Bicep/brachialis/anconeus pain that doesn't seem related to squats

[Al Copersino]

Hi, all. Thanks for your patience about me asking online strangers to diagnose an injury sight unseen.

The last week or two I've been getting sharp pains in my arm in the area where the bicep and forearm meet. I'm not sure if the problem first arose in the biceps, brachialis, or maybe the anconeus.

I don't THINK it relates to arm/grip position in the low-bar squat as I had that issue several months ago in the other arm: that situation felt different and it went away when I made adjustments after rereading the books/rewatching the SS videos. No pain when I squat - or bench, for that matter.

A little more background: I'm a 51 yo intermediate who completed a NLP in December. For my three pulls each week, one day I do supine bent rows, one day I do chins, and one day I do deadlifts. On deadlift day I'd also been doing a few sets of curls/hammer curls - but I've put the curls/hammers on hold for now since that's when the pain is worst. Once a week I do HIIT; lately I've been using farmers' walks for that (another possible source of strain, I suppose).

Any thoughts as to diagnosis or treatment? I'd be happy to use the Starr rehab protocol if it's a muscle issue, but I'm guessing (but really have no idea) that my injury MIGHT involve a tendon or ligament since several muscles hurt, not just one.

Thank you in advance.

[Mark Rippetoe]

How much weight are you rowing? BW/height?

[Al Copersino]

Thanks, Coach.

I'm rowing 165x5x3. I add a rep every week or so, and then add some weight when I can do 3 sets of 9 with good form.

I'm 5'9", 185.

[Mark Rippetoe]

Pronate your row grip, and this should resolve itself.

[Al Copersino]

Thank you, Coach.

[Al Copersino]

Coach - thanks once again for your help.

The advice to pronate the bb row helped a lot, for a few weeks.

But the pain is back: sharp and pretty much constant. I’m guessing distal bicep tendonitis. -not an MD or even remotely qualified to opine

Two questions for you, please:
1) I don’t want to but should I stop for a few weeks doing every lift that causes the pain? That’s unfortunately a long list of lifts, from chins+rows even to bp+ohp.
2) Any idea what lift(s) might be the culprit? Excluding lifts that DONT hurt - like squats - the lifts I’m doing each week that hurt are bp/dips/incline press, ohp/lateral delt raise, dl/chin/row/curl.

I’d just do a Starr rehab protocol for my right arm, but I think I’ve read here that that’s good for muscles, not so good for tendons. Thank you once again.

[Nick D'Agostino]

This sounds like a tendinopathy. I would not stop training but you are going to have to manage the load of painful movements for awhile. You have to change your mindset from avoiding pain or training through pain to nudging the pain. It is ok to feel pain as you train as long as it is tolerable and not worse the next morning. There is most likely not a single cause as to why you have the pain. Part of the reason why you are having this experience is that the total load you are exposing your bicep tendon to is greater than it can regularly recover from. The total load is being perceived as threatening and that is why you have pain.

Practically speaking, I would drop the dips, lateral raises, chins, rows and curls. I would put in lat pulldowns and/or maybe cable rows instead. Switch how you are loading the exercises that are bothering it from a sets across scheme to a ramping to a top set scheme. Start the reps for these accessories around 10 and drop them by 2 every couple of weeks. This type of thing does not go away overnight and will immediately come back if you avoid it. Set the expectation to be doing significantly better in 9-12 weeks.

I would not do the Starr rehab protocol for this.

[Al Copersino]

Thanks very much. That makes a lot of sense. Yeah, I think chins and bent rows in particular aren’t good for me for the time being.

Three follow up questions if you don’t mind.

1) You said not to do a Starr protocol. That makes sense as my problem seems to be tendon not muscle. I found a Matt Reynolds article in TAOM where, among other things, he suggests light-weight reverse wrist curls to help relieve the bicep tendon. That’s not exactly a Starr protocol, so would you agree with that in my case?

2) I just want to make sure I understand. Could you give me more details: you say ramp the accessory exercises to a top set of 10 reps, then drop those reps over several weeks. So, to start, just keep adding weight to accessory warm up sets (of 5 reps?) making sure the pain gets no worse? I guess I’m asking, how many warm-up sets and reps, and, how do I know the right weight to use for the top set?

3) This ramping scheme: this applies only to accessory lifts? Or also to the main lifts that currently hurt my arm (bp and ohp)?

Thanks again and sorry for all the follow ups.

[jfsully]

Practically speaking, I would drop the dips, lateral raises, chins, rows and curls. I would put in lat pulldowns and/or maybe cable rows instead. Switch how you are loading the exercises that are bothering it from a sets across scheme to a ramping to a top set scheme. Start the reps for these accessories around 10 and drop them by 2 every couple of weeks. This type of thing does not go away overnight and will immediately come back if you avoid it. Set the expectation to be doing significantly better in 9-12 weeks.

I would not do the Starr rehab protocol for this.

Nick, thanks for this. I am dealing with something similar, and it seems to come right back after I take a break from chins/rows/curls. I can usually train through the pain, but it is definitely worst the next morning until I get my arm moving a bit.

I am a little dense, though: could you clarify your recs to do sets of 10, then drop the reps by 2?

Do you mean drop the reps as you add weight? Or keep the same weight and taper the reps off? And then eventually add the chins etc in as per the program once the pain is gone?

Thanks
Jfsully

[Nick D'Agostino]

Thanks very much. That makes a lot of sense. Yeah, I think chins and bent rows in particular aren’t good for me for the time being.

Three follow up questions if you don’t mind.

1) You said not to do a Starr protocol. That makes sense as my problem seems to be tendon not muscle. I found a Matt Reynolds article in TAOM where, among other things, he suggests light-weight reverse wrist curls to help relieve the bicep tendon. That’s not exactly a Starr protocol, so would you agree with that in my case?

2) I just want to make sure I understand. Could you give me more details: you say ramp the accessory exercises to a top set of 10 reps, then drop those reps over several weeks. So, to start, just keep adding weight to accessory warm up sets (of 5 reps?) making sure the pain gets no worse? I guess I’m asking, how many warm-up sets and reps, and, how do I know the right weight to use for the top set?

3) This ramping scheme: this applies only to accessory lifts? Or also to the main lifts that currently hurt my arm (bp and ohp)?

Thanks again and sorry for all the follow ups.

1) I would not add reverse wrist curls.

2) For the accessory motions like lat pulldowns and cable rows I would have 3-5 total sets. All of the sets are initially 10 reps. The last set should be pretty hard. Once you get a starting point for the top set your goal is to try and do a little more weight each time. After 3 weeks drop all the reps to 8. After 3 more weeks drop all the reps to 6.

3) I would start with the accessory lifts. If you are not making any progress in a few weeks then I would also intervene on the bench/ohp.