Shoulder asymmetry and elbow tendonitis

[leo92]

Hi coaches,

I've been having initial signs of elbow tendonitis (on the outside of the elbow) the last 2-3 workouts. It's really bothering me - unfortunately, there are no Starting Strength coaches around here (India), so I'd really appreciate any help you can give me.

The pain is more on the left elbow, but is present in both. I don't know if it's caused by

a) the squat: the pain started at 155 lbs
b) the power-clean - I just started 3-4 workouts ago, and my power cleans are at 55 lbs, making sure I get the form right.
c)the chin-ups - I can only do 7-8 singles at BW; I started these recently as well.

The elbow pain started when I reached a squat weight of 155 lbs, and just 1-2 workouts after I started power-cleans and chin-ups.

I've searched the forum extensively, and from what I can gather:

1) some folks say a narrower grip works for them, others say a wider grip works for them. Either way, it looks like what's critical is to keep the upper back tight, and keep the elbows up throughout, so that the bar sits in the shelf created by the rear deltoids.
2) I've seen Rip say being able to do high-volume chins helps prevent elbow tendonitis (http://startingstrength.com/resource...763#post617763), but I've also seen him say chins can irritate elbows (http://startingstrength.com/resource...ad.php?t=28729). So I'm not sure what to make of this.

Now earlier today, I discovered to my great surprise that I've been squatting with a very asymmetrical bar position. I'm right-handed, but surprisingly, the bar is way too much to the right - meaning that my right shoulder is probably less flexible than my left. Rip says that an asymmetrical bar position should per se not lead to tendonitis (http://startingstrength.com/resource...301#post606301), but I was wondering if that could be a factor.

I also noticed that towards the end of the set, the bar is really off-balance - the right end of the bar has come down vs. the left. Throughout, however, I was making a strong effort to keep my back tight, my elbows up and I felt I was managing to do so well. However, the pain was back.

Here's the video of my squat from the back, and one other view from the side from a few days ago:

Rear view: https://www.youtube.com/watch?v=tfE-BtA3vWk

https://www.youtube.com/watch?v=tfE-BtA3vWk

Side view: https://www.youtube.com/watch?v=ouYje7gZ03Q

https://www.youtube.com/watch?v=ouYje7gZ03Q
Questions for you:

1) Should I do power cleans or put them off till I've sorted my squat issues?
2) Would you recommend that I continue doing chin-ups?
3) This might be a stupid question: what's the most tangible way to deal with an asymmetric bar position on the back? Just force myself to move it back to the centre?
4) It looks like this elbow tendonitis issue really won't be solved unless I can position the bar in the centre, and lift my elbows some more. To do that, I'll need to improve my shoulder flexiblity. Is my assessment correct? Are shoulder dislocations the best way to do this?

Thank you again for all your help. You guys are life-savers for those of us without access to a coach!

Regards.
Leo

[Paul Horn]

Summarize your question and pick one link/video you want us to look at?

[leo92]

Sorry Paul, here's my question: what should I change about my squat form to prevent elbow tendonitis?

The video is here: https://www.youtube.com/watch?v=tfE-BtA3vWk

Thanks again.

[Paul Horn]

I don't see anything there that would cause it. Your wrists might be in flexion, but I can't really tell. The bar is not centered on your back so you need to fix that. Hopefully the guy filming you can help.

[leo92]

Thanks, Paul. Just two specific related questions:

a) Do you think I should delay introducing chins and power cleans into my program to make sure I give my elbows a chance to get used to the workload?

b) Is it possible wrong chin-ups form could be triggering the tendonitis? (e.g., arms too wide on the chins)

[Paul Horn]

How bad is it? When do you feel it? How long does it last? How far into the program are you?

Also, I'm confused. If you think "wrong chin-ups" are causing the pain, why are you asking if you should delay introducing chins? Are you doing them or not?

[leo92]

It's worst just after I finish squats - maybe 5/10, certainly bad enough that I couldn't do my bench press work sets in my last work-out. It goes away within an hour of my workout, after I've taken Ibuprofen. It's present in both elbows, but a bit worse in my right.

I was at 170 lbs squat, 130 lbs bench, 100 lbs press when the pain started. Because I don't have access to a coach, I have been working hard on my form. I'm 34, M, 190 lbs.

I'm doing singles of shoulder-width chins (too weak to do even doubles currently), but I'm not sure if I have some shoulder/ elbow inflexibility that would require me to have a narrower grip on my chins. More generally, I don't know which of the following could be causing my tendonitis:

a) Arms intercepting weight during the squat - you said this might be unlikely
b) Asymmetrical bar position in the squat - I'm going to fix this ASAP in any case
c) Starting power cleans and chins at the same time in my program, leading to my elbow being overworked
d) Wrong form in my power cleans or chins

[Paul Horn]

The short answer is that I don't know, but you have to train through it. I'm having a similar problem right now prepping for a meet. The extra benching is pissing off my elbows. Here's what I'm doing:

Ibuprofen - 800mg 4 times a day for 5 days - don't miss doses - STOP after 5 days.

It seems to be helping. Obviously, I'm not a doctor and this is not medical advice. Just letting you know how I handle this kind of thing.

Fix your bar position. Make sure your wrists are straight. Search the board on using chins to drive out tendinitis.