Elbow Pain with CrossFit: How to Get Rid of it for Good
Injury rates in CrossFit
The injury rate in CrossFit is approximately 2.0–3.24 injuries per 1,000 training hours, which is comparable or lower to other sports such as soccer, running, gymnastics and powerlifting.
The most common site for injuries in CrossFit is the shoulder, followed by the low back and then the knees, but in my time as a CrossFit coach I saw many athletes with complaints of elbow pain.
In fact, I myself suffered from medial elbow pain in my early days in CrossFit (before I became a physical therapist).
In this blog, I will go over what causes elbow pain with CrossFit and why rest is not the answer to get rid of it for good.
Elbow pain with CrossFit
Often times, we see medial elbow pain (commonly known as Golfer’s elbow) with CrossFit due to the high rep nature of the sport coupled with lots of gripping and pulling.
The injury is caused by degeneration of the tissue rather than true inflammation.
This injury is driven by the microtrauma of wrist flexion and forearm pronation exercises with inadequate recovery time.
Think, pull-ups, toes to bar, cleans, deadlifts, ring rows… the list goes on. And CrossFit is full of movements that can overlap and cause build up of repetitions, especially for beginners to the sport.
Why Resting Fails
Usually people come to me as a sports physical therapist and tell me very similar stories when it comes to elbow pain with CrossFit.
They are new to the sport and it just crept up on them, or they ae avid CrossFitters who completed a heavy week of pull-ups and cleans and the pain started, or one workout caused forearm soreness that increased throughout the following week.
Almost all of my patients tell me they have already tried resting or tried a handful of exercises they found on tick-tock or Instagram, but when they returned to their workouts, the pain returned with a vengeance.
Here’s why resting fails:
Tendons need mechanical stimulus
The underlying pathology is degenerative, not inflammatory
Rest creates a vicious cycle
Pain recurs because the deficit has not been addressed
Tendons need mechanical stimulus in order to function. Immobilization and unloading reduces blood flow, moisture content and tensile strength. Without loading the tendon, it cannot maintain or restore its normal collagen architecture.
The underlying pathology of Golfer’s elbow and Tennis elbow is degenerative, not inflammatory. Since the condition is not driven by inflammation, rest does nothing to address the underlying cause. It can decrease pain in the short term, but rest acts as a band aid and does not address the weakness and disrepair that caused the condition or reverse the degenerative process.
Rest creates a vicious cycle of deconditioning and reduced load tolerance. When you rest Golfer’s or Tennis elbow and then resume activity, the weakened tendon is even more susceptible to overload than before, which can continue the cycle of microtrauma and failed healing.
Pain recurs because the deficit has not been addressed. Evidence clearly shows that loading-based exercise therapies far surpass non-loading or rest strategies for tendon pain.
Why Generic Tick-tock and Instagram exercises don’t help
Another story I commonly hear from my patients with elbow pain is that they looked up exercises on Tick-tock or Instagram and they tried them, but they didn’t work.
One of the reasons is that they loaded the tendon too much for the stage of rehab they were at. Another reason these generic exercises may not work is they choose 10 of them to try randomly instead of picking 2-3 to really focus on and complete consistently.
Tick-tock and Instagram may provide you with some ideas, but nothing compares to a real human testing your tolerance and adjusting exercises to your goals based on the exact muscles involved and that’s what a sports physical therapist can do for you.
Loading should be slow and progressive to allow for the tendon to heal and not go above your individual pain threshold.
Phases for Rehabbing Elbow pain with CrossFit
Phase 1: Pain management. This can include trigger point dry needling, manual therapies, and isometrics to decrease pain and load the tissue to your tolerance.
Phase 2: Load capacity. This phase can include wrist flexion eccentrics, banded pronation and supination and heavy, slow resistance to begin to build load capacity in the tendon.
Phase 3: Higher speed movements, hanging and carrying and return to sport. This can include cleans (which train going from a flexed to extended position quickly), kipping movement and farmer’s carries.
Activity modification during all phases is important to keep the elbow pain from increasing.
Work with your sports physical therapist to find ways to modify your workouts so that you can continue to progress and return to sport quickly.
Looking for sports physical therapy in Jacksonville Beach, FL?
If you’re looking for personalized, one-on-one sessions to address your elbow pain, we provide performance physical therapy services to active adults and athletes in the Jacksonville Beach area.
If you’re looking for providers who will listen to you and help you get to the root cause of your pain so you can go back to crushing it in the gym, we’ve got you. We will never tell you to “just rest” or “stop lifting”. Our individualized process helps you get back to the things you love without pain, injections or surgery.
References:
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The Epidemiology of Injuries Across the Weight-Training Sports. Sports Medicine. 2017. Keogh JW, Winwood PW
Incidence of Running-Related Injuries Per 1000 H of Running in Different Types of Runners: A Systematic Review and Meta-Analysis. Sports Medicine. 2015. Videbæk S, Bueno AM, Nielsen RO, Rasmussen S.
Epidemiology of Injuries in National Collegiate Athletic Association Women's Gymnastics: 2014-2015 Through 2018-2019. Journal of Athletic Training. 2021. Chandran A, Roby PR, Boltz AJ, et al.
Epidemiology of Injuries in Professional Football: A Systematic Review and Meta-Analysis. British Journal of Sports Medicine. 2020. López-Valenciano A, Ruiz-Pérez I, Garcia-Gómez A, et al
Clinical management of tendinopathy: A systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments. Scandinavian Journal of Medicine & Science in Sports. 2020. Irby A, Gutierrez J, Chamberlin C, Thomas SJ, Rosen AB.
Is Tendon Pathology a Continuum? A Pathology Model to Explain the Clinical Presentation of Load-Induced Tendinopathy. British Journal of Sports Medicine. 2009. Cook JL, Purdam CR.
Current Trends in Tendinopathy Management. Best Practice & Research. Clinical Rheumatology. 2019. Cardoso TB, Pizzari T, Kinsella R, Hope D, Cook JL.
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