Correcting Elbow Pain When Squatting

No one thinks the pain they are experiencing in their elbow is originating from the back squat. Most people will think it is caused from a previous workout where pushing movements occurred, or they will just choose to ignore and forget, but the pain you are experiencing once you generate tension under the bar may actually be from the back squat.

Elbow pain when squatting comes from one or a combination of the following:

1. Tight Upper Body (pecs).

2. Underdeveloped Upper Back causing poor external rotation.

3. Improper Elbow Positioning when squatting.

When squatting you want to maintain proper stiffness, and that goes beyond breathing and bracing. You need to generate tightness around the bar too. Having the bar tight on your back will ensure that tension will distribute in the correct areas of the body to maintain safe mechanics. To create tightness around the bar while squatting you need to have an optimal platform for the bar to lay on. This can be done by retracting and depressing your shoulder blades to make a muscular platform for the bar to rest on. Without tightness around the bar from a proper muscular platform, tension is transferred to your elbows in order to maintain tightness throughout the lift, which leads to elbow pain. Improper elbow positioning, stiffness in the chest region, as well as underdeveloped muscles in the upper back area behind the shoulders will prevent scapular retraction from occurring, generating that muscular platform.

Pectoral Tightness — Screening

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In todays lifestyle our pecs are prone to becoming tight from hours behind a desk or on our devises with protracted shoulders and bad posture.

The pectorals are made of two major muscle groups; the pectoralis major and the pectoralis minor:

• The pectoralis major consists of two parts, the clavicular head and the sternocostal head. The clavicular head originates from medial half of the clavicle. The sternocostal head originates from the sternum, upper costal cartilages (1–6), and the aponeurosis of the external oblique. both heads insert at the intertubercular sulcus of the humerus.
• The pectoralis minor originates from the costal cartilages of ribs 3, 4 and 5, and inserts at the medial border and coracoid process of scapula.​

The overall chest regions function is to perform internal rotation and abduction of the arm and the shoulder joint.

Tightness in the pectoral area will prevent you from physically executing bar stiffness effectively as shoulder mobility is limited. Your tight pecs will hold your shoulders in an internally rotated position resulting in limited external rotation and scapular retraction. This means you would not be able to generate optimal bar tightness, creating that needed muscular platform.

One way to judge whether tightness in the chest region is cause for elbow pain is with the ‘Wall Angel’ mobility screen. To perform this exercise:

1. Stand approximately five inches away from a wall and lean backwards into the wall, planting your glutes against the wall.
2. Posteriorly pelvic tilt so that your lower back is flat to the wall.
3. Hold hands upward with your palms facing away from the wall and at a 90-degree angle at your elbows.
4. Pull arms backwards to the wall while maintaining proper back positioning.​

The objective of this exercise is to place your whole arm and forearm flush on the wall without your lower back

coming off the wall, losing posterior pelvic tilt positioning. If you cannot fully place your arms and forearms flush on the wall while maintaining lower back positioning this may be one reason why you have elbow pain when squatting.

Pectoral Tightness — Mobilization

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Stretching the pectoralis major and minor has been a very controversial topic over the years, debating on which exercises are actually beneficial and which ones are damaging to your shoulders. Many common stretches like holding on to a wall or squat rack and turning away from the fixed hand have been proven to be harmful to your shoulders, but there are two less common exercises that I have found to be very effective while still being safe on your shoulders; the ‘corner stretch’ and the ‘pec roller stretch’.​

The corner stretch is similar to the common wall stretch but this variation has been proven to be much safer on your shoulders. Primarily targeting the pectoralis minor, the cues for performing this stretch are:

1. Find a corner in the room and extend your arms laterally outward with your hands above at 90-degrees.
2. Place your hands against the joining walls slightly above your head.
3. Slowly lean inward, pushing your chest forward Into the corner gap in the wall.
4. Hold position for about 10 to 30 seconds per repetition.

It is important that you are gentle with this exercise as your shoulders are still relatively vulnerable. Forcing your chest inward will put strain on your shoulders. You will know you are pushing too hard if you feel stress travelling from your pecs to the front side of your shoulder. Make sure that you maintain proper thoracic and lumbar posture. You do not want any thoracic or lumbar spine sagging occurring when performing the wall angel stretch.​

The pec roller stretch is also a very effective exercise for mobilizing the pecs while still maintaining shoulder safety:

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1. Lay down on a foam roller positioned down your spine.
2. With some sort of light bar (broomstick, PVC pipe) grasp the stick a little over shoulder width apart and hold the bar above your chest with your arms fully extended.
3. Bring the bar from over your chest, upward to over your head while maintaining full extension of your arms.
4. Hold the bar over your head for 10 to 30 seconds, before returning to above your chest.

You will want to keep your core braced to prevent your lower back from arching or your ribs from sticking out. Performing this exercise with a weighted bar (like a barbell) will put excessive force on your shoulder joint leading to potential shoulder pain and injury.

Underdeveloped Upper Back — Screening

An underdeveloped upper back, more specifically underdeveloped rotator cuff muscles, will result in poor external rotation. The rotator cuff, consisting of the supraspinatus, infraspinatus, teres minor and subscapularis, function to perform many mechanics but one of their major contributions is shoulder external rotation. A weak rotator cuff, compared to your other muscle groups, will result in poor external rotation of the shoulder, affecting your ability to maintain proper bar stiffness and the generation that muscular shelf.

To find if a weak rotator cuff is your issue, the ‘forearm external rotation drill’ is anoptimal exercise. To perform this screening exercise, you will need a partner:​

1. Stand upright with your forearms directly outward and your elbows bent at a 90-degree angle.
2. Have a partner place their hands on the backside of your of your hands and attempt to force your hands inward as you resist the pressure.

There is not a precise measurement of force for this exercise as everyones personal strength is different, so you will need to use some judgement. You want to be able to resist your partners pressure relatively easily. If your hands cave in easily when not much pressure is added, poor external rotation may be the issue to your elbow pain.

The ‘lying 90/90’ test is another option to determine your external rotation strength:

1. While lying on a bench face down, bring one arm to the ‘90/90 position’ — your arm ninety degrees laterally outward from your torso, and your forearm facing forward with a ninety degree angle at your elbow.
2. Turn your head to face away from the arm that is in the 90/90 position.
3. While maintaining that 90/90 positioning, externally rotate your arms backwards until parallel with spine/torso.
4. Have a partner apply pressure, attempting to force your arm downward while you resist this pressure. Then attempt the same mechanics on your other arm.​

Like the previous screening exercise , there is no precise measurement of force and you will have to use some judgement. If arms fail to stay in that parallel position when not much pressure is added, power external rotation can possibly be the issue.

Underdeveloped Upper Back — Mobilization

If based on the results of the above testing you find your external rotation to be poor with the tests provided above, ‘Banded external rotations’ will fix the issue. To strengthen your rotator cuff and external rotation:​

1. Stand upright with your forearms directly outward and your elbows bent at a 90-degree angle hold a light band in your hands.
2. Perform shoulder retraction — push your shoulders back and together, and tuck your elbows to your sides.
3. Externally rotate your elbows outward. Once at full external rotation hold positioning for around five seconds.

Keep your elbows tucked the whole time, do not move them outward when externally rotating to compensate for the banded tension. Keep shoulders fixed as well, any rounding forward when performing this exercise will place stress on your shoulders. You should feel tension placed on the muscles behind your shoulders — supraspinatus, infraspinatus, teres minor and subscapularis.​

Improper Elbow Positioning

The final cause to elbow pain when squatting may simply be from improper positioning of the elbows/arms when performing the back squat. Improper elbow positioning usually develops from poor back stability, not achieving that muscular wall. To compensate for this poor back stability lifters will either drag their elbows under the barbell in an attempt maintain proper stability (putting unwanted tension to the elbows), or pull their elbows backward and up putting stress on their shoulders due to biomechanics of the body.

The simple solution to this issue is practicing scapular retraction (pulling your shoulder blades back and together), to create that proper tightness around the bar when squatting and not having to compensate with dangerous elbow positioning.​

When using these cues, screens, and mobilizations, your elbow pain from squatting will cease to exist in no time.

Sources

The Painful Shoulder: Part 1. Clinical Evaluation. Thomas W. Woodward, M.D., and Thomas M. Best, M.D., PH.D., University of Wisconsin Medical School, May 15, 2000, https://www.aafp.org/afp/2000/0515/p3079.html

Pectoralis Minor Muscle, Carolyn Perry MSc, phD, November 17, 2020, https://www.kenhub.com/en/library/anatomy/pectoralis-minor-muscle

Pectoralis Major Muscle, Roberto Grujičić MD, October 29, 2020, https://www.kenhub.com/en/library/anatomy/major-pectoralis-muscle​

Pectoralis Major Muscles — Attachment, Action & Innervation, Get Body Smart, https://www.getbodysmart.com/arm-muscles/pectoralis-major-muscle

Manual Muscle Testing: Shoulder External Rotation, Physiopedia, https://www.physio-pedia.com/Manual_Muscle_Testing:_Shoulder_External_Rotation

Improving Lat & Pec Flexibility, Squat University, September 14, 2018, https://squatuniversity.com/2018/09/14/improving-lat-pec-flexibility/

How To Fix Elbow Pain When Squatting, Squat University (Youtube), September 23, 2017, https://www.youtube.com/watch?v=6PxpAxqU1UE

9 Squat Cues To Improve Technique (And 1 You Should Not Do), Avil Silverberg, powerliftingtechnique.com, December 11, 2019, https://powerliftingtechnique.com/squat-cues/

What Is My Rotator Cuff, And Why Does It Hurt? Web MD, https://www.webmd.com/pain-management/physical-therapy-rotator-cuff-tear