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Aaron Shaffer
03-05-2008, 10:05 AM
I've had problems with pain in my right elbow for about 8 weeks, first initiated by near 1RM by overhead press. The first 4 weeks were spent at a chiro, the last four weeks have been active rest - meaning I do WOD-like workouts that don't involve any arm movement.

The right elbow is near healed so yesterday I did 3 rounds of 21 overhead press (bar only) & medium pace 500m row. When I got home that evening my left elbow began hurting for the first time - and at exactly the same spot as the right elbow!!:ranting2:

Considering this was a low rep low weight workout, there has got to be something incorrect about how I am doing presses. I've read the SS chapter 2x about overhead presses and I thought I was doing them correctly with my forearm directly vertical under the bar but I must be wrong. Is there something weird about my anthropometry? No one else in the gym is having this pain.

Below is a link to a video and a picture of the spot where I feel pain. Resting the pain is neutral, but when I curl my arm towards my mouth (when drinking a beer for example) the pain become sharp. So you can understand how important it is to prevent this :D

http://clevelandcrossfit.com/1900/01/what-is-incorrect.html (WFS)

Derrick Robinson
03-06-2008, 11:18 AM
I had the same injury location and description. Started in August last year over reaching goals, tried everything; active rest, ice, heat rest, crying…….

I figured out what exercise were causing most of my grief: ME Dips, HSPU, kipping Pull-ups/chins, by the initial pain immediately after/ during using these. So, I cut these exercises out of my weaponry. But, the dull pain still lingered.

Overtime I re-evaluated my program by "lurking" on the Crossfit boards/ other sites and started using a lot more warming up, ring work with pullup/ dips, stayed away from the other exercises. But, the dull pain still lingered, but a little better.

Refining my training and conclude that I was over working my grip, I started using straps on ME Deadlifts/ ME BB rows; which took the stress off of my forearms/grip, no more BB complexes, more usage of DB’s, low damper settings on the C2 etc etc. But, the dull pain still lingered, but improving more so.

Finial Step, I bought some elbow sleeves that I use for warmth. Added forearm stretching during my regular stretching routine. Purchased a light exercise tube-band /w handles and started doing tricep extensions and bicep curls in everyway possible thought the day 2x20 (Gets the blood flowing to the area) Upped my Fish Oil dosage 20grams, removed nightshades from my diet(I miss potatoes). Finally found a “squashy” stress ball that I use all day. At last pain free, as long as I use continue to Prehab and Deload on my programming!

Derrick Robinson
03-06-2008, 01:22 PM
Oh, and your form with that weight.....looks pretty good to me:D To be nitpicky tuck your chin down a little I guess. Whats your Shoulder Press x1 or x5?

Aaron Shaffer
03-06-2008, 02:02 PM
Derrick, thank you for your comments.
It was three sets of 5 @ 125 eight weeks ago.

So nothing unusual about my arm position or anything? I was wondering if maybe I need to go wider or something to prevent this pain? Or narrower? Is the elbow path unusual / incorrect?

I just can't believe it started up in my left elbow too with only the bar for weight. I did CrossFit for 14 months without joint pain with most of the WODs as rx'd or near rx'd. I'm so frustrated with this!
:ranting2:

Derrick Robinson
03-06-2008, 02:32 PM
Ive looked at the video more, again nothing is striking me as unusual. Nothing is set in stone bio-mechanically speaking, test your hand width out some.

BTW I'm no elite lifter....185x1 Shoulder Press @ 195BW. It helps me when I squeeze the bar hard, and focus on finishing with active shoulders.

Robert Callahan
03-06-2008, 02:45 PM
To be very nitpicky your elbos could be out a bit more infront of the bar to give you a more vertical forearm, but i do not think you were too bad.

The x on your arm for where the pain is is directly on one of the triceps tendons and could thus very easily be a tendonitis developed there. Were you on an SS program when it started and was your strength increasing rapidly? Anytime you increase strength quickly you run the risk of developing tendonitis.

On a scale of 1-10 what is the pain? and is it sharp or dull or whatever?

also just for future training 1RM can be a usefull check for strength but also increase the risk for injury, 3-5RM can be just as usefull with less risk of problems so I would recomend shying away from doing 1RM very often. Not to make you afriad of 1RM just wouldnt recomend using it as a training tool, just a strenght check.

As to treatment, Ice the elbow(s) for 25 min after workouts, and if you can do it throughout the day if they are bugging you that would be best also. Second take Ibuprofen (400-600mg) ever 6-7 hours and try to time it so you take some an hour or so before workout. This is not a pain killer but an anti-inflamitory drug that will reduce swelling in that triceps tendon and prevent it from getting further irritated. Icy-hot or tigger balm can help as well if you have it. Oh and heating before workouts also helps a lot if you can. Lastly massage. If it is a tendonitis thing really digging in (or getting someone else to dig in) to that area of your arm will hurt but hurt in a good way :) it will help the muscle release and provide long term relief.

Hope some of this is usefull, sorry for the long reply, and hope you have a swift recovery! :)

-Robert

Brandon Oto
03-06-2008, 02:48 PM
Ask Rip. I know you're familiar with the Strength Mill forum.

Aaron Shaffer
03-06-2008, 02:57 PM
Robert, thank you for the advice. I appreciate your detailed response for recovery but I understand that part well now. I'm primarily concerned with the cause at this point.

Yes, I did 5 weeks of SS and gained 15lbs. This is when the pain in the right elbow developed initially. My press went from 130 1RM to 125x5 (three sets) in those 5 weeks. Done with correct form though, the press shouldn't be causing tendinitis right? I mean I was only doing 3 sets of 5 plus warm-up weights on SS. And an unweighted bar shouldn't cause a new pain should it?

This recent pain, it was mostly light pain but got sharp as I moved my hand towards my mouth. It didn't occur during the movement but developed increasingly until the evening. Today, two days later, I have no pain -- but now I'm afraid to even go under an unweighted bar for fear the press will injure me more. :(

Aaron Shaffer
03-06-2008, 02:58 PM
Brandon, yes, I have a request in on his board and am awaiting a response. I am hoping to get a second opinion here.

Robert Callahan
03-06-2008, 03:13 PM
the excersises in SS are incredibly functional and when done correct will not cause joint or any other long lasting injury. Tendonitis though can still occur. This is one way to think about it:

Your muscles are bundles of fiber rapped in a thin fascia (kind of like a saran wrap) to keep them together. Anytime the muscle grows that fascia needs to expand and grow with it. If the muscle grows too fast that fascia can tear and as long as the muscle continues to grow the tear will get worse. Putting on 15lbs in a little over a month and rappidly increasing the overhead press which is very tricep heavy (at least for lockout) sounds like it easily could cause tendonitis. The reason Crossfit doesnt have this problem as much is because all the excersises are so well varried and proportional. SS though, while an incredible program, does have the potential for these kinds of over-use injuries.

Good news though, is that tendonitis is easily delt with and does not cause any kind of long term problems. Just give it a bit more time and lay off heavy weight stuff. Soon you can start working arm stuff back in as long it is low weight high rep and the pain isnt too bad, though you can work through light pain if you want. Also try going back to crossfit for a bit to see how it holds up? if you want more strength latter come back to SS but be a bit cautious for how fast you procceed. :)

-Robert

Jake Di Vita
03-06-2008, 04:10 PM
My first thought was to widen your grip, as I had a similar issue that sorted itself out with a wider grip. Beyond that I really don't know. Looks like good form to me.

Aaron Shaffer
03-06-2008, 09:02 PM
Jake, this is refreshing to hear. Elbows are pain free tonight. I'll try again tomorrow with a wider grip.

Mirza Besic
03-07-2008, 04:03 AM
Derrick, thank you for your comments.
It was three sets of 5 @ 125 eight weeks ago.

So nothing unusual about my arm position or anything? I was wondering if maybe I need to go wider or something to prevent this pain? Or narrower? Is the elbow path unusual / incorrect?

I just can't believe it started up in my left elbow too with only the bar for weight. I did CrossFit for 14 months without joint pain with most of the WODs as rx'd or near rx'd. I'm so frustrated with this!
:ranting2:

get a joint supplement, you can't beat up on your joints for 14 months and expect them to be in superb health. Remember your joints, ligaments and tendants recover and heal slower than muscle.

Leonid Soubbotine
03-07-2008, 08:07 AM
Aaron - do you have/use a foam roller?

If you don't have one - get one. EliteFTS.com has really good ones. This is my favourite one:
http://www.flexcart.com/members/elitefts/default.asp?m=PD&cid=143&pid=1476 WFS

Foam roll your T-spine (mid back - all the way from neck to low back keeping abs tight) and chances are - that'll fix quite a bit of your elbow issues.

Aaron Shaffer
03-07-2008, 09:08 AM
Leo - I ordered it just now. When I'm at the Oly cert next week you'll have to explain how this is related to my elbow -- I'm very curious.

Carina Randolph
03-07-2008, 09:49 AM
Total newb to CF here so the value of my advice may be worth exactly what it costs (nothing in other words)....but naturally that doesn't prevent me from offering my opinion. :p

Tendonitis is really common in my sport because we use a constant tight grip and our elbows take a deal of abuse. Here are two fixes we commonly use (in addition to the usual ice/heat type treatments) that work for me. Make your hand into a duck bill putting all four fingertips onto your thumb. Then take a thick rubber band (like the ones that come on the stalks of broccoli - you've certainly got a few of those laying around if you eat Zone) and put that around your fingers. Flex your fingers opened and then close them. Repeat until fatigue. I do it when I'm driving around in my car. Also, find someone that can do a good deep muscle massage on your bicep. In some fashion, it releases the tension on that cranky tendon. Before I tried it, I ck'd with my physical therapist and she gave it a thumbs up. It cut my therapy time down a bunch. Anytime I start to feel it act up, I start with the rubber band and generally head it off before it goes anywhere. Maybe one of the med types can better explain it, but the therapist told me it not only strengthens the tendon but helps get it back in alignment.

Brandon Oto
03-07-2008, 10:02 AM
I think the idea with that exercise is to balance the extensors of the hand (the "opening" muscles), which basically never get worked, against the gripping muscles we train so often.

Aaron Shaffer
03-07-2008, 10:04 AM
Carina, thank you. I have the Iron Mind bands of varying resistance for the exercise you mention. I've been using them religiously for the last 3 weeks.

Leonid Soubbotine
03-07-2008, 10:43 AM
See you in a week. I'll bring the foam roller with me.

Doug Holland
03-07-2008, 11:26 AM
Aaron,

I believe Robert is correct (tendinitis). Your form is fine. But your body is going through some major changes.

When I push press 275 overhead my elbow's will get sore. Heavy weight increases inflammation at the joint structure.

This will sometimes cause a trigger point to develop.

However, it is an easy fix maintenance wise. I work on my patient's who come to my office with the very thing you describe on a monthly basis. If you lift heavy and grow quickly you will experience pain in the fascia.

Here is link to a basic exercise (http://www.triggerpointbook.com/tendinit.htm) that will help.

I would ice my elbows (cryotherapy) after every DIP, Bench, Press, Clean type workout. 20 minutes on 10 minutes off for one hour.

Once your fascia adjusts to the new muscle size you will have less issues.

Doug

Aaron Shaffer
03-07-2008, 01:34 PM
Haha, I like that explanation. I got strong too quickly :D

Doug Holland
03-07-2008, 03:32 PM
Aaron,

Do you think you could get CF headquarters to do a CF1 certification at your new facility?

I would go.


Doug

Aaron Shaffer
03-07-2008, 04:51 PM
Doug, I'd love to. I think there are certain equipment requirements and perhaps sq footage requirements that we do not meet at this point. As we outgrow this building and move into another -- definitely!
:D

Check out the certs in Ann Arbour, MI at HyperFit. That's fairly close...