Dr. Michael Hartle 

Occasionally I receive letters from powerlifters and see questions/comments on the Internet regarding elbow pain. The squat and the bench press, to name two exercises, seem to be the most common exercises that increase the elbow pain.  These lifters usually state that the pain has developed over a period of time, not happening suddenly.  On the squat, it starts most frequently while setting up for the lift and during the performance of the lift and for a short time after.  When it occurs during the bench press, the athletes state it usually starts approximately 4-5" off of the chest during the descent and gets worse right before and during the pause. 

    Unlike the knee, the elbow is able to rotate more than a few degrees either direction.  This presents possible future trouble for the elbows of powerlifters.  During the squat, the elbow is under a lot of stress as it must help the wrist and hand stabilize the bar on the lifter's shoulders.  It is especially under a lot of stress when the athlete places the bar on their shoulders in typical powerlifter fashion - low.  By placing the hand on the bar during the squat, one must pronate (turn away from you) the elbow/wrist in order to grip the bar.  Doing this over a period of time can sometimes cause chronic elbow pain, usually helped by not squatting.  Another cause of this elbow pain during the squat is I see many powerlifters that will push up against the bar while they are holding it on their shoulders.  A lot of them do not know they are doing this.  This activates the various muscles surrounding the elbow and when done often enough and with enough weight, it will eventually overuse these muscles.  This will then lead to microtrauma (small tears in the muscle/tendon) which will eventually lead to formation of scar tissue and then the muscle will become weak and the athlete will develop pain and possibly numbness and tingling below their elbow due to peripheral nerve entrapments of the upper extremity.   

    During the bench press, the hands are placed in another pronated position, yet not quite as far when compared to the squat.  The elbow flexors must help stabilize the bar during the descent phase of the bench.  Again, done over a period of time this could possibly wreak havoc on the elbow joint.  This is especially true if the injured athlete's elbow is repeatedly subjected to the main cause (for example, the bench) and then utilized later in the week (during the squat), reaggravating the problem. 

    The main elbow structures involved in this problem are the biceps brachii, the brachialis, the brachioradialis, pronator teres and sometimes the triceps.  As powerlifters we cannot get away from the hand positions we must use during the lifts.  Therefore other measures must be taken.  If in pain and you have a meet coming up that you need to train for, try a light-medium wrap job on the affected elbow while training in the gym.  This will take some stress off of the joint and not aggravate it as much.  I donít recommend doing this too often as oneís body can develop a dependency on this support and when it comes time for the meet, it wonít be there to help support you.  A second measure one can take to either help rehabilitate or prevent future problems is to strengthen the elbow flexors to handle more stress.  As powerlifters, we tend to concentrate on the triceps (elbow extensors) more as they are one of the primary movers during the bench press.  We must make sure that the elbow flexors receive good quality exercise to keep them strong.  This helps keep the muscle balance around the elbow intact and help prevents future joint problems.   

    Examples of exercises to do are dumbbell curls (there are many variations of these - either one will work), and barbell curls with either the straight bar or the E-Z curl bar.  While doing these to help rehabilitate the elbow, one must do these exercises with light weight, high repetitions (10-20 repetitions) and do this at least 3 times per week.  This will force blood and the various nutrients it carries into the muscle/tendon areas and help heal the problem.  Stretching the elbow musculature will also help to prevent problems as well.  Sometimes elbow pain can come from problems with the wrist and the associated wrist flexors/extensors.  If none of the above ideas help, either write/call me or seek the proper medical/chiropractic attention in your area for further advice. 

Please send your questions for the Sports Medicine Committee to Dr. Michael Hartle, 3835 W. Jefferson Blvd., Ft. Wayne, IN,  46804.  If you would like a personal response, please send a SASE with $2.00 to cover additional postage and other expenses. I also welcome your comments on the committee/column.  You can contact me at (219) 432-7339/ FAX (219) 745-1098/ e-mail at pwrdoc@mail.fwi.com.   Michael A. Hartle, D.C., D.A.C.B.N., C.C.S.P., C.S.C.S., E.M.T. 

Michael A. Hartle, D.C., D.A.C.B.N., C.C.S.P., C.C.N.,  C.S.C.S., E.M.T. is the USAPL Vice-President and the Chairman of the Sports Medicine Committee.He is an National Referee and a nationally ranked competitor in the USAPL.Dr. Hartle is also the developer and webmaster of the USAPL's Internet Website.  He contributes on a regular basis sports medicine and nutritionarticles for various publications, including the USAPL web site.  He treats and consults with numerous athletes, from the local to the elite level, oninjury treatment and prevention, nutritional advice (especially sports nutrition) and proper sport specific strength and conditioning training.Dr. Hartle just finished construction on his first fitness center where he will be able to more closely monitor his patient's and athletes progressduring their rehabilitation.  Dr. Hartle is in private practice with his wife, Dr. Monique Levesque-Hartle, also a competitive powerlifter.  

Reproduction of this article, in whole or part, for any purpose other than personal use is prohibited without written consent. Copyright 1998 Dr. Michael Hartle.