense at the outset, but the first goal is calm the elbow down. Some elbows are so jacked up any grabbing is going to flare it up.
The thing that I find is often forgotten here is if you type for work, you grab *a lot.* Your fingers are grabbing every time you hit a key. Then this is often in conjunction with a bunch of exercises where the person is grabbing more. I’ve had guys who are doing 8 different bicep exercises, 3 days a week, and sit at a desk 9 hours a day (AND are doing tons of other exercises all necessitating grabbing). Is strength really the problem? Do they really need more grip work? Again, maybe some very, very specific strengthening is ok, but calming things down is first priority. (This sometimes involves not typing, or significantly lessening typing, which can be quite hard for many to pull off.)
Or say strength was the problem. Where you could use the rationale “Their tendon or whatever is getting beat up because it doesn’t have the strength to handle the workload.” Alright, but think of it like someone who doesn’t have the strength to do a 400lb squat. Do you just throw 400lbs on their back and say, “We need more strength.” There’s more to it than that.
If you’re swinging a racquet a thousand times a day, and the muscles still aren’t strong enough, they could also be at their physiological limit. (Some more on tendinosis, rates of breaking down and building up, and more here if interested: http://b-reddy.org/2015/06/22/how-freaky-was-kyrie-irvings-knee-injury/ )
Then, once things are calm, some strengthening can come into play more.
As far as that NYT article goes-
That’s an all too common throwaway phrase from research. I’d have to dig in to that to really see. You can see what I mean in this post I did on shockwave therapy: http://b-reddy.org/2015/05/01/does-shockwave-therapy-have-merits/
Joe Bernard
July 1, 2015
Yea I definitely have tendinosis. My elbow is fine with typing and grabbing stuff, it just flares up now and again with golf. I agree with your logic, makes complete sense. So once the inflammation and pain with grabbing is calmed down, then you would start doing eccentric work, right? I don’t do direct bicep or tricep work so I was able to calm mine down and not re-aggravate it in the gym.
I know what you mean about studies and them being funded by the people supplying the product, so it’s possibly not 100% accurate. I’ll check out your two posts, thanks for taking the time to reply to my comments!
reddyb
July 3, 2015
Keep in mind even if typing and grabbing feels ok, that doesn’t mean it’s not part of the solution. You’re still gripping during those activities, so that musculature is still getting worked.
Could start doing eccentric work, or other grip work, yep.
I pretty much never do direct grip work though. Once I get someone back into regular exercises, that tends to take care of all the grip work one would need. Doesn’t mean some may not benefit from direct grip work though. Or, say you aren’t doing other gym exercises. Where golf is your one exercise. Then adding some grip work could be beneficial.
The other big consideration here is volume of golf work. A common mistake I see is X hurts, take some time off, go right back into Y activity which caused X to hurt…pain comes right back, take break again, go right back into Y activity, etc. A gentle ramp in volume after a break is often a necessity, but many take a break then go right back into the same amount of volume they were doing. In other words, it’s common to take time off from golf, then the first day back go do a round of 18, rather than perhaps only a few shots and see how that feels. Then to build from there.
Wrote about this here if interested: http://b-reddy.org/2015/02/23/the-biggest-mistake-recreational-athletes-make/
Peter
July 20, 2015
I have both tennis and golfer’s elbow. What can I do, especially, since you noted that exercises for medial worsens the lateral epicondylitis?
reddyb
July 21, 2015
What type of activities give you trouble?
More than likely, you need a nice break from gripping activities.
Peter
July 30, 2015
Bodybuilding, baseball
However, I have the ulnar impingement from medial epicondylitis for the past 2 months and no PT seems to totally resolve it. Good days and bad days kinda thing.
reddyb
August 1, 2015
Sometimes it’s not a matter of any therapy, but a matter of taking a break from gripping activities.
Slim
August 16, 2015
Been dealing with inner elbow pain for literally 5+ years. Never had it properly looked at by my doctor but I’ve suspected for sometime that it’s probably golfers elbow. Taken extensive time off from the gym, I’m talking 1-2 years at a time and as soon as I’m back to lifting the pain is just as bad as before. I also sometimes get a numb sensation and shooting pains down the elbow to the pinky finger even in a relaxed state. Something that wasn’t mentioned in this article (unless I completely overlooked it), is elbow clicking. I get this literally every time I do a bicep curl with my left arm, there’s an audible and painful click. I don’t believe it’s the bone but rather the tendon. I’ve always had a problem flexing my bicep even without weights, and because of this my left bicep is significantly under developed in comparison to the right. For the longest time thought it was a problem with the bicep itself. But I’m now beginning to think it’s because of nerve entrapment due to golfers elbow. Thoughts?
reddyb
August 18, 2015
Hey Slim,
A theme of some of the comments is you can adjust the gym stuff all you want, but if you don’t also adjust your daily life, you may not get very far. For instance, you may have taken 2 years off the gym, but did you take an extended break from typing? Or change how you typed? Or changed how you gripped things during the day? (I hit on this some here- http://b-reddy.org/2015/07/20/why-typing-annoys-your-neck-shoulders-elbows-and-wrists-and-what-to-do-about-it/ )
The gym may be a few hours a week, of which half might consist of gripping something. If you have a desk job, you’re working some of your forearm gripping muscles potentially 8+ hours a day.
As far as elbow sounds, those are very tough in my experience. I can’t say I have solid info for you on them right now.
Peter
October 14, 2015
So after my last note, I took time off from work and rejoined back last week after about 2 months. While I was off, I rested my arms totally. Pain went back down considerably but ulnar pain hasnt completely gone away. Obviously I cannot NOT work for ever, so I am back at office. What can I do to recover while I still do my job? Stretching flexors and supinators after 30-40 minutes? Heat and painkillers? How do I build the strength back?
reddyb
October 16, 2015
In terms of strengthening, what I usually do is just slowly get the person back in the weight room with gripping activities. That’s strengthening enough. For instance, when you do a bicep curl, that works the forearm musculature as well. I haven’t found a need for direct work in this capacity.
That said, some are fans of much more direct exercises. This has been discussed in the comments some. You may find it helpful.
In terms of work itself, you may be interested in this. It contains a lot about typing and making things upper extremity friendly: http://b-reddy.org/2015/07/20/why-typing-annoys-your-neck-shoulders-elbows-and-wrists-and-what-to-do-about-it/
Peter
October 14, 2015
Read supinators as extensors 🙂
Anthony
October 14, 2015
just done your finger stretching exercise i am amazed how well my inner elbow joint now feels . had constant pain for about 2 years ( 55 year old welder been griping a welding gun for 38 ) elbow is now making some noise but no pain.
cheers
reddyb
October 16, 2015
That’s great to hear Anthony! That’s exactly the type of job you’d expect this type of elbow pain to occur in.
Prince
December 29, 2015
Thank you I’ve gotten this from throwing quite a few baseballs. This will help.
reddyb
January 1, 2016
You’re welcome! Best of luck.
Justin
January 5, 2016
Great advice; I’ve searched for some time to find this valuable information. Thank you
reddyb
January 7, 2016
Thanks for the nice words Justin. I appreciate it.
nmninjasadmin
January 22, 2016
Over the years of lifting, I searched for help on this. Typical advice to lay off pulling exercises, etc. I have over the last several months moved into ninja obstacle course training – upper body, pull/grip, etc. intensive. And that pain was coming back. This article is of great help to this population and to me specifically. I have a blog dedicated to ninja obstacle competition and I try to get guest posts that help this population with training or recovery. This article is perfect and I want to use it, link to it or have you do a guest post about this and then I will get link backs to your pages and products. let me know what you think. the blog is https://nmninjas.wordpress.com/
reddyb
January 22, 2016
Hey (I believe it’s) James,
Linking back here would be great, thanks. I also have some stuff on tennis elbow, which your readers may be interested in too: http://b-reddy.org/category/pain-2/elbow-pain/tennis-elbow/
That’s a neat idea for a site. I’ll have to cruise around it some. Have some clients who are getting into that type of stuff. I hope it goes well.
nmninjasadmin
January 22, 2016
Hey Brian, yes this is James. I have added the article to my blog, linked back to you. thank you for thumbs up to post on my blog. I believe it can be useful for many others as it was for me. Thanks again!
reddyb
January 24, 2016
That’s great. Thanks!