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Avoid Elbow Pains to Keep Making Gains

Several common forearm injuries can plague trainees. The most well known is tennis elbow, which is a strain of the origin, or tendon attachment, of the wrist extensor muscles on top of the forearm. Strain and pain on the bottom of the elbow is often called golfer’s elbow, and I’ve addressed that pain from triceps training several times. The last strain is to the large forearm muscle known as the brachioradialis. Regrettably, strains to that muscle can linger and be very resistant to treatment.

The brachioradialis has a broad origin on the lower portion of the humerus, or upper-arm bone, and inserts, or attaches, by a long tendon to the thumb side of the wrist. It’s certainly the largest muscle of the forearm. Its function is to flex, or bend, the elbow; it also helps to turn the palm partially upward, in supination, or downward, in pronation. The brachioradialis is used strongly in pulling movements such as pullups, pulldowns and all types of rows. For many trainees those movements develop the brachioradialis sufficiently. Trainees who want to develop the muscle more should include hammer curls in their arm workouts. Many powerlifters also incorporate them because they feel the exercise helps support the arm and elbow during very heavy bench presses.

The brachioradialis can be strained from overtraining. It can also be injured if you carry heavy items for long distances. An example is moving many dozens of boxes to and from trucks while moving in or out of an apartment or house. Another example is carrying luggage for long distances in airports.

Once the muscle is strained, you become aware of how many exercises use it. Suddenly back and arm workouts are compromised. Trainees typically train lighter, hoping the strain will pass quickly, but instead it lingers. The next step is to stop training back and arms. The strain is often aggravated; for example if a trainee has to travel and carry a suitcase. Halfway across the airport it starts to ache—and recovery is further delayed.

Medical treatment for this injury usually includes various combinations of anti-inflammatory medication, soft-tissue mobilization, ultrasound, electric muscle stimulation and laser. For reasons that are not clear, brachioradialis strains resist treatment. That means they can last for many weeks or months.

A strain of the wrist flexors on the bottom of the forearm is usually aggravated by triceps training when you don’t keep your wrist straight. When the wrist bends upward in an extension position, there’s a stretch on the flexor muscles, and that pulls on the tendons and origin. The stretch is magnified when trainees try to force an extra rep or two by accelerating the bar through the movement. The strain usually resolves when they begin to keep their wrist straight during triceps training.

Tennis elbow can also linger. Strains of the wrist extensors on top of the forearm at the elbow are usually caused by a combination of overuse and the weakness of the wrist extensors. Strengthening the wrist extensors will improve the condition. That info, by the way, is circulating on the Internet as if it were a new discovery. It isn’t. I learned it in biomechanics courses in the late 1970s, and it was supported by research. The traditional reverse wrist curl is a great exercise for the wrist extensors, as is a wrist roller.

Keep in mind that these muscles are used in many activities, and that’s why it’s painful to shake someone’s hand during an acute episode of tennis elbow. While reverse wrist curls will help—start with very light weight—other exercises may aggravate the condition. I often see trainees in the gym performing laterals with their wrists bent downward, in a flexed position. That loads the elbow unnecessarily.

A little preventive work can save your elbows and keep you in the gym and training. Train smart; then train hard.

—Joseph M. Horrigan


Editor’s note: Visit for reprints of Horrigan’s past Sportsmedicine columns that have appeared in IRON MAN. You can order the books, Strength, Conditioning and Injury Prevention for Hockey by Joseph Horrigan, D.C., and E.J. “Doc” Kreis, D.A., and The 7-Minute Rotator Cuff Solution by Horrigan and Jerry Robinson from Home Gym Warehouse, (800) 447-0008, or at


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