Lateral epicondylitis, commonly known as tennis elbow, is a frequent condition that affects individuals who engage in repetitive forearm activities, including strength training. This injury involves pain and tenderness located on the outer side of the elbow, which can radiate down the forearm. For those who lift weights, managing this condition requires a strategic approach that allows for continued training without aggravating the inflamed tendons.
Understanding the Injury in Weightlifters
Tennis elbow occurs due to overuse and subsequent micro-tears in the tendons that anchor the forearm muscles to the lateral epicondyle, the bony bump on the outside of the elbow. The extensor carpi radialis brevis (ECRB) tendon is often the primary source of discomfort, as it is responsible for extending the wrist backward and stabilizing it during gripping activities.
For weightlifters, the mechanism of injury is typically an eccentric overload on this tendon, meaning the tendon is stressed while lengthening under load. Repetitive, forceful gripping required to hold dumbbells or barbells, especially when combined with poor wrist position, introduces excessive strain. Exercises that demand constant wrist extension, such as certain types of curls or heavy pulling movements, contribute to this cumulative tissue stress. The resulting pain indicates that the tendon’s capacity has been exceeded and requires a temporary reduction in applied forces.
Immediate Adjustments to Lifting Technique
The most immediate and impactful change a lifter can make is to drastically reduce the weight being used. Tendons respond poorly to high-intensity, maximal loads when they are already irritated, so focusing on submaximal efforts is necessary for recovery. A reduction of 30 to 50% of your typical lifting weight for affected movements is a prudent starting point to minimize aggravation.
Another technique modification involves regulating the speed of movement, particularly the eccentric or lowering phase of a lift. Performing the eccentric portion slowly—taking three to five seconds to lower the weight—can promote beneficial changes within the tendon structure. This controlled tempo helps improve the tendon’s ability to tolerate load while reducing the sudden, jarring forces that often exacerbate pain.
The way you grip the weight must also be addressed to alleviate strain on the ECRB tendon. Utilizing a neutral grip, where the palms face each other, significantly reduces the activation and stress placed on the wrist extensor muscles. When a neutral grip is not possible, maintaining a completely neutral wrist position, avoiding excessive bending or extension, is paramount during all pressing and pulling movements.
For exercises that require a fixed grip, like deadlifts or heavy rows, the use of lifting straps or hooks is highly recommended. These tools bypass the need for maximal grip strength, effectively unloading the forearm extensors. This allows the lifter to continue training large muscle groups without overloading the compromised tendons.
Modifying Exercise Selection
Certain exercises inherently place the wrist extensors in a vulnerable position and should be temporarily avoided or replaced entirely. Traditional barbell curls and overhead triceps extensions, for example, often force the wrist into uncomfortable extension or flexion, making them high-risk choices. Similarly, heavy pronated-grip (palms-down) rows or pull-ups demand high grip tension and can be significant pain triggers.
Swapping barbells for dumbbells or cables provides a simple yet effective solution by allowing for natural wrist rotation throughout the movement. Dumbbell curls can be performed with a supinated (palms-up) or hammer (neutral) grip, which shifts the stress away from the most sensitive tendons. For chest and shoulder work, substituting a standard barbell bench press with dumbbells or a Swiss bar permits a neutral grip, offering a more comfortable angle for the elbow joint.
Machine-based exercises often provide a safer alternative because they stabilize the path of motion and frequently remove the need for a tight, stabilizing grip. Using a cable lat pulldown with a neutral grip attachment instead of pull-ups can target the back muscles effectively while sparing the elbow. Pin presses or floor presses are also useful substitutions for standard bench presses, as they reduce the range of motion and decrease the eccentric load near the bottom of the movement.
Lower body training can also be affected if the grip is a limiting factor, such as with heavy barbell squats or deadlifts. In these cases, utilizing a safety squat bar for squats or a trap bar for deadlifts minimizes the required wrist and forearm stabilization. For exercises like lunges or split squats, using lifting straps to hold dumbbells or simply performing them with bodyweight can prevent unnecessary forearm strain.
Supporting Recovery and Long-Term Prevention
To further support healing, incorporating a forearm brace or counterforce strap can help redistribute tension away from the painful tendon insertion point during lifting. It is important to ensure the strap is snug but not so tight that it impedes circulation or causes numbness.
Once the acute pain begins to subside, a structured rehabilitation program focused on tendon strengthening is beneficial for long-term prevention. This program should center on light, controlled eccentric wrist exercises, such as slowly lowering a very light dumbbell while performing wrist extensions. These movements are designed to gradually increase the tendon’s load tolerance and improve its structural integrity.
Regular stretching of the wrist extensors and flexors helps maintain tissue health and flexibility in the forearm. A simple stretch involves extending the elbow fully and gently pulling the hand back to feel a stretch along the top of the forearm.
When to Seek Professional Help
Any sharp, radiating, or intense pain that persists despite these modifications is a clear signal to stop the activity immediately. If elbow discomfort continues for several weeks or severely limits daily function, consulting a physical therapist or physician for a formal diagnosis and treatment plan is the appropriate next step.