Elbow Tendinitis(?) After Power Cleans

[mstrofbass]

<b>- Age, Gender, current training status:</b> 30, M, experienced by not very strong

<b>- Chief Complaint:</b> Trouble locking out elbow, pain when gripping (left hand)

<b>- Narrative describing the mechanism of injury:</b> For reasons not particularly relevant, I have haven't done power cleans consistently for the past two years or so, and never heavier than 185 lbs. (that I can remember). For more reasons not particularly relevant, I wanted to figure out if I could still power clean 195 lbs. My previous PR was 225 lbs.

By the time I got to 195 lbs., I was impressed/surprised/excited with how well it was going, and decided to keep going until I was close to a 1RM. I ended up stopping after I hit a PR of 230 lbs. with a little bit of room to spare. In hindsight, I realized it's probably not a good idea to go for an all-time PR on a lift that you've performed less than ten times in two years and never particularly heavy.

<b>- Pain (on a scale of 1-10):</b> 3
<b>- Describe the pain (burning, shooting, aching, deep, sharp):</b> Sharp
<b>- What makes it better?:</b> Not doing things that make it worse.
<b>- What makes it worse?:</b> Anything that requires fully locking out my elbow or requires significant use of my pinky/ring finger to grip.
<b>- How do your symptoms behave throughout the day?:</b> Fairly consistent; i.e., no discernible pattern. However, it MAY be more noticeable right after waking.

<b>- Signs and Symptoms:</b> There may actually be two distinct problems, as there are two distinct symptoms that may or may not be related.

First, when I try to fully lock out my elbow, it feels similar to being jammed. I.e., it feels as if there's something wedged in the joint that keeps it from fully locking out. I can't exactly tell how much of an impact it is having, it just feels like it's not locking fully and I get a tiny bit of pain (but it's more just discomfort). If my arms are down by my side, I don't have a problem at all if my palms are facing behind me (anatomy terms are not my strong suit). The more I rotate my arms such that the palms are facing more forward, the more noticeable it is.

However, when I grip something, particularly when my pinkie/ring finger becomes more involved, I get a sharp (but not unbearable) pain where the forearm tendons attach to the inside of the elbow (inside being with palms facing out). I can press my finger in that same spot and elicit quite a bit of pain, should I choose to. As the stress shifts more towards the thumb, the pain decreases, and is definitely more prominent when the stress is on my pinkie.

I first thought it might be related to not having proper elbow flexibility due to not doing anything similar to power cleans. However, after testing it with some light cleans, I had no noticeable pain when the bar was racked, but definitely felt it when dropping the bar to my thighs. So, my working theory is that dropping and catching 230 lbs. (and the weight leading up to that, even though only singles) on my thighs put a stress on the tendon by way of my grip that was not commensurate with what it was prepared for.

In general, it has not caused sufficient problems with any other lift. Presses aggravate it the worst, but generally only during warm ups. When I get to my work sets my grip regresses a little from what I want it to be. I can do pull ups and chin ups without any significant issue, although I make it a greater point not to hang there limp. In short, the injury has not caused any problems with progress. However...

I'm about to switch back to deadlifting every other week, and would like to start power cleaning on off weeks. Further, even though it appears to not be causing issues with other lifts, the injury does not appear to be healing, and I don't want this to turn into a chronic problem.

My current program is basically:

M: Squats, Press (three sets, five reps), Pull ups (three sets)
W:Squats, Bench, DL (to be alternated starting this week)
F: Squats, Press, Chins

Search terms used: elbow tendinitis power cleans
Best thread found: http://startingstrength.com/resource...s+power+cleans

Suggestions on ways to specifically attack this issue?

[Mark Rippetoe]

Something is either swelled up because of inflammation, or there is a loose body in your elbow. It's probably the former, so train through it. Maybe Will Morris has a suggestion.

[Will Morris]

The latter of your problems is almost certainly medial epicondylitis (Golfer's Elbow) and this is a very common overuse-type injury in people who are members of the Bench and Curl Club. You mentioned being experienced but not strong, so I have to ask the question, did you curl a lot in your former training or do you curl often now? Flexing the wrist is going to keep the inflammatory response going, so it would be wise to dissect your training and see if you have a tendency to lift things with a flexed wrist. Also, mobilization with movement is great for medial and lateral epicondylitis, but you would need a therpist with good hands. I would caution the use of corticosteroid injections as the evidence is pretty clear that it helps a lot in the short term but has very poor outcomes in the future.

The first problem you report (pain and trouble locking out the elbows) can be a couple of things. Most likely, and dove-tailing off what Rip said, this type of presentation typically indicates some type of structural pathology. It could be a loose body, it could be an osteophyte (an abnormal outgrowth of bone), Snapping Tricep Syndrome, etc.

My guess, since you don't report the joint locking, is that you have a condition called Posterior Elbow Impingement which results when you have bony changes in the elbow that causes the olecranon and ulna to butt up against each other at the terminal ends of flexion and extension. Over a short amount of time, this causes sclerotic lesions where the bones jam against each other, and those are painful as hell. This particular pathology is most common in people with a throwing history (pitchers, quarterbacks, centerfielders or shortstops and "weight lifters".....although I would venture to guess the "weight lifters" who experience this had a history of a bodybuilding type training split where they used lighter weights for higher reps and shitty form).

You probably notice it more in the morning, because we all tend to sleep in a flexion posture and being in near terminal flexion throughout the night will flare that up. If you want that part to stop, go to WalMart and pick up a cheap pair of volleyball knee pads and wear one on the affected elbow with the pad towards the inside of your arm. This will keep you from being able to bring it into flexion, and will make the morning pain go away. For training, keep yourself from going into terminal extension on your pressing movements for a couple weeks. I found that a "tennis elbow" elbow sleeve worked well for giving me enough proprioceptive feedback to keep me from going into terminal extension or flexion when I was dealing with my own case of posterior impingement.

[mstrofbass]

Something is either swelled up because of inflammation, or there is a loose body in your elbow. It's probably the former, so train through it. Maybe Will Morris has a suggestion.

I'm doing a few days of high dose naproxen for something unrelated. We'll see if that helps.

[Will Morris]

I'm doing a few days of high dose naproxen for something unrelated. We'll see if that helps.

You will have to take anti-inflammatories for several days (+5) to really start getting any anti-inflammatory benefit. 2-3 days of it is just going to give you an analgesic effect.

[mstrofbass]

The latter of your problems is almost certainly medial epicondylitis (Golfer's Elbow) and this is a very common overuse-type injury in people who are members of the Bench and Curl Club. You mentioned being experienced but not strong, so I have to ask the question, did you curl a lot in your former training or do you curl often now? Flexing the wrist is going to keep the inflammatory response going, so it would be wise to dissect your training and see if you have a tendency to lift things with a flexed wrist. Also, mobilization with movement is great for medial and lateral epicondylitis, but you would need a therpist with good hands. I would caution the use of corticosteroid injections as the evidence is pretty clear that it helps a lot in the short term but has very poor outcomes in the future.

I have been doing the basic barbell lifts for years now (I learned and studied SS for the first time five years ago, or so). So, I'm fairly experienced as that goes, just various other things have resulted in my not being particularly strong at this point in time. I have curled three or four times in the past five years. There was, at not point in time prior to the day or day after this happened, any noticeable indication that there was an impending issue (whether lifting weights or playing golf). I will pay extra close attention to my wrists while lifting.

The first problem you report (pain and trouble locking out the elbows) can be a couple of things. Most likely, and dove-tailing off what Rip said, this type of presentation typically indicates some type of structural pathology. It could be a loose body, it could be an osteophyte (an abnormal outgrowth of bone), Snapping Tricep Syndrome, etc.

My guess, since you don't report the joint locking, is that you have a condition called Posterior Elbow Impingement which results when you have bony changes in the elbow that causes the olecranon and ulna to butt up against each other at the terminal ends of flexion and extension. Over a short amount of time, this causes sclerotic lesions where the bones jam against each other, and those are painful as hell. This particular pathology is most common in people with a throwing history (pitchers, quarterbacks, centerfielders or shortstops and "weight lifters".....although I would venture to guess the "weight lifters" who experience this had a history of a bodybuilding type training split where they used lighter weights for higher reps and shitty form).

What is "a short amount of time?" Those all sound like they would noticeably develop over some period of time, as opposed to appearing within a day with no previously noticeable symptoms.

You probably notice it more in the morning, because we all tend to sleep in a flexion posture and being in near terminal flexion throughout the night will flare that up. If you want that part to stop, go to WalMart and pick up a cheap pair of volleyball knee pads and wear one on the affected elbow with the pad towards the inside of your arm. This will keep you from being able to bring it into flexion, and will make the morning pain go away. For training, keep yourself from going into terminal extension on your pressing movements for a couple weeks. I found that a "tennis elbow" elbow sleeve worked well for giving me enough proprioceptive feedback to keep me from going into terminal extension or flexion when I was dealing with my own case of posterior impingement.

That's a good idea. I will try to ensure I do not hug myself while sleeping. :P However, it's not a big enough problem that I care if it stops or not. I'm less interested in getting rid of the pain, which is fairly minimal, and more interested in making sure this doesn't become a chronic issue or get worse.

I am, for the most part, not going to full extension "instinctively," in that I don't try to force my elbows to lockout when I'm pressing, but I bet that breaks down during my work sets. I'll check out some sleeves tomorrow and pay closer attention to where I'm stopping.

As I mentioned, this isn't really causing an issue with my training, i.e., holding me back. I'm just trying to be extra conservative thanks to some prior lessons I learned the hard way. So, other than paying extra attention to the things you mentioned, should I continue as I have been as long as the symptoms aren't getting worse?

Thanks for all the info, guys, I appreciate it!

[mstrofbass]

You will have to take anti-inflammatories for several days (+5) to really start getting any anti-inflammatory benefit. 2-3 days of it is just going to give you an analgesic effect.

That's really good to know. I've done high dose naproxen/ibuprofen before, and usually start noticing a difference in pain/symptoms after a few days, and stop once the pain goes away. I'll keep stay on it for a bit longer this time.

[Will Morris]

What is "a short amount of time?" Those all sound like they would noticeably develop over some period of time, as opposed to appearing within a day with no previously noticeable symptoms.


I'm less interested in getting rid of the pain, which is fairly minimal, and more interested in making sure this doesn't become a chronic issue or get worse.


As I mentioned, this isn't really causing an issue with my training, i.e., holding me back. I'm just trying to be extra conservative thanks to some prior lessons I learned the hard way. So, other than paying extra attention to the things you mentioned, should I continue as I have been as long as the symptoms aren't getting worse?

The structural changes happen over a long period of time, however, the increase in symptoms can happen rather acutely, even though the problem has been brewing for a long time.

Posterior Elbow Impingement is indicated in the development of Cubital Tunnel Syndrome / Ulnar Neuritis. You have it right that pain is secondary in concern to further problems associated with this, but the same types of bony changes occuring (I suspect) in your elbow can easily start encroaching on the ulnar nerve's turf, and once the ulnar nerve gets involved, pain will become a HUGE concern of yours.

You can assume that if you are feeling that sharp pain in your elbow acutely (that is to say you extend your arm and you get a sharp pain), you are causing further damage. If you give this some time to calm down by still training, but not doing whatever it is that causes it to hurt, you are going to have a much better outcome.

If you start getting elbow pain that goes along with a clawing of the ring and pinky finger or numbness and tingling that you can map out to the pinky and half of your ring finger closest to your pinky finger, you sir are the new owner of a pathologic ulnar nerve.

[mstrofbass]

The structural changes happen over a long period of time, however, the increase in symptoms can happen rather acutely, even though the problem has been brewing for a long time.

Posterior Elbow Impingement is indicated in the development of Cubital Tunnel Syndrome / Ulnar Neuritis. You have it right that pain is secondary in concern to further problems associated with this, but the same types of bony changes occuring (I suspect) in your elbow can easily start encroaching on the ulnar nerve's turf, and once the ulnar nerve gets involved, pain will become a HUGE concern of yours.

You can assume that if you are feeling that sharp pain in your elbow acutely (that is to say you extend your arm and you get a sharp pain), you are causing further damage. If you give this some time to calm down by still training, but not doing whatever it is that causes it to hurt, you are going to have a much better outcome.

If you start getting elbow pain that goes along with a clawing of the ring and pinky finger or numbness and tingling that you can map out to the pinky and half of your ring finger closest to your pinky finger, you sir are the new owner of a pathologic ulnar nerve.

Thanks! I'll keep a close eye on it and try to pin down the specific triggers, etc. Appreciate it!

[Kazzin]

I've developed elbow tendinitis from squatting, so I've been following your suggestion of high volume chins twice a week, and it seems to be helping. Would this not be suitable here?