CrossFitters’ Elbow (aka Lifters’ Elbow, Golfers’ Elbow) is a common injury, and has a tendency to become persistent if not dealt with properly and thoroughly. The commonality of this injury is simply due to the volume of pulling that comes up in programming. With this volume of pulling it is very easy to accumulate stress and load in to the wrist flexor group at a rate that is faster than the body can adapt. When this happens we get sensitization on the inside of the elbow, where the muscles attach to the bone.
Typical self treatment advice will focus on icing and stretching however that is a terribly oversimplified plan of attack that can set you up for a failure to improve or reoccurrence down the road. Below you will find a much more thorough self treatment plan to help you bulletproof your elbows:
Step one Assessment of Wrist Flexor and Shoulder Internal Rotation Mobility:
We showed you how to assess your wrist mobility in the video above. Do you have 80-90 degrees of wrist extension in both the pronated to supinated position?
You also need to know if you have full shoulder internal rotation ROM? If not, this can pull your shoulder out of centration and overload the elbow. If either your wrist mobility or shoulder internal rotation were limited, then you want to start with some standard issue wrist and shoulder mobility.
Here’s a quick explanation of why shoulder internal rotation is relevant in lifters’ elbow. A good movement based physical therapist or chiropractor will perform a full body functional assessment, but rarely would this be looked at in a normal orthopedic testing model.
Phase 1 of your progression (traditional mobility)
Wrist Mobility 1.0
Self myofascial Release of the wrist flexors
Banded distraction stretches in multiple planes
Hanging stretch (face your palms away, hand shoulder width apart and hang from pull up bar)
Shoulder Internal Rotation Mobility 1.0
Phase 2 of the progression (Forearm exercises)
1. Isometric wrist extension strengthening in the new range (windshield wipers)- IMMEDIATELY after performing the wrist mobilizations, follow them up with some end range isometrics in the newly created range. PERFORM 10 REPS at 5 seconds per REP
2. Eccentric “Pay up” exercise to strengthen and lengthen the wrist flexor group (performed by tying a knot in to a theraband, hold the knot between your fingers and ask them to “pay up”)- This is an eccentric exercise for the wrist flexors that will help lengthen, strengthen, and remodel the wrist flexor group. Create enough tension that 10 reps is a max effort, each rep should last 5-10 seconds, perform 1 time per day (for around 4 weeks).
Phase 3 of the progression (Tying in scapular stability and wrist movement)
3. Push up PLUS with Wrist Rocking- (the goal here is to tie in active wrist movement in full range with scapular engagement) Push up Plus with rocking works by creating engagement of the scapular stabilizers while actively mobilizing the wrist flexors. Perform 10-20 wrist rocks per rep for 10 reps.
4. Motor control drill- Loss of shoulder positioning or joint centration creates a weaknesss of grip and an overstraining effect on the wrist flexor group. To combat this we need to learn scapular control and stability, especially in the sagittal plane. This is a quick and simple motor control drill to see if the athlete can maintain proper shoulder and scapula position while creating a wrist extensor moment, and going through a pull phase. No recommended sets or reps, just until the athlete can perform properly .
5. Dynamic Scapular Stability Exercises- As the athlete begins to make some progress, it’s time to begin to really strengthen scapular stability. There are many options for this, but personally I like to use the DNS exercises. I will normally utilize the prone extension and side lying shoulder stabilization (reflex turning 2). I also will utilize many of the great shoulder exercises demonstrated by Dan Pope, DPT on his youtube site.
Training modifications and other notes
1. On pulls (deadlift, cleans, snatches)- focus on centration of your shoulder joint at set up, then engage the lats and use the the lat to create an anti-shrug force and a proper bar path, rather than using wrist flexion to hold the bar towards your body.
2. Grip with your entire forearm musculature rather than gripping and flexing. (360 degree grip) Other resources: Okinawan strength
3. On pull ups, maintain control and awareness of shoulder blades rather than allowing them to passively move through the motion.
Phase 4 of the progression (skill/technique/motor control drills)-
DRILL 1- Here is a great drill for creating proper bar path using lats rather than overusing wrist flexors. Very helpful for motor control and also for strengthening the lats when strength is the limiting factor. Shout out to Jeremy Shepard and East Alabama Weightlifting Club for this drill.
DRILL 2- After the athlete gains strength or technique in the above position, we can utilize a halting deadlift to teach lat engagement and proper bar path, in a more functional position.
*A QUICK NOTE REGARDING LOAD- Also it may critical to modify the volume of pulling that you are currently doing. It’s helpful to roughly quantify that volume, and depending on the severity and chronicity of the problem, appropriately scale it back.