Tennis Elbow: Managing Elbow Pain for Weightlifters

Nurudeen Tijani (T.J.) Founder of TitaniumPhysique | Pain Relief Fitness Coach

Written by: Nurudeen Tijani
Last updated: June 3, 2024

I've been lifting for ten years, and I've dealt with and overcome many elbow injuries. This exercise fixed my elbowsFor weightlifters, the primary cause of tennis elbow (pain outside the elbow) is restricted wrist extensors that strain the common extensor tendon during push movements. To prevent discomfort, maintain pliable forearms through self-myofascial release exercises. These exercises can instantly relieve the restrictions in the muscles and minimize the risk of injury, overuse, and inflammation.

Take the first step to eliminate muscle and tendon pain. Get Started Now.

An illustration of the forearm extensors muscles and tennis elbow

Listen to the article: 15 minutes

YouTube video

Understanding Tennis Elbow


Why does the outside part of my elbow hurt from lifting? How do I fix it?

Pain on the outside of the elbow can occur for several reasons:

  1. Restricted forearm/wrist extensors (shortened, tight, and tense muscles)
  2. Inadequate stretching and warm-up of these muscles before exercising
  3. Excessive resistance
  4. Poor lifting form or technique
  5. Overtraining
  6. Inadequate recovery
  7. Lack of myofascial release

These factors, individually or in combination, can cause discomfort at the outer part of the elbow. Yet, for most people, the primary cause is restricted forearm/wrist extensors that strain the extensor tendon due to lack of myofascial release.

To prevent this condition, prioritize proper form, gradually increase resistance, allow adequate rest periods, and, most importantly, maintain pliable forearms through self-myofascial release (SMR) exercises.

SMR involves using tools like foam rollers or massage balls to release tight and tense muscles. Restricted muscles exert tension and strain tendons. When you release these muscles, they become more pliable and elastic, reducing the pulling tension on the tendon and joint.

SMR is the fastest way to treat and alleviate muscle and tendon pain. Follow the step-by-step guidance of the TitaniumPhysique Program to see fast results. Get Started Now.


What is tennis elbow?

Also known as lateral epicondylitis, this overuse injury causes pain at the outer part of the elbow joint due to inflammation of the common extensor tendon.

Lateral elbow discomfort results from strain during repetitive movements and exercise in weight training. It can develop gradually over time (chronic) or occur suddenly (acute) from overloading the tendon.

Here are the signs and symptoms of this condition:

  • A burning sensation or pain on the outer part of the elbow
  • Tenderness, swelling, and soreness in the elbow
  • Sharp, shooting, sudden, severe, or dull pain on the outside part of the elbow
  • Difficulty bending and straightening the arm
  • Weak grip strength
  • Difficulty performing activities or exercises that require wrist extension
  • Pain that radiates from the outer elbow down the forearm
  • Increased pain when applying pressure to the affected area
  • Stiffness and limited range of motion in the elbow joint
  • Pain that worsens with repetitive movements or gripping activities
An illustration of the forearm extensor muscles and tendon

An illustration of the forearm extensors and the common extensor tendon.

Can you get this condition from weight training?

Yes, you can develop tennis elbow from lifting. For example, "push" exercises like the overhead press, bench press, or tricep pushdowns can trigger acute pain or worsen chronic discomfort.

However, it's essential to understand that weight training is not the underlying cause of this condition. The root causes of elbow tendonitis injuries include chronic inflammation, magnesium deficiency, and muscle restriction.

For a deep dive into the root causes of elbow tendonitis, elbow bursitis, chronic versus acute pain, and the fastest way to fix these conditions, check out these helpful resources:


Why do I suddenly feel pain on the outside part of my elbow without an apparent cause?

The muscle conditions that lead to outer elbow discomfort develop gradually and cumulatively. Over time, the repetitive use of the forearm extensor muscles can lead to muscle restriction, causing them to become shortened and inelastic.

This process of muscle restriction can take months or even years to develop.

When the forearm extensors are chronically restricted, everyday activities at the gym, working out, picking up weights, and gripping exercise bars or dumbbells can unexpectedly trigger pain without an apparent cause.

Unfortunately, most people are often unaware of the restricted state of their forearm extensors until they experience this sudden onset of pain during these activities. This point is the biggest takeaway from this article.

Whenever someone tells me they have elbow issues, I show them how to perform the forearm pliability test (see the video below).

During the test, most people will feel a dull but intense pain in the area, usually within a few seconds. Every time I have performed this test on friends at the gym, they are surprised by the tense and restricted states of these muscles.

YouTube video

In this video, I demonstrate how to perform the forearm pliability test to discover the hidden/root cause of most elbow tendonitis injuries.

Can muscle tension from lifting contribute to pain in the outer elbow?

Yes, tight muscles in the forearm can contribute to tennis elbow. Muscular tightness is one of the root causes of elbow tendonitis.

The forearm extensor muscles can become restricted when you lift weights over an extended period. This restriction occurs as the muscles shorten, tighten, and tense up due to muscular contraction, overuse, and a lack of myofascial release.

The shortened muscles exert increased tension on the common extensor tendon (the tendon on the outer part of the elbow), reducing its elasticity. As a result, the tendon becomes strained and inflamed, causing discomfort.

Further muscle tension in the forearm can contribute to related elbow issues like golfer's elbow or triceps tendonitis.


What's the difference between tennis elbow and brachioradialis tendonitis?

Both conditions are different types of elbow tendonitis and affect different tendons, but their symptoms can be felt on the outer part of the elbow joint. They cause pain, discomfort, and inflammation.

  • Tennis elbow is irritation or inflammation of the common extensor tendon that attaches the forearm extensor muscles to the outer part of the elbow. This condition causes pain at the lateral epicondyle (the bony bump at the bottom of the humerus, the upper arm bone).
  • Brachioradialis tendonitis is inflammation or irritation of the brachioradialis tendon, which connects the brachioradialis muscle from the humerus to the forearm bone (radius). This condition causes sharp pain that can be felt on the outside part of the elbow joint at the bottom of the upper arm bone (near the triceps).

So there is a chance that pain at the outer part of the elbow could be tendonitis in the brachioradialis muscle.

An illustration of tennis elbow vs brachioradialis tendonitis

This photo illustrates the difference between lateral epicondylitis and tendonitis of the brachioradialis.

Impact of Tennis Elbow


Is tennis elbow typical among gym-goers and weight-lifting athletes?

Yes, this condition is typical among individuals who lift weights.

Popular exercises commonly performed by weight lifters, including bench press, overhead press, push-up, pull-up, tricep pushdown, tricep dip, and machine chest press, contribute to the development of this condition.

According to the National Health Service, tennis elbow is the most prevalent cause of persistent elbow discomfort, accounting for two-thirds of cases.

Back in the days when I experienced persistent elbow issues, I remember having more occurrences of pain on the outside part of my elbow than other types of injuries (golfer's elbow and triceps tendonitis).


Will this injury go away by itself?

The acute symptoms of lateral epicondylitis can go away with rest.

However, the underlying factors contributing to this condition, such as restricted and tense forearm muscles, do not resolve on their own. For many athletes and weight lifters, it often worsens over time.

Here's why: the root causes of this tendonitis injury include chronic inflammation, magnesium deficiency, and muscle restriction.

Firstly, once a muscle becomes restricted and dysfunctional, it tends to remain in that state or worsen unless specifically addressed.

Secondly, muscle dysfunction is often associated with magnesium deficiency. "The Magnesium Miracle," a scientific reference on the health effects of magnesium, highlights that around 40% of magnesium in the body is in the muscles. A significant portion of the population is magnesium deficient.

Heavy exercise, physical activity, and various factors like caffeine, stimulants, diuretics, stress, and dehydration can deplete magnesium levels in athletes. These factors are one reason why restricted muscles persist and worsen.

Thirdly, chronically restricted muscles eventually become dysfunctional and stop working correctly. This condition leads to repeated injury and stress on the common extensor tendon, resulting in chronic tendonitis (i.e., chronic tennis elbow).

Generally, when the injury first occurs, the forearm extensor tendon experiences micro-tear damage (medically known as tendonitis). As fitness training continues, the tendon condition deteriorates and degenerates (tendinosis).


What happens if tennis elbow is left untreated?

  1. Tendon deterioration: If left untreated, this condition can progress and lead to the degeneration of the common extensor tendon. Collagen in the tendon deteriorates, weakening it over time and increasing the risk of tendon tears or ruptures. Medically, this condition is known as elbow tendinosis.
  2. Elbow arthritis: Left untreated, it can contribute to autoimmune conditions like elbow arthritis.
  3. Forearm, wrist, and hand pain: When restricted muscles in the forearm are left untreated, they become dysfunctional and cause pain in the wrist, forearm, and hand.

Managing Pain Outside the Elbow


Can I still lift weights or work out?

It depends on the severity of the pain and injury. If it's mild, you can use conventional pain relief medicine or short-term remedies such as sports or kinesiology tape, elbow sleeves, braces, or straps to reduce discomfort during exercise. However, if it's chronic, severe, or causes sharp pain, it's best to treat the underlying cause of the tennis elbow before resuming exercise.


Which exercises should I avoid?

Avoid "pressing" or "push" exercises. These exercises require an overhand grip and can place excessive load on the forearm extensors and strain the common extensor tendon.

Here's a list of 10 exercises to avoid if you have tennis elbow:

  1. Bench Press
  2. Shoulder and Overhead Press
  3. Push-Ups
  4. Pull-Ups
  5. Tricep Dips
  6. Tricep Pressdown
  7. Reverse and Hammer Curls
  8. Heavy Upright Rows
  9. Lat Pulldowns (overhand grip)
  10. Overhead Tricep Extensions
YouTube video

In this video (2017), I perform tricep dips.

What upper body exercises can I perform?

If you're still training while recovering from tennis elbow, there are a few essential things to remember.

  1. Replace "push" and "press" workouts with "pull" and "fly" exercises.
  2. Opt for resistance band or cable machine variations of exercises instead of using barbells, dumbbells, and stationary machines.
  3. Consider performing partial reps, where you don't fully bend or extend the arm during the movement. This modification can help reduce strain on the tendon and alleviate pain.
  4. Use less resistance and focus on performing more repetitions.

Here's a list of 26 upper body exercises you can try. These exercises put a lighter load on the forearm extensors and elbow tendon while effectively engaging the upper body muscles.

You can find most of these exercises on the JEFIT exercise database.

Back Exercises:

  • Lat Pulldown (using Resistance Band)
  • Wide-Grip Lat Pulldown (with Palms Facing In)
  • Rows (using Resistance Band)
  • Machine Assisted Pull-Up (using Hammer Grip)
  • Full Cobra (Supermans)
  • Back Hyperextensions
  • Machine-Assisted Dead Hang Stretch
  • Back Fly (using Resistance Band)
  • Dumbbell Reverse Fly

Shoulder and Arm Exercises:

  • Machine Deltoid Raise
  • Cable Upright Row
  • Dumbbell Shrugs (lower weight, higher reps)
  • Lateral Raises (with a Resistance Band)
  • Front Raises (with a Resistance Band)
  • Close Grip Dumbbell Press
  • Machine Tricep Extension
  • Machine-Assisted Tricep Dips
  • Cable Kneeling Tricep Extension
  • Bicep Curl

Chest Exercises:

  • Cable Chest Fly
  • Cable Chest Crossover
  • Chest Fly (using Resistance Band)
  • Wall Push-Up or Kneeling Push-Ups (with Wide-Arm)
  • Dumbbell Pullover (with Straight Arm)
  • Machine Inner Chest Press (with Palms Facing In)
  • Machine Fly (using Pec Deck Machine)
YouTube video

In this video (2023), I perform wide-grip cable lat pulldown (with palms facing in).

Can compression sleeves help?

Yes, compression sleeves, such as elbow wraps, straps, and support braces, can alleviate discomfort from exercise.

However, it's essential to consider the pros and cons of using compression sleeves to manage tennis elbow.

Pros: Elbow compression sleeves provide compression, which improves blood flow, enhances joint position awareness (proprioception), and offers support to the muscles and tendons surrounding the elbow joint. The compression promotes better circulation, stabilizes the joint, reduces swelling, alleviates pain, and can help prevent further damage during intense workouts.

Cons: Relying only on sleeves for pain relief can mask the underlying problem, allowing athletes to continue lifting without addressing the root cause of their pain. This masking will further perpetuate the injury and potentially lead to long-term degenerative conditions in the elbow.

YouTube video

In this video (2017), I perform bench presses while wearing elbow sleeves to manage pain.

YouTube video

In this video (2021), I perform variations of bench presses.

Healing and Prevention


How long does it take to heal a tennis elbow?

By combining post-workout treatments such as cold therapy (to relieve burning pain), magnesium supplementation (to reduce inflammation), and self-myofascial release (to alleviate sharp or dull pain), it is possible to treat and heal tennis elbow within 7-10 days.

This process involves performing self-myofascial release (SMR) on the forearm extensor muscles at least 2-3 times daily.

Get step-by-step guidance with my TitaniumPhysique Program to ensure you do these exercises correctly and effectively, and see results as fast as possible. Get Started Now.

Remember - resting the elbow (i.e., taking a break from physical activity) may provide temporary relief, but it will not fix the underlying cause of the pain - restricted forearm extensors that strain the elbow extensor tendon, leading to discomfort.


What options do I have to stop the pain in my elbow?

To stop pain on the outside of the elbow, you have two options: using short-term pain relief remedies for temporary relief or addressing the root cause of the pain to prevent its recurrence.

Option #1: Short-term relief remedies. These include:

  • Using joint supplements and vitamins
  • Taking anti-inflammatory painkillers (NSAIDs)
  • Undergoing physical therapy
  • Incorporating stretching exercises
  • Applying ice and resting the affected area
  • Wearing elbow braces or straps
  • Using kinesiology tape
  • Applying topical anti-inflammatory solutions such as oils and creams

Option #2: Fix the root cause to prevent tennis elbow from interfering with your workouts. Address muscle restriction by improving pliability in the forearm extensors.

Learn how my TitaniumPhysique Program can help you quickly eliminate pain at its source. Get Started Now.

Resources

• Elbow pain
https://www.mayoclinic.org/symptoms/elbow-pain/basics/causes/sym-20050874

• Muscle Stiffness
https://my.clevelandclinic.org/health/symptoms/25147-muscle-stiffness

• Tennis elbow
https://www.nhs.uk/conditions/tennis-elbow/

• Pain-relief medicines
https://www.healthdirect.gov.au/pain-relief-medicines

• The Magnesium Miracle (Second Edition)
https://books.google.com/books/about/The_Magnesium_Miracle_Second_Edition.html?id=2lBcDAAAQBAJ&source=kp_book_description

• Elbow sprain - aftercare
https://www.mountsinai.org/health-library/selfcare-instructions/elbow-sprain-aftercare#:~:text=Ice%20your%20elbow%20for%2015,ice%20can%20damage%20your%20skin

• Arthritis of the Elbow
https://www.cedars-sinai.org/health-library/diseases-and-conditions/a/arthritis-of-the-elbow.html

• Patient education: Elbow tendinopathy (tennis and golf elbow) (Beyond the Basics)
https://www.uptodate.com/contents/elbow-tendinopathy-tennis-and-golf-elbow-beyond-the-basics

• Elbow Compression Sleeve
https://dunbarmedical.com/product-category/compression-wear/compression-sleeve/elbow-compression-sleeve/

• JEFIT Exercise Database
https://www.jefit.com/exercises/

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