Elbow pain can be one of the most irritating and inconvenient issues. I once had a patient say that the most painful part of his day was just cutting butter for his toast in the morning.
Classically, we tend to blame the tissues at the joint—wrist extensors/flexors. Sure, the common insertion for these muscles becomes inflamed, but what causes that? I like to view the elbow similarly to the knee; it is a joint that is pushed and pulled on either side by very complex joints. The shoulders will largely influence the biomechanics of your elbow and the amount of torque that passes through the joint.
Although somewhat simplified, we could group you as either tight and immobile or mobile and bendy. Each characteristic has its own pros and cons, but the cons are where pain manifests. With decreased shoulder mobility and/or control, the elbow will take the brunt of the force when lifting weights or swinging a racquet. Shoulder stabilization and control are important for correct biomechanics of the shoulder girdle and upper extremity. Lack of control upstream, allows more movement downstream at the elbow. The repetitive, small insults at the elbow joint will eventually result in elbow pain.
Hammering away at the soft tissue around the elbow is often where athletes start when self-treating. Don’t get me wrong, a little forearm smash with a lacrosse ball or barbell is great. But if it does not improve your problems, move on! In this case, we are going to check out the shoulder.
Less mobile folks: To decrease the torque at the elbow, it would be ideal to improve both the external rotation (front rack) and flexion (overhead position) or your shoulder. Tight lats can often be the cause of the restrictions. Try these two mobility pieces:
More mobile folks: Shoulder stabilization is going to be the key for you. A simple way to start on this is kettlebell carries, all variations! Here are two simple, yet effective stabilization drills:
As always, do a movement screen/ form check first. Get a coach or super friend to watch you move and see if they notice any faults. Racquet sport athletes—if you constantly have elbow pain, check your grip size. Grips too small or too large can cause elbow issues as well. If you are a desk jockey, check out your work station and the ergonomics!
Try these mobility exercises and tips out. If you continue to have issues, come see us at Athletes’ Potential. We see elbow pain often and are able to effectively treat it with an evaluation! Keep devoting time to making your body work and feel better.
Dr. Jackie, PT, DPT, OCS, CSCS
In the words of Jay-Z, “I’ve got 99 problems but wrist pain ain’t one.”
Nice front rack, Mr. Farris!
Well, maybe those aren’t his exact words but since I’m actively giving up using profanity (which is very hard to do) we’ll keep this quote the way it is. We know that Jay-Z doesn’t have wrist pain but in the last CrossFit Movement and Mobility Trainer Course I taught, about half of the class had wrist issues. Usually when I informally poll the class to see what problems most people are having, back pain comes up number one. This weekend wasn’t any different until the Sunday course. Wrist issues were a plague for this group, predominately in the front rack position. So we spent a ton of time working on the wrists right? Wrong. We fixed their shoulders!
How many of you have seen big strong guys/gals that can back squat a ton of weight but when you get them to front squat their weight drastically decreases? These are typically males that used to love bro'ing out at some globe gym where everyday is bench press day. They are pretty strong but have never put in some legitimate mobility work in their lives.
Don't be this freaking guy!
Let’s be clear on one thing: There are many reasons for why someone could have a very weak front squat compared to their back squat. In this example, however, we are going to focus on improving the front rack position and unloading the wrist. The higher you can keep your elbows during the entire range of motion of a front squat, the easier that movement will be. High elbows also allow for the wrist to be unloaded during the lift.
How do we get those nice high elbows? By having enough shoulder flexion and lateral rotation. In coaching terms this allows us to keep our arms parallel with the ground and maintain a strong front rack position. There are multiple problems that occur when the elbows start to drop in the front rack. It’s a huge loss of force production potential but also puts the poor wrists in a terrible position.
A combination of these two movements at the shoulder makes up the front rack position.
Here’s a quick test. Un-rack a decent amount of weight (75-90% of your 1RM front squat) and hold it in your front rack position like the example in the top section of the picture below. See how your wrists feel and see if you can hold it for 30-45 seconds. Now do the same test but hold the weight in the position like the athlete in the bottom of the picture below. No wrist wraps allowed!
Thanks to www.twinfreakscrossfit.com for the photo.
Which one were you able to hold longer? Which one felt more comfortable?
For the majority of athletes the first position will feel dramatically easier when holding the load. If you have terrible front rack mobility you will always end up in some variation of the dreaded lowered elbow position. This is wrecking havoc on your wrists and costing you PRs. If your wrists hurt, fix your shoulders!
Now how do we fix the shoulders? Here is an old school (2011) MWOD video of Kelly going over fixing the front rack position. If you haven’t checked out Mwod recently, you really need to. MWOD Pro is only $8 a month and has new mobility techniques to help improve your performance and resolve pain everyday. That’s about the cost of two lattes! In the words of Kelly himself, “make a better decision.”
Take a crack at fixing this stuff yourself first! If you're still having issues, come and see us at Athletes' Potential! If you don't live in the Atlanta area, check out this out the 4 Keys To Picking The Right Physical Therapist in your area.
- Danny, PT, DPT, OCS, CSCS
The Front Rack is a position often utilized in CrossFit and is definitely required if you have Weightlifting ambitions. If you are into barbell training the front rack is a fundamental shape, that when achieved, can be a building block to establish many quality barbell movements, including the Front Squat, Cleans, Presses, Push Presses and Jerks.
Before the boys discuss fixing your front rack they talk about the recent flooding in Columbia SC where Coach Joe lives.
The front rack discussion first begins with why and how folks experience poor positioning with this shape and why limited positioning with this shape can negatively affect your performance. In particular we see limitation in the ability of an athlete to get into an optimal front rack because of over development of upper body musculature, limited external rotation and flexion in the shoulder.
According to Dr. Danny, the two areas of focus should be the shoulder and the thoracic spine. If your T-Spine is so lacking in ROM and a safe front rack cannot be achieved, athletes should look to the goblet squat. To break up areas of restriction in the T-Spine it’s also a good to promote extension by laying on a lax ball and getting some downward pressure. Joe also mentions Donnie Thompson’s tempering to strengthen the back and a way to gain neutrality in the spine. Dr. Danny counters with a discussion about paying attention to the rib cage and diaphragm.
The conversation then moves to the shoulder. In order to have a quality front rack your shoulder needs to do two things, flexion (bringing your arm straight up in front of you) and externally rotation (turning your palm up). When your shoulders have both of these movements you can not only take a wider grip with the bar, but when you receive the bar in the clean you are able to carry the load throughout the shoulder and chest, not hold the bar in your hands.
The boys continue their discussion about grip width and why taking a wider grip is more optimal but why you may want hold off to save your elbows.
Danny and Joe then provide insight on how to achieve more external rotation pre workout. Danny believes the best mobility drills look like the exercise you are trying to achieve. Joe then discusses using PNF as a means to gain positioning pre workout.
The segment is concluded with a discussion addressing why self maintenance is so important. Being aware of your body's needs is cheaper, quicker, and you end up learning more about yourself through the struggle.
Joe then end the conversation explaining why he advises novice athletes to work their front racks with an open palm. In Joe’s mind the benefit is forcing the athlete to utilize their legs to move the bar overhead, not the hands.
Check out these videos of techniques discussed in the episode.
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Thanks for listening and remember, if you have a BODY you’re an ATHLETE!
Dr. Danny and Dr. Jackie's views on performance improvement, injury prevention and sometimes other random thoughts.