Elbow Pain in CrossFit – Part 1, How It Happens
Can CrossFit make you sore? Absolutely.
Can you get hurt from doing CrossFit? Sure. There is inherent risk in any physical endeavor you undertake.
It is our responsibility as your coaches, and your responsibility as an athlete, to mitigate that risk as best as we can. The best way we can do our job is by providing the best coaching and appropriate amount of volume and intensity (reps, load, difficulty of movement, etc) to each and every one of your workouts. The best way you can do your job is by giving us feedback on a daily basis on how you’re feeling and also by continuing to trust that we have your long-term well-being at heart.
But let me be perfectly clear – this does not mean its “ok” or “expected” that you will, or should, get hurt while doing [insert any activity here].
Ok, now with that out of the way, lets dive into this thing called elbow pain.
First, we need to define a few things. Injuries fall into two main categories:
- Acute – Dropped a barbell on your head? Fell off a plyo-box? Broke Wall-Ball rule #1? (For those unaware of our rule, it’s catching it with your face!)These are examples of acute injuries – they are immediate in their expression of symptoms: pain, redness, tenderness, swelling, inability to bear weight, etc. They hurt, right away.
- Chronic – Shoulders always stiff and sore? Elbow tender to the touch? Dull aches in the low back when resting?These are examples of chronic, or ‘overuse,’ injuries – they are characterized by pain that develops over time.
I’m sure you can identify that the type we are covering today is of the chronic variety. The folks I’ve seen with elbow pain didn’t trip and break their fall with their elbow. They didn’t fall out of any trees and land on their elbows. Its something that came on over time and eventually the pain came to be too much to ignore and interfered too much with their activities of daily living. And that is probably the most frustrating part – when you can barely steer your car with the questionable limb or can’t open a can of (paleo-friendly) tomato sauce, thats a problem folks! You don’t do CrossFit to make your life harder; you do it to make your life better.
The next thing we need to understand is the anatomy surrounding your elbow joint. Your entire arm (not including your hand) is made up of three bones: the humerus (upper arm), ulna and radius (two lower arm bones). Holding all three of those bones together are a group of muscles, ligaments, and tendons. Muscles are responsible for the movement of your limbs while the tendons and ligaments hold things in place. Tendons are similar to ligaments; both are made of collagen. Ligaments join one bone to another bone, while tendons connect muscle to bone.
What is “tendonitis?” Well, if you’ve been around Aero Health and Fitness long enough, you know that anything ending in “-itis” is simply an indication of the body’s inflammatory response to you pissing it off. So in this case, it means your tendons are inflamed. This is the underwhelming diagnosis that you receive when you visit your doctor. There are differing grades, but its beyond the scope of this post.
Now to the fun part – how it occurs within the confines of the gym. The muscles of the body are responsible for a few types of contractions: isometric (position remains the same – think of holding a pull-up where your elbows remain at 90 degrees), concentric (muscles are shortening – think of pulling yourself up from a dead hang), and eccentric (muscles are lengthening – think of lowering yourself down from the top of a pull-up). Each time you perform a movement, not only are you stressing your muscles, you are stressing your entire body – from your heart to your lungs, your muscles, and yes, even your ligaments and tendons. Now here’s the important part – tendons do not have the same resiliency or recovery ability as your muscles. So while you are busy jamming out more pull-ups, or squats, or [insert any movement here], your body is busy keeping up with the repair phase. Except it doesn’t occur as rapidly for your dear old tendons. No pun intended! This is why tendon pain can linger for so darn long.
Errors that I see as most common culprits in this issue:
- Pulling with the arms too early in the clean or snatch. When you do this, you take the bulk of the lifting off of your legs and put the strain on your arms. On top of that, when you pull with the arms, there is often a rapid re-straightening (a heavy eccentric load/tear) of them as the bar passes your hips. This is a similar mechanism to how shin splints occur (the heel-toe gait that generates a quick eccentric load/tear on your shin muscles). If the re-straighten does not happen, then that means your arm is supporting that heavy load on its own that much longer…not what it is designed to do.
- Using the elbows to control a rapid descent from the top of a pull-up (or muscle-up), rather than relying on the stronger shoulder complex. Same can be said for the lowering of a barbell from the shoulders.
- Slowing your descent too much from a pull-up (or muscle-up) or barbell coming from shoulder height. There is a fine line that we teach that is between dropping from the top and turning it into a 3 second descent. Show control on the way down through an active shoulder complex.
- Doing a higher level of difficulty movement than your body (and your training capacity) is ready for.
- Doing too much
- Doing too much
- Doing too much
- DOING too much
- DOING TOO much
- DOING TOO MUCH
Ok, so numbers 1-3 above are things that we as coaches can help with from a coaching technique standpoint. Number 4 is one that we control through programming – only after you’ve gone through the proper progressions of foundational movements should you attempt more difficult movements. Numbers 5-10 are what we attempt to control through very deliberate programming – number of sets, number of repetitions, exercise selection, etc. Its a very deliberate and systematic way to control your progress in a manageable fashion. One that favors long-term results, not shortcuts. Your body needs to be given the ability to adjust to greater intensities, higher loads, across all movements (this means those that are both strengths AND weaknesses of yours), over time. It does not happen overnight.
And therein lies the rub – its human nature to celebrate a new skill obtained and then want to utilize that new skill every chance we get…no matter the number of sets…or what the programming calls for…or what your coaches advocate for you to do. When you get regular kipping or butterfly pull-ups for the first time, you want to show all your Aero Health and Fitness friends – and that’s great. Until it isn’t. Its human nature to lose sight of what most (read: 99.9%) truly came in for, in the interest of short-term goals (and clicking the RX button), namely long-term health and fitness. But when the pain bug bites, and you’re relegated to scaling back everything, was it worth it?
But how do you know how much is too much?
You probably don’t.
You trust us to know this.
I can tell you this – be patient.
Volume (more reps, more sets) is earned after intensity.
Intensity (doing more work in less time) is earned after consistency.
Consistency (does rep 100 look as good as rep 1?) is earned after basic mechanics (how good is your air squat technique vs your 1rm squat technique?) are met.
In part 1 above, we learned about the mechanism of how elbow pain can occur. In the next post I will outline what to do if it does happen to you.
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- The Crew At Aero Health and Fitness