Why Your Elbows Hurt During Skull Crushers: Common Injuries and Mechanical Issues

Written by: Nurudeen Tijani (Wellness and Pain Relief Fitness Coach)

Nurudeen performs skull crushers in a gym

I've been lifting for ten years and have personally experienced and overcome elbow pain from performing skull crushers.

In this article:

I’ll explain the causes of this issue and suggest alternative triceps exercises you can try.
I’ll also share treatment exercises and a detailed program to fix and prevent elbow problems.

Injuries That Cause Elbow Pain During Skull Crushers

The two primary injuries that cause pain during skull crushers are triceps tendonitis and golfer’s elbow.

Both conditions stem from excessive tension and stress on tendons caused by restricted or tight muscles. These restrictions overstretch and inflame tendons, leading to discomfort or pain.

Here is a list of common elbow injuries that can occur during skull crushers. These injuries are listed based on prevalence among lifters performing this exercise.

Follow the links below to learn more about each specific condition.

Triceps Tendonitis (pain at the back part of the elbow): Triceps tendonitis occurs when the tendon connecting the triceps muscle to the elbow becomes inflamed due to repetitive stress or improper form. This condition often arises from restricted triceps muscles, which can overload the tendon during the extension phase (where you move the barbell or weights back to the starting position from above your head). Learn more about triceps tendonitis.
Golfer's Elbow (pain at the inside part of the elbow): Golfer’s elbow, also called medial epicondylitis, involves irritation or inflammation of the tendons at the inside of the elbow. This condition often arises from a narrow grip, poor wrist positioning, or restricted wrist flexor muscles, which can overload the tendon during the eccentric phase of the exercise (when lowering the barbell or weights towards your head). Learn more about golfer's elbow.
Brachioradialis Tendonitis (pain at the outside of the elbow near the forearm and triceps): This condition involves irritation of the brachioradialis tendon and can occur when using improper grip width or performing the exercise with heavy resistance. It is distinct from tennis elbow or triceps tendonitis.
Tennis Elbow (pain at the outside part of the elbow): Tennis elbow, or lateral epicondylitis, results from overuse and strain on the tendons at the outer elbow. The repetitive motion and improper arm alignment during skull crushers can exacerbate this issue. Learn more about tennis elbow.
Distal Bicep Tendonitis (pain in the lower biceps near the elbow): This injury occurs due to inflammation of the tendon connecting the biceps to the elbow. Using excessive weight or poor control during skull crushers increases the likelihood of this condition. Learn more about distal bicep tendonitis.
Brachialis Tendonitis (pain at the crease of the elbow): This condition affects the brachialis tendon, which runs at the front of the elbow. Sudden or heavy resistance without proper warm-up can cause this injury, leading to discomfort in the elbow crease. Learn more about brachialis tendonitis.

Tip: Recognizing these injuries early and addressing the underlying cause—restricted muscles—is critical. A holistic approach to treatment, including addressing the entire arm, such as the triceps, biceps, and forearm, can effectively fix and prevent elbow issues during skull crushers.

Ready to get started? Yes, I’m ready to eliminate pain .

Skull Crushers Specific-Issues and Elbow Mechanics That Cause Pain

This section explains specific factors related to skull crushers that can contribute to elbow pain.

While the details below highlight unique issues and mechanics, the underlying cause for most individuals remains the same: muscle stiffness. When muscles are pliable and flexible, many of these issues become less significant.

Type of Grip

The grip you choose can have a significant impact on the tendons and muscles around the elbow. Here’s how different grip styles can influence elbow mechanics:

Overhand vs. Underhand: An overhand grip often places additional tension on the forearm extensors, while an underhand grip may overload the triceps and forearm flexors, potentially aggravating the tendons.
Neutral Grip: This grip style typically reduces stress on the elbow by keeping the wrist and forearm in a more natural alignment.
Wide vs. Close Grip: A wide grip increases pressure on the outer elbow tendons, while a close grip shifts tension to the inner elbow. Both require proper form to avoid discomfort.

Type of Bar Used

The bar you choose for skull crushers can affect elbow strain and overall tendon health. Each bar type has unique mechanics:

Barbell: A straight barbell may force the wrists and elbows into less ergonomic positions, increasing tension on the tendons, especially if grip width is not properly adjusted.
EZ Bar: The angled grip of an EZ bar provides a more natural wrist position, reducing stress on the elbows compared to a straight barbell. This is a popular choice for skull crushers due to its ergonomic design.
Swiss Bar: With its neutral grip handles, the Swiss bar minimizes strain on the wrists and elbows, making it ideal for individuals who experience discomfort with other bar types.

Type of Weights or Resistance Used

The type of resistance you use during skull crushers can significantly impact elbow mechanics and tendon stress. Here’s a comparison of the most common options:

Dumbbells: Dumbbells allow for greater freedom of movement and a natural range of motion, which can reduce tension on the elbows. They also help ensure equal workload distribution between arms, minimizing imbalances.
Barbell: While effective for targeting the triceps, a barbell can restrict the wrists and elbows to a fixed position, potentially leading to increased stress if alignment or grip width isn’t optimal.

Type of Machine Used

The equipment you use for skull crushers can influence elbow stress. Here’s a comparison of common machine options, ranked from least to most impact on the elbow:

Cable Machines: Cable machines provide smooth, adjustable resistance that minimizes jerking motions, reducing pressure on the elbow tendons. This setup allows for precise control over the movement, making it a good choice for individuals with elbow discomfort.
Stationary Machines: These machines offer guided movement paths that stabilize the exercise. However, improper alignment or fixed grips may still place undue stress on the elbow tendons, especially if the setup isn’t customized to the lifter.
Smith Machine: While the Smith machine provides additional stability, its fixed bar path can limit natural movement, potentially increasing tension on the elbows if not performed with proper mechanics.

Bar Path

The path the bar travels during skull crushers directly affects elbow mechanics and tendon stress. A proper bar path ensures the movement is efficient and minimizes unnecessary strain.

Improper Bar Path: If the bar drifts too far forward or backward during the lift, it can force the elbows into unnatural angles, increasing stress on the tendons and joints.
Optimal Bar Path: The bar should move in a controlled arc, staying aligned with your wrists and elbows throughout the movement. This reduces unnecessary tension and ensures the triceps are the primary muscles engaged.

Uneven Hand Position or Alignment on the Bar

Misalignment of the hands on the bar can create uneven force distribution, leading to imbalances and added stress on the elbow tendons.

Causes: Uneven hand placement, whether intentional or accidental, often results in one arm overcompensating during the lift. This overcompensation can irritate the tendons and muscles on the dominant side or the side bearing more load.
Prevention: Ensure your hands are evenly spaced and properly aligned on the bar before starting the movement. Using markers or knurling on the bar as a guide can help maintain symmetry.

Overall Tendon Stress

Tendon stress is a common issue during skull crushers, often stemming from improper technique, excessive load, or restricted muscle flexibility.

Causes: Tight or restricted triceps and forearm muscles can increase tension on the tendons, making them more susceptible to irritation and overuse injuries. Rapid increases in weight without proper progression can also overload the tendons, leading to discomfort or pain.
Prevention: Gradually increase weight and focus on proper warm-up routines to enhance muscle flexibility. Incorporating self-myofascial release (SMR) techniques and stretching can help reduce overall tendon tension and improve exercise mechanics.

Degree of Elbow Bend

The degree to which you bend your elbows during skull crushers can significantly influence tendon tension and overall comfort.

Over-Bending the Elbows: Excessive bending during the lowering phase can overstretch the triceps and place unnecessary stress on the tendons at the back of the elbow. This is particularly problematic for individuals with restricted triceps flexibility.
Under-Bending the Elbows: Insufficient bending limits the range of motion and reduces triceps activation, often shifting the load to the elbows and wrists instead.
Optimal Elbow Bend: Aim for a natural bend where your forearms point straight up toward the ceiling at the lowest point of the movement. This ensures the triceps are effectively targeted while minimizing undue strain on the tendons.

Weight Load and Joint Compensation

Using excessive weight during skull crushers can force your body to compensate in ways that stress the elbows and surrounding joints.

Excessive Weight: When the weight is too heavy, it often leads to improper form, causing the shoulders or wrists to take on additional strain. This can irritate the elbow tendons over time.
Compensatory Movements: To manage the load, lifters may unintentionally flare their elbows or shift the bar path, increasing the pressure on the elbow joints.
Optimal Load: Choose a weight that challenges your triceps without compromising form. Focus on controlled movements and avoid relying on other joints to "cheat" the lift.

Type of Bar Used (Thick vs. Thin Bar)

The thickness of the bar used during skull crushers can affect your grip and elbow mechanics, potentially leading to discomfort.

Thick Bar: A thicker bar can be harder to grip, causing more tension in the forearms and wrists. This extra effort can transfer stress to the elbow tendons, especially for those with smaller hands or less grip strength.
Thin Bar: While easier to grip, a thin bar can lead to instability, causing the wrists or elbows to overcompensate. This instability can create uneven pressure on the tendons.
Choosing the Right Bar: Select a bar thickness that allows for a secure grip without overloading your forearms. For most people, a standard EZ bar or barbell provides a good balance of comfort and control.

Misalignment of Weights

Misaligned weights during skull crushers can lead to uneven force distribution, causing unnecessary stress on the elbow tendons.

Causes: Misalignment often occurs when one side of the bar or dumbbell is heavier than the other or when the weights aren’t secured properly. This imbalance forces one arm to bear more of the load, increasing tension on the elbow of that arm.
Prevention: Always ensure that weights are evenly distributed and securely fastened before starting the exercise. For dumbbells, focus on maintaining consistent movement and positioning in both arms.
Benefits of Proper Alignment: Balanced weights ensure that both arms work equally, reducing the risk of tendon irritation and promoting better triceps activation.

Type of Workout Program

The structure of your workout program can influence the strain placed on your elbows during skull crushers, particularly if the exercise is overused or poorly integrated.

Repetitive Stress: Repeating the same movement patterns with excessive weight or frequency can lead to repetitive stress injuries in the elbow tendons. Overusing the same motion prevents tendons and muscles from recovering properly.
Lack of Variety: Programs that fail to incorporate alternative triceps exercises can increase tension on the elbow tendons, as they don’t allow other muscles to share the workload.
Balanced Programming: Include a variety of triceps exercises, such as pushdowns or close-grip bench presses, to reduce repetitive strain and allow for balanced muscle development.

Overly Extended Wrists

Bending your wrists too far backward during skull crushers can increase tension on the wrist flexors and strain the connective tissues at the inner elbow.

Causes: Overextension of the wrists often happens when the bar or weights are not properly aligned with your forearms. Using a barbell or weight that is too heavy can also force the wrists into an unnatural position.
Impact: This can lead to discomfort in the wrists and inner elbow, as well as reduced triceps activation due to improper form.
Prevention: Maintain a neutral wrist position throughout the movement. Consider using wrist wraps for additional support, especially if you are lifting heavier weights. Choosing an EZ bar or dumbbells can also help promote a more natural wrist alignment.

Wrist Stability

Poor wrist stability during skull crushers can disrupt form and increase strain on the elbow tendons.

Causes: Weak wrist stabilizers or improper grip can cause the wrists to wobble or bend excessively during the exercise, transferring tension to the elbows and forearms.
Impact: Instability in the wrists reduces control over the movement, making it harder to isolate the triceps effectively. It can also lead to discomfort or injury in the wrists and elbows.
Prevention: Strengthen the wrist stabilizers with targeted exercises, such as wrist curls and reverse wrist curls. Using equipment like wrist wraps can provide extra support and improve stability. Additionally, ensure a secure grip on the bar or dumbbells to minimize unnecessary movement.

Tip: By improving muscle pliability with SMR exercises, most of these issues resolve themselves. The TitaniumPhysique program can help you achieve pliable muscle.

Ready to get started? Yes, I'm ready to eliminate pain .

Alternative Exercises to Avoid Pain

If skull crushers are causing elbow discomfort, consider these alternative exercises. They target the triceps effectively while reducing stress on the elbow tendons:

You can find instructions of the exercises below on the JEFIT exercise library.

Cable Tricep Pushdown (Rope or V Bar): This exercise allows for controlled movement and a neutral wrist position, minimizing stress on the elbows. The adjustable resistance also lets you tailor the load to your comfort level.
Machine or Cable Kneeling Tricep Extension: By using a machine or cable setup, you benefit from a guided range of motion that reduces unnecessary strain on the elbows. Kneeling adds core engagement for additional stability.
Cable Tricep Kickback: This isolates the triceps without the need for heavy weights or awkward wrist positions, making it a joint-friendly alternative to skull crushers.
Band Back Flys: While primarily a back exercise, this movement engages the triceps and helps build stability in the shoulders and arms, indirectly supporting elbow health.

Additional Helpful Tips to Avoid Pain:

To avoid pain, incorporate these alternatives into your routine alongside stretching and myofascial release techniques. Stretching the triceps and forearm muscles between sets helps improve flexibility and reduce tension in the elbow tendons. Here's a quick demonstration of the overhead tricep stretch by ACE Fitness. However keep in mind that stretching alone will not resolve the underlying causes of elbow pain.
For targeted relief, use elbow self-myofascial release exercises to relax tight muscles before your workout.

For a simple-to-follow video course to eliminate elbow pain, check out the TitaniumPhysique program. Yes, I’m ready to eliminate pain .

Next Steps and Helpful Resources

Treatment Exercises: If you're looking for exercises to fix "elbow pain from skull crushers," check out this post and photos: Elbow Tendonitis Treatment and Relief Exercises. I demonstrate simple exercises using self-myofascial release (SMR), a highly effective method for addressing muscle and tendon pain.
Comprehensive Guide with FAQ: For a complete guide on elbow pain related to lifting, get the details in this article. It covers the root causes of elbow pain, common injuries, elbow anatomy, exercise mechanics, treatment options, and a detailed FAQ section packed with valuable insights.
Tendon Relief Program: For an easy-to-follow video course to fix "elbow pain from skull crushers," consider the TitaniumPhysique program. It’s the fastest way to eliminate and prevent elbow pain. In the program, I teach SMR techniques that provide instant relief. Trusted and used by athletes and bodybuilders, the program boasts a 98% satisfaction rate.

Ready to begin? Yes, I'm ready to heal my elbow .

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