Ep. #382: Mark Rippetoe on the Absolute Best Way to Get Rid of Elbow Pain

Mark: If your elbows are hurting and they’ve just started hurting, look carefully at your training and figure out what it is you’re doing wrong, you’re doing something wrong, and fix it.

Mike: Hey, Mike Matthews here from US for Life and Legion Athletics and welcome. To another episode of the Muscle for Life podcast, another episode where I interview the one and only Mark Ripoteau, always fun to chat with Mark. And this time, we talk about elbow pain. Now, if you have spent any amount of time pushing or pulling heavy things, You have probably experienced some elbow pain.

Maybe it only flares up when you are doing heavy compound movements like the bench press, or overhead press, or barbell row. That one will do it for some people. Or maybe it only happens when you’re doing isolation exercises like curls, triceps extensions, or skull crushers. Or maybe it comes and goes with no rhyme or reason whatsoever.

That is common too. Regardless of what triggers it, elbow pain can be maddening, and finding good answers for how to resolve it can be even more frustrating. Luckily, though, Mark Ripoteau is a buddy of mine, and he has some answers, so I invited him on the show to shed some light on this common theme. Now, Mark has worked with thousands and thousands of lifters over the years and thus has dealt with many weightlifting injuries and actually had quite a bit to say about how to deal with elbow pain in particular.

In this episode, you are going to learn the three most common types of elbow pain, the difference between golfer’s elbow, which I’ve had, from golfing, unsurprisingly, and tennis elbow. You’re going to learn how to diagnose what is causing your elbow pain, what exercises usually contribute the most to elbow pain, how to resolve elbow pain, and More.

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Mr. Mark Rippetoe, thank you for returning once again to grace all of us with your wisdom. 

Mark: I appreciate the invite, Michael. I’ve always enjoyed talking to you. Those of you don’t understand Michael and I have wonderful private conversations. You guys don’t get to hear. And We enjoy each other’s company.

Anytime, man, glad to be here. 

Mike: And one day that might flower into something public. Who knows? Yeah, could be very, will be. So we’re here to talk about Gillette versus a schick, right? 

Mark: Absolutely. I’m changing. If I had done anything, but use electric clippers in a long time, I’d be moving all my business to shake personally.

But. 

Mike: Yeah, I actually I shave I shave my chest and my stomach, which is probably a little bit weird, but they get hairy and I get rid of the hair. 

Mark: You’re just, you’re girlier than I am. I haven’t shaved anything, but my face in a long time. And I’ve got five inch long hair on my traps.

That’s it’s distressing. Isn’t that’s very weird. It’s like something out of a movie. Yeah. It really is. Altered States . I may, yeah. If you remember that, . 

Mike: I may have Gillette at home. That’s gonna be my last one. Go throw 

Mark: that away, man. Don’t be, don’t let it touch you. These people choosing upsides, man, and that’s fine.

This is what it means to choose 

Mike: upside. Fun times, no, I for anyone listening, interestingly, I think we were, Mark and I were talking about this before we got on, I think that Procter and Gamble could care less about social justice or really the political climate. I think they go, they’ll go into whatever direction is going to make their shareholders.

The happiest and ironically, I’m sure PNG is run by a bunch of super racist old white dudes. So the point though, is that doing something like this, it can be smart from a marketing perspective and a branding perspective, not because they care about the activism side of it, but, or the actual message.

Yeah, exactly. But because This is a video that maybe they’d spend a hundred thousand dollars on. It was a low, as far as this kind of stuff goes. It was a low budget, just viral video. They just put it up on the internet and then the media picks it up. And so they get all this free attention and you have now millions and millions of people just hearing Gillette and you have a lot of people who don’t.

Even know what the controversy is over. They don’t read the, even the headlines or the articles or even watch the video, they just hear Gillette around the water cooler Gillette. And then maybe a month later, it’s time to buy a razor. And they’re like what kind of razor should I buy?

And. The fact that they have heard the word Gillette repeated over and over for whatever, for the last month or a point at a point, it’ll die off. But it’s in Gillette’s interest to try to keep this thing ke, keep people talking about it, the more likely they are to go buy Gillette, and that’s just how advertising works.

Repetition alone has value. I guess that’s good for people out there who are, who think that, Oh, Gillette’s really trying to make a statement and they’re really on the right side of this thing. No, they’re not. They’re just trying to make money. They’re just, 

Mark: They had better hope that’s the case.

Hey, and B they had better hope their market research was done correctly. Because if somebody does pay attention to this message that they’re sending out beyond just brand. Recognition and brand exposure. That’s an interesting wager they’ve made. We’ll see how it turns out. 

Mike: Yeah, definitely. Nike did a similar thing with Kaepernick.

And as far as what I’ve heard, it worked out pretty well for them. And again, it might just be because a lot of people heard about Nike for, an extended period of time and Nike sells all kinds of shit. There’s all different ways you can spend money with Nike. So anyways, that’s actually not what we’re here to talk about.

We’re here to talk about elbow pain, something a lot more exciting. 

Mark: Right? Elbow pain. We hear about all the time and that’s true. It’s it’s fairly common. Not really amongst people that have just started training, but for people who have trained for any length of time at one point or another, their elbows hurt and, there’s about five different ways your elbows can hurt.

And it’s important to understand That the different causes of the different types of elbow pain, they’re not all the same thing. When somebody says my elbow hurts, I say the elbow is a big place. Can you be more specific about where your elbow is hurting? Because where it’s hurting determines is determined by why it is hurt.

You’ve probably done something wrong. There are ways to do this without hurting your elbows and it gets complicated. So settle in boys and girls, and let’s just have a little discussion about the causes and cures of elbow pain. Let’s go over the three basic types of elbow pain. All right, there is triceps tendonitis and triceps tendonitis.

Is not as common amongst the people we train as it is in a lot of different gyms, because we don’t do a lot of isolated tricep work. Tricep tendonitis is going to be felt. On the posterior proximal side of the olecranon process. So the olecranon process of the ulna is the thing that’s the bony knob of your elbow.

If your pain is above the bony knob of your elbow and posterior, then it is in the triceps tendon. And the triceps tendon is the thing that attaches all three heads of the triceps to the elbow, the olecranon process. Yes. This is a difficult type of tendinitis to develop if you are just pressing and bench pressing.

It pretty much requires that you be excessively focused on triceps isolation exercises like lat, tricep extensions. Flying tricep extensions on the bench. Yeah, I felt it. Forgot to take French press. Skull 

Mike: crushers, I’ve noticed it. 

Mark: Skull crushers occasionally do that. The worst thing I’ve ever seen for those is an old exercise called the French press that most people don’t do anymore.

Cause it really is stupid. It’s a standing exercise where you stand up and hold usually an easy curl bar, which is basically a triceps bar in a position over your head. And without moving your shoulders, without flexing or extending the shoulder joint, you lower the weight down behind your head and press it up.

And this results in an extreme isolation of the triceps and a lot of loading on the triceps tendon. Itself. And if you’re having triceps tendonitis, you really need to review your exercise selection. They’re just not useful for big arms. You want big arms, you get your press and your bench press up, get your barbell curl up real heavy.

And that’s how you get big arms, but you don’t really get big arms from isolating a bunch of tricep work. 

Mike: Yeah. Yeah. I now, even now I, I do some push downs. I do a little bit of extra triceps work, but I’d say the majority of my, whatever triceps development is occurring is just coming from heavy pressing.

And that’s it. 

Mark: Sure. Compound movement development, not isolation. I think everybody’s experience, if you’re honest about it, has been that your big arms come from the compound pressing movements. Any lat work you get involves the triceps. Triceps are involved in all kinds of different things, and I don’t know that it’s really necessary to isolate them.

But more importantly, if you do isolate them, and your triceps tendon is inflamed, stop. And 

Mike: just to be specific on, so people understand this would be higher up on your arm, not lower, right? This is 

Mark: posterior proximal side of the olecranon process. 

Mike: It’s just even that term proximal many people listening wouldn’t even know what that means, which I understand.

Mark: Proximal to the what I mean by that is, all right, proximal means closer to the center of the body. Distal means further away from the center of the body. Your foot is distal to your knee. Your knee is distal to your hip, right? So this is on the posterior side of your arm. In other words, the back of your arm where your triceps live, but it is also, it is proximal to the olecranon process.

Which means it is just above the olecranon process, but it is on the distal end of the humerus. So let’s, it’s right above the elbow on the back. It’s above the elbow. Okay. And it’s right in the middle of the thing. I hope that’s more clear. Because I see, I can see the confusion between proximal and distal in the way I used it.

Yeah, it’s on the distal end of the humerus. But it is. Above proximal to the olecranon process. All right. Which is the bone of the elbow. All right. Now it’s going to be impossible for me to refer to the rest of the elbow anatomy without using some technical terminology. So just learn it. All right. 

Mike: Yeah.

And also anybody listening, you could just pull up, just look at some images online and it’ll be right. 

Mark: It’s easy enough to look this up. The olecranon process is the bony end of the ulna. That’s what forms the elbow. If you hit somebody with your elbow in the face, then you’re hitting them with your olecranon process.

You are probably a toxic male. It might very well be, I’d very well be mad about something. So that’s the olecranon process. And probably the least important type of elbow pain is triceps tendonitis. Now, the most common type. Of elbow pain is what is called tennis elbow and golfer’s elbow. These are sometimes they’re found at the same time.

Sometimes they’re found together. So let’s talk about these separately. First tennis elbow is a type of tendonitis. That affects the forearm extensors and the origin point of the forearm extensors are on the lateral condyle of the ulna. They’re up on the forearm on the lateral side, the outside. So think with me about this just a second.

If you extend your forearm, in other words, you open your hand up to the back. And show the palm of your hand to the ceiling. For example, if you are similar to the position you would be in, if you’re going to press a bar upward and you extend your wrist, you are using the forearm extensors to do that. Can everybody visualize that?

Mike: Yeah. You can even feel the tension. You can feel the 

Mark: tension along. Remember, normal anatomical position is a supine palm. So if you’re standing up, point your palms of your hands forward. Now we’re in normal anatomical position. And that means that the forearm extensors in that position are on the back.

They’re posterior. So if you open up your hand, you extend the wrist, then you can feel the tension in the forearm extensors. Those muscles attach at the elbow. On the lateral condyle and what is a condyle for anyone? The condyle is a, the bony knob on the end of a bone that forms an articulation like on the femur, the distal end of the femur.

Has two condyles. You’ve seen this, with a dog bone, you see the bony ends around. The tibia articulates with that. And the condyles are the lateral and medial round things that allow for the attachment, allow for the articulation of the joint. So in tennis elbow, those muscles attach right up there and.

Tennis elbow. If you really feel of these things real closely, it’s on the forearm side. Of the joint. Okay. It’s on the forearm side of the joint. People would diffuse elbow pain. Sometimes find it very difficult to tell without somebody that knows their way around an elbow, where the pain actually is. And I’d say more than half of the people with elbow pain really don’t know exactly where in the elbows and flank tennis elbows, terribly common.

And it’s common. It’s probably more common among people that don’t lift weights than it is among people that do lift weights. Okay. And it’s it’s, it can get very painful if it’s not dealt with. And it is an inflammation right at the bone, the change over at that particular location from the muscle.

To the tendonous attachment is not very long. It’s not a long tendon like you get used to thinking about when you think of a biceps tendon. It’s a short musculo tendonous juncture that goes right into the bone, that insertion point of the tendon, a little short piece of tendon that’s left there, that over the change between muscle, tendon and bone can get inflamed.

Now, golfer’s elbow. Is an extremely similar type of situation on the other side of the elbow. It’s also on the forearm side of the joint, and it would be an inflammation on if you’re in normal anatomical position with your palm facing forward, it’s on the inside. Of the elbow. It’s not above the joint.

It’s on the forearm side of the joint. And that hold mass of muscle insertion on the bone is right on the inside of the elbow joint, right underneath the. The elbow articulation itself, and this is forearm flexor. This is forearm flexor tendonitis elbow. A tennis elbow is extensor tendonitis and golfer’s elbow is flexor tendonitis.

And. The different points of insertion of the extensors and the flexors determine the difference in the location of the paint. 

Mike: Yeah, I had a bit of golfer’s elbow back when I first started golfing and funny by this thing. So if you look down at your arm and if you flex your forearm as if you’re trying to show off how big your forearm is, The muscular bulge on the inside of your arm, when you go down it and you start getting to where your elbow is, it’s right down in there.

I had it for, fortunately it didn’t get bad, but yeah, it sucked. It was a pain in the ass. It’s a real 

Mark: giant pain in the ass because a lot of times if it goes on long enough, if either tennis or golfer’s elbow goes on long enough, the medical people will tell you that it becomes tendonosis. Not tendinitis.

In other words, a necrotic, the tendon dies. Now, I don’t think that’s true. All right. And I’ll tell you why in a minute. I don’t believe that. I think that’s complete bullshit. And I think a lot of unnecessary surgery is being performed on. A lot of people’s elbows and typically it doesn’t make them any better after the surgery.

You’ll know. Yeah, 

Mike: that’s 

Mark: right in 

Mike: line with, I had Dr. Stuart McGill on for an interview regarding back pain and just spine mechanics. And that’s right in line with what he was saying. Like he doesn’t believe in the term like degenerative disc disease. He just debunks that entire concept that the body is constantly actually trying to heal itself.

So that would be in line with that, that it wouldn’t quite make sense. Hey that’s dead now. That’s good. That tendon’s gone. Your body and the body can, can’t do anything with that anymore. 

Mark: And that’s just, you and I talked about the back thing and Miguel and I are in agreement that these changes are normal.

It’s just what happens in a bipedal animal. You’re going to have what could be identified as degenerative spinal pathology. But if everybody on the planet has it, is it pathology? No, 

Mike: it’s not. Yeah. And I like also his take, which is very much in, in line with yours, which is, it’s very practical and functional and that can we get people to be able to live their lives without back pain and exercise without back pain?

And yes, we can. Great. Let’s just do that. And let’s not worry about trying to invent diseases or invent reasons for people to get surgeries. Let’s just work on getting them healthy and pain free. 

Mark: And even if you can’t get pain free, and a lot of people can’t get pain free, then what you can do is re educate yourself about what you’re feeling.

More importantly, the way you react to what you’re feeling. Just because your back hurts doesn’t mean you can’t deadlift heavy. You can’t. And you just got to get used to the idea that you can’t, just because the back hurts doesn’t mean you should not load it. Do you want a back in pain that is strong or a back in pain that is weak?

Back to our elbow discussion, the elbows are the same thing in that the medical community regards both golfers and tennis elbow as if it’s embedded long enough, it’s something we have to do surgery on, and that’s just not true. Now, I have actually developed a way to treat elbow pain. And the vast majority in fact, I’d say everybody that’s done it exactly like I told them to do it has had a resolution in the elbow pain.

Now I stipulate to exactly the way I told him to do it because. Most people not do it the way you tell them to do you’re familiar with that. You coach these people and you hand them a program to do, and you’re fairly confident that they’re doing the program. And then you get to looking closer and they’re not doing the program.

They’ve added a bunch of shit to it. Their squats are three inches above parallel. 

Mike: They saw that they saw this Instagram and, he had abs. He had abs. 

Mark: If you do what he does, you’ll have abs too. And that’s, like I told you earlier, people, average IQ is a hundred.

They don’t understand the difference between cause and effect and correlation. And you can’t explain it to them. But this method that I have developed for dealing with elbow pain works virtually every time it’s tried. If you will do it the way I tell you to do it. And it’s a rather interesting process that I ran across.

Okay. A long time ago. And I just applied it to what we do in the gym. I was in the horse business for a long time. And there is a tendency among courses that are worked real hard to develop flexor tendon pathology, especially in the front legs. Now a horse walks and runs on his middle. On the terminal phalanx of his middle finger, all of the other digits have receded and the horse’s hoof is the terminal digit of his middle finger.

It is what we call that digit is the same as the digit in your middle finger, but it’s called the coffin bone in a horse and the joint above the coffin bone is called the Fetlock joint. And around the Fetlock joint. Is the same tendon you have in your middle finger, but it’s big and strong. And it’s called the flexor tendon in a horse.

And if a horse is how it happens by accident, horse steps in a hole or first one thing or another some horses are more prone to it than others, but if a horse develops. What is called a bowed tendon or tendon damage in the flexor tendon above the Fetlock joint. And he can’t heal it. He’s pretty much useless.

Horses are livestock and they’re not really our friends, except, some, middle aged ladies keep a horse in a barn and love the horse and all this other stuff. 

Mike: And you have guy, what was it? Who is that internet guy? The mr. Hands. I think it was, did you ever hear about that?

No, I don’t know him. Okay. Just some internet shit, some dude that got plowed by a horse and died. 

Mark: I didn’t know about that, these ladies treat their horses like pets and stuff. And so this process for healing the flexor tenant of a horse seems cruel and most vets won’t do it anymore, but I’m telling you that it works and if you’ll think about the mechanism of why it works, it’s very interesting, the process is called pin firing.

Pen firing and formerly it was accomplished with pointed piece of iron, like a very blunt pencil that was heated to red hot. And what was done was you took this red hot iron and you burned a series of wounds into the skin. Over the fat injured flexor tendon on both sides of the leg. So it’s a series of 10 or 12, depending on the size of the horse wounds, burns along the backside of the leg the foreleg.

And what this does is create a giant weeping, chaotic mess of inflammation all along the tendon sheath. And guess what happens? The inflammation becomes very big and very systemic. And the increase in the inflammation goes ahead and makes the whole area heal. Because inflammation is the first part of the granulation process in healing a wound.

And this is essentially an enhanced form of ushering along enough inflammation to overwhelm the whole area. Area of the leg that was burned and the tendon sheath underneath it. And quite frequently, this resulted in a healed front leg. On a horse that would otherwise had to have been put down.

Mike: And it’s not just the subsequent rest. No, 

Mark: no, it’s not because the horse has been rested. He’s lame. 

Mike: Okay. 

Mark: I don’t 

Mike: know shit about 

Mark: he’s already resting. Cause he’s lame. He’s not good for anything. He’s just standing around. If we can’t get him healed, he’s got to get off the payroll. So in earlier days, when horses were much more popular.

Portant to the economy than they obviously are. Now we needed to save our investment and it’s a shame to put down a perfectly useful horse if we can get him healed up and if it hurts the horse a little while enables him to hang around another 20 years what do you do, you do what’s necessary.

So I got thinking about this and I thought, my elbows and fucked up for a while. Let me see what I can do about this. So what I did. I like where this is going. You got a nail out. I went out to the, to my track and I’ve got a chin up bar beside my track out on the North side of the gym.

So I did five chins and then I walked a lap and I did another five chins and I walked another lap and I did five more chins and I did 20 sets of those. And by about the sixth set of those, my elbows were hurting really bad. And I kept doing them because I know I’m not going to hurt anything.

They’re just hurting. I’m not going to structurally damage my elbow. It just hurts. So you’ve got to get over the idea that pain indicates that something. Is being damaged. It may not indicate that at all. It may merely indicate that something’s already damaged. Okay. So I got through with my hundred chins and next day I’m predictably very sore.

Everything is sore. My biceps, my lats, my scabula retractors. My triceps, everything is sore, my elbows are sore, everything is inflamed. Okay, I waited four days and I did it again. And then I waited four more days and I did it again. And I went up to 10 sets of five and 10 sets of six. So I’m slowly increasing the load and the stress.

And by the fifth workout, my elbow pain was completely gone. And this isn’t supposed to happen. I’d had that elbow pain for a long time. Out of curiosity, what kind of elbow pain was it? It was golfer’s elbow. And I’d had it for a very long time. And, I of course don’t talk to doctors much unless I just have to.

But if you talk to an orthopedic surgeon about that, he wants to cut it open and scrape things and read, hell, I actually don’t know how they do that surgery, but it doesn’t seem to make a great deal of sense to me. So I put other people that have had elbow pain on the same process and we tailor it obviously for the strength of the individual.

I could at the time do 10 or 12 chin ups. So I did five. If you can’t do but three or four chins one time, maybe you want to do one or two reps. The set itself is not maximum. The idea is to accumulate a large amount of submaximal loading enough to cause an inflammatory response in the injured elbow tendons and to keep doing that.

And typically what I hear from people is by the fifth workout, it’s gone. The pain is gone. And this is a real interesting approach because I’d never heard of anybody doing it before, but we’ve put a lot of people on it and we know it works. So it’s an interesting application of this pin firing thing that I’ve learned from the horse business.

Now, people won’t hardly let their horses be pin fired anymore. Most vets won’t do it. If you can find one that will. They probably come out Saturday afternoon to the barn and do it. And what they do is they do a nerve lock. Above the tendon so that the horse doesn’t try to kill you while you’re burning his legs.

And they might give him some romp them or something like that to calm them down before they do this. But what you find is that this big giant weepy mess of a burn wound on the back of this horse’s leg goes ahead and resolves within a month or two into a normal tendon with a series of scars.

And scars on a horse turned into white hair. So if you see white hairs on the back of a horse’s foreleg, he’s been pin fired, but he’s sound. And you can be sound too. If you’ll try this, you just do a prudent application of this method I’m telling you about. Now, what I find is that the people that do not have good luck with this have not done what I told them to do.

You have to start off with a whole bunch of sets. You can’t just do five sets. Five sets of five won’t work. If you could do 10 chin ups, you might want to do four reps, maybe even three reps, but you need to do between the first day you need to do between 10 and 15 sets, and then you would get that up to 20 sets.

On this, by the second or third workout, and then add a rep to the sets. Now, while you’re doing this, you don’t go ahead and do a bunch of other arm work. 

Mike: Yeah, that’s it. That was going to ask that is because it’s going to be probably key is that you’re not then going in the gym and also blasting it with other things.

Mark: This, you have to let it, You give it time to work. And if you want to adulterate this and do your own version of it, go right ahead. But I’m not telling you that’s the part that works. The kind that works is the way I’m telling you to do it. You accumulate a high number of sub maximal low rep sets so that the total volume is high, but that not any one of the sets is a limit set.

And I’ve had people do this just with singles. Have them do 20 singles and it accomplishes the same thing for a person who can’t do a whole bunch of reps when they chin a single is 20 singles is a hell of a bunch of work, but it goes ahead and pushes through the problems. 

Mike: Hey, quickly before we carry on, if you are liking my podcast, would you please help spread the word about it?

Because no amount of marketing or advertising gimmicks can match the power of word of mouth. So if you are enjoying this episode and you think of someone else who might enjoy it as well, please do tell them about it. It really helps me. And if you are going to post about it on social media, definitely tag me so I can say Thank you.

You can find me on Instagram at Muscle for Life Fitness, Twitter at Muscle for Life, and Facebook at Muscle for Life Fitness. 

Mark: Now, what about training would cause golfer’s elbow? You’ll find it associated with the squat quite frequently, because if, when you take your grip on the squat and you take the bar out of the rack and you take the correct neutral grip on the squat and you finish your set of five and you rack the bar, if you notice that your L your wrist is in extension, Then you have allowed your wrist to open up during the set, and now you have placed a huge amount of stress on the flexors down there at the golfer’s elbow site.

If you don’t control your grip and keep your wrist straight and neutral when you squat, you’re going to have some problems. Ultimately with golfers elbow. And if you’re squatting and you’ve got golfers elbow, get somebody to video a set of squats and see what you’re doing with your hands. Cause you can’t always tell.

Mike: Yeah. Especially when, the weight’s heavy and you are working at a pretty high RPE, your wrists are really the. You’re 

Mark: not 

Mike: even aware 

Mark: of them. No, you’re thinking about other stuff and you’re concerned with driving your hips up out of the bottom and actually completing the squat.

You’re just not, yeah, you’re just not babysitting your wrist like you need to be. And if you don’t put your wrist in the right place, they’re going to inflame your elbow. So look at that. I don’t know what about the squat would cause. Tennis elbow, usually the problems associated with the squad or the golfer’s elbow, but I’ve used this method for tennis elbow.

And it works just as well because of the fact that when you chin, both extensors and flexors are tight. Both sides of the elbow are squeezing to hold position. On the bar when you’re hanging in and when you’re chinning, the palms are faced, you or each other palms facing in is a chin 

Mike: palms facing out is a pull up.

I know, but you have the middle, where you have the little handles and people don’t do that. Is that a chin up or is that a pull up? What is 

Mark: that? I don’t know. Just do chin ups. All right. Everybody just shut up and do chin ups. Okay. And chin ups work for both sides. All right. Don’t use fancy equipment.

See, that’d be another way of not doing exactly this recommendation. You want to do it your way. We’ll go ahead and do it your way, but I don’t know if it’ll work and hell, it may make things worse. If you don’t do it, like I’m telling you to, it could make it worse. But the idea is, and this is real important to understand.

The idea is if you do it this way. It’s going to get worse before it gets better. Expect it to hurt. If it’s not hurting, then you didn’t increase the inflammation. And if you don’t increase the inflammation, you do not increase the mechanism by which the thing can go ahead and heal. Terribly important to understand this, if you rather not have it hurt pretty bad after a couple of workouts, then don’t do this.

Just go ahead and get the surgery or take heroin or whatever you’re going to do, but don’t expect this thing to feel good. It doesn’t work if it feels good. 

Mike: And for people listening, because inflammation these days. always associated with bad things that, inflammation causes disease and causes various types of degenerative conditions, blah, blah, blah.

And while there may be some validity to some of that, let’s also remember that inflammation, for example, is also a vital part of the 

Mark: healing process of every healing process. It starts with inflammation, the prostaglandin cascade. Healing is facilitated by inflammation. You look it up. There’s a lot been written on this.

Look up insulate inflammation on the, on Wikipedia and learn about the mechanism by which I’m suggesting that you can heal your elbows. 

Mike: Yeah. And it’s also related to building muscle, for example, which we all want to do in the gym. So you have. It can be counterproductive if you are in the gym every day, lifting heavy weight and then outside of the gym doing as much as you can to reduce inflammation in the body.

Isn’t that also why I think one of the reasons why the old rice therapy has been rethought and that, you 

Mark: know it’s the application of going ahead and realizing that inflammation is a normal part of this process and an understanding that wrist ice. Compression and elevation just doesn’t work.

It doesn’t work, and those of you that have eyes to sore elbow or a sore knee, no, as well as I do that, it doesn’t work. It never works. Why do we do it then? Because physical therapists tell us, okay you got to do something, right? And ice might make it feel better, but that’d help inflammation.

Ice on a knee doesn’t make a knee better. That’s dumb. If you’re just honest with yourself, you realize it didn’t change a damn thing. So yeah, rice is going out of going out of style finally. And with it a bunch of wasted time, because it takes a while to just lay around on your ass with ice on your knee, 

Mike: yeah. And then, and it also then opens the door to actual resolutions as opposed to. Prolonging a condition, doing something that isn’t effective. Exactly. So what about bench? What about the bench press? Unless there’s something else you want to say specifically. I want, that’s my next question.

No, 

Mark: there’s one more thing. I want to, I want one more kind of elbow pain. I want to talk about that’s less common and it’s good that it’s less common because it’s real bad. And this is the kind of elbow pain that happens because of the squat. And it is. Essentially an inflammation, but in the, Oh, no humoral ligament, I believe is what it’s called.

The radio humoral ligament is what it is. So there are ligaments that hold the forearm to the humerus and they’re deep in the elbow. If you take an incorrect grip on the bar, when you squat and you apply a bunch. Of compression down the forearm at the elbow, then it is possible to develop a very deep, painful irritation in the middle of the elbow that feels like a headache.

It feels completely different than the other types. of elbow tendinitis. It’s a ligament inflammation is what it is. And it feels exactly like a headache. It’s just a deep ache, and it’s down in the middle of the elbow. It has nothing to do with your curls, nothing to do with your chins. Typically, it is the result of your squats, you keeping your elbows in the wrong position on the squat and taking too much breath.

Of the load, holding the bar up with your arms, the bar on the squat sits on the posterior deltoids and your back and the posterior deltoids hold the bar up your arms. Don’t hold the bar up. They support it with some compression up the shaft of the forearm from the elbow. But if you are trying to hold the whole load of the bar in your hand.

Instead of laying it on your back and supporting it with your elbows in the back, then that’s how you get this deep kind of headache type elbow pain in the elbow ligaments. Now, this obviously requires that you be squatting heavy before you’re even susceptible to this. Just in case you are and you have been and you’ve got this deep ache in your elbows, that’s what’s causing it.

You got to reevaluate the way you’re carrying the bar in the squat. Once you figure this out and start carrying the bar correctly, it’ll take this about three weeks to heal. Don’t expect it to go away immediately. It’s not serious damage. It’s not ever, I’ve never heard of anybody dislocating an elbow because of this, but it is very painful and that’s what’s causing that.

So those are the basic three types of elbow pain is The triceps tendonitis, which occurs pretty much as a result of isolated tricep exercise. The golfer’s and tennis elbow, which are caused by lots and lots of different things, both in the weight room and out of the weight room, but they’re easily managed with the protocol I’ve just laid out for you.

And this deep pain in the elbow that’s a result of squatting that most people won’t run into. But if you do run into, it’s a giant pain in the ass and it’ll puzzle you as to what’s causing it. I’m telling you the squats causing it. So reevaluate your grip in the squat. And those are the basic three types of elbow pain you run into.

That’s great. And on 

Mike: the, on the triceps tendonitis situation, I can speak personally. I had a bit of that along the way and I’ve run into a number of people just in my travels who have. who have had it happen to them as well. And it seems to in my case, if I remember correctly, it was a bit earlier on when I started training with heavier weights in general.

So I moved away from just the traditional bodybuilder workout stuff, just high reps at whatever intensity and a lot of isolation. So in the beginning, I remember having some of those issues and they just went away. I just worked through them and I didn’t Push myself to agonizing pain, but I didn’t necessarily back off of exercises that if they were mildly uncomfortable and that I’ve seemed to remember working with a number of people over the years where it was similar where they just had some joint issues, whether they would have, whether it was elbow stuff or other joints.

Particularly with people that were new to heavy weightlifting and they just kept going and it just went away. It’s not like super helpful, but I was just curious as to your experience. 

Mark: Anytime I’ve had the triceps tendon, elbow pain, it’s Gone away when I quit doing the isolation shit that was causing it.

Now, a lot of tendon stuff, a lot of tendon pathologies will spontaneously heal. And I think a lot of people have had that experience with plantar fasciitis. I remember having that shit about, Oh, 18 years ago when I bought this, the gym, when we bought the building, I’m in now I was on a ladder every day for about three months, hanging your heel off of a ladder and my God, that thing, I got it in one foot.

Didn’t get it in the other foot. I, it’s weird sometimes and tried all kinds of things. Tried the golf ball, the massage, nothing worked. We got through with the ladder and the thing still hurt. And one day I just woke up and had just got up out of bed and was walking around and realized after about 10 minutes, my foot doesn’t hurt anymore.

Just one day resolved. I don’t know, man. It’s some things are just. It’s wonderful like that most of the time they’re not, but sometimes it’s just wonderful. It just goes away and just spontaneously heals or, one day you, it’s been healing and you’ve still been perceiving it.

You’re used to being mad about it and everything. It’s been healing the whole time. And then one day it drops below the level at which you can perceive it as pain. 

Mike: Yep. I just wanted to throw that out there for anybody might be dealing with it. It it may just go away for no. Even particular reason, 

Mark: no apparent reason.

It went away for a reason, but it may not be apparent to you. Why typically tendon overuse injury is the result of either weakness in the muscle groups involved in the movement pattern that’s causing the problem such that you’re having to use a rather high level of your absolute strength to make the repetitive motion and that causes inflammation.

It’s either that or it’s an incorrect movement pattern that’s causing the tendon to be loaded in a way it was not designed to be loaded. Either way will inflame the tendon. And either getting stronger or fixing the movement pattern problem can remove the cause. And then subsequent to that, the tendon will heal.

But there’s always a delay between those two events. So don’t, even if you fix the tendon, The cause of the tendon problem, the tendon is going to remain inflamed and feel like shit for a number of weeks after you get through it. And then one day it’ll be gone. 

Mike: Makes sense. Question on the bench press has that been something that’s commonly associated with a elbow?

Mark: I think way more commonly associated with shoulder issues. Yeah, of course. No, I don’t think that properly performed bench press is particularly tough on elbows at all. And what 

Mike: about, what about improperly? I just mean out there. And the reason why I’m asking you that is, I’m thinking myself, it’s definitely not a common thing that people reach out to me saying, Hey, my, my elbows hurt when I’m benching, but I figured I would ask.

Of course, it’s more common that it’s shoulders. 

Mark: I haven’t had it. I think it back over the past 10 or 15 years, and I don’t think anybody has come to me with a dose of elbow pain as a result of the bench. Now, the bench the elbow pain caused by the squat that I referred to earlier, both golfer’s elbow and that deep pain.

Shear caused pain will definitely hurt during the bench press, but I don’t think that they’re caused by the bench press. I think you feel that’s 

Mike: a good point to make though, because a person may not know what, once it sets in and they feel it when they bench, they feel it when they squat, and they don’t feel it when they wiped 

Mark: their butt. You get your, you get golfer’s elbow hurts all the time. It’s real bad. There’s no doubt about it. And you’ll feel it when you bench while it may not have anything whatsoever to do with the bench press itself. You’d feel it while you bench.

Absolutely. Yeah. 

Mike: I remember what helped for me again, it didn’t get bad. And it was actually from golfing. It was when I started picking up golfing and I was, sitting at the range, hitting balls for five hours straight, but there was from where there was like a forearm, it was a strap with a shock absorber of sorts, and that, that ended up helping me.

That was specific for golf because of the impact into the ground over and over. And 

Mark: yeah, the reverse of a tennis elbow strap. You’ve seen those things that fit around the outside of the elbow that just put a little pressure on that terminal end of the muscle right before the attachment. Take some of the stress off the attachment itself.

I had never seen one of those for golfer’s elbow, but I certainly can understand why they would be produced. And I see why they work too. 

Mike: Yeah. Yeah. I know it helped. And I was wearing that for a couple of weeks and that was really the end of it. Did your golfer’s 

Mark: elbow just resolve? 

Mike: Yeah, it didn’t get too bad either.

It was like, 

Mark: and you’re doing enough forearm work in your training to where it wasn’t a strength issue. It was just a, the shock of the divots, you’re slamming your club into the floor. And it, it caused a bunch of dynamic loading on the tendon and got it inflamed. And you eventually learned how to play golf and it went away.

Mike: It’s even I think it happens probably among, even among good golfers because the impact is what it is. There’s no getting away from it. No, it’s going to happen. Yeah. Even when you’re good. Yeah. You’re not, even when you’re good, you’re still hitting the ball.

And you’re still going into the ground, you’re still at that moment. All right I think then, those are all the questions that I had. If there’s any, is there anything that is floating around? 

Mark: No, I can’t think of anything else except to add that if you’ve got an early dose of this, an early case and you can catch it early, the earlier you can catch it, The less developed and the less embedded it’ll be in the tendon and the easier it’ll be to fix.

At that stage, some ibuprofen or some naproxen or some other type of NSAID might be helpful to make it feel a little better while you get in the process of either strengthening the part of the elbow that needs to be worked on or stopping doing the thing wrong that’s causing it to hurt. In an embedded case, I think that elbow tendinitis, bad elbow tendinitis has led to a bunch of unnecessary inset use.

You can’t treat it with insets. Because if you’ll remember, you want the inflammation to go ahead and help you heal the thing up. Okay. Now, if you can’t get to sleep because it hurts so bad, you got to do something. And a combination of ibuprofen and Tylenol works very well for that. But if you can, if your elbows are hurting and they’ve just started hurting, look carefully at your training and figure out what it is you’re doing wrong.

You’re doing something wrong and fix it. And as usual I’m available at starting strength. com. We have a forum over there. I have a Q and a. Feel free to ask me any non stupid questions, but let me first encourage you before you post over there to search the board. We’ve talked about these types of things for years and years over there, and there’s a giant amount of data out there.

On the boards about all these types of injuries, people much smarter than myself are talking about this all the time because the injuries are one of the most common topics on the board. People are hurt. People get hurt. People want to know what the hell to do about it. And we’ve talked about it quite a bit.

So before you post a question, go to the board, go to starting strength. com and search the forums and look around. And there’s probably an answer to your question there already. If I can help after that, post something. Okay. But be assured that injuries are one of the primary topics of our conversation over there.

In fact, our strength con that is coming up the first week. End in April this year in 2019, first weekend at April here in Wichita falls. It’s a large convention of fans of the method and everything. We cut it off at 200 people. And there are speakers all weekend from various bodies of expertise throughout this industry.

And we are specifically talking this time about injuries. And if you’re, if injuries are your concern, if you’re hurt, or if you’re a trainer, who’s Is interested in dealing with people with injuries. That’s what this whole weekend will be about. And you register for that online too. It’s a first weekend in August and April of 2019 here in Wichita falls.

And we’d like to see you there. And you can ask any questions you want firsthand. And again, it’s called strength con, right? Strength con it’s on our website, the events page on our website. You can sign up for it. I like it. And that was a smooth pitch. My friend, wasn’t it? I’m getting better. It’s this advertising thing I can segue into an ad.

I certainly can’t. 

Mike: I wonder what your ad might look like if we were to envision the shape of the Mark Rivetao shaving ad look like 

Mark: I might, there’s a viral. I wouldn’t be, I wouldn’t be shaving my chest. Mike, I’m what you’re going to fuck up and cut your nipple off. One of these days, just keep that in mind.

And I heard it here. First, 

Mike: you gotta be real careful. You got to 

Mark: slice that fucker all the way off and it’ll happen so fast. And you’ll just go, Oh my God, that’d be pretty fun. I’ve only got one nipple. That’d be pretty funny though. Actually. Yeah, it would be real. 

Mike: All right, brother. Thanks as always.

Really appreciate you taking the time and we will figure out. What the next talk will be and yeah, we’ll announce it in the upcoming days. All 

Mark: Man. Enjoyed it as usual. Thanks. Same. Thank you. 

Mike: Hey there. It is Mike again. I hope you enjoyed this episode and found it interesting and helpful.

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