Muscle for Life with Mike Matthews - Mark Rippetoe on the Absolute Best Way to Get Rid of Elbow Pain

Episode Date: March 1, 2019

If you’ve spent any amount of time pushing or pulling heavy things, you’ve probably experienced elbow pain. Maybe it only flares up when you’re doing heavy compound exercises, like the bench press, military press, or barbell row. Or, maybe it only happens when you’re doing isolation exercises like curls, triceps extensions, or skullcrushers. Or maybe it comes and goes with no rhyme or reason. 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, one guy who has good answers is Mark Rippetoe, so I invited him on the show to shed some light on this common nuisance. Mark has worked with thousands of lifters, and thus helped people work through many, many injuries, and he has quite a bit to say about how to deal with elbow pain. In this episode, you’ll learn: - The three most common types of elbow pain - The difference between “golfer’s elbow” and “tennis elbow” - How to diagnose what’s causing your elbow pain - What exercises usually contribute the most to elbow pain - How to resolve elbow pain - And more 9:29 - What are the three types of elbow pain? 14:58 - What is the most common type of elbow pain? 18:58 - What is golfer’s elbow? 31:17 - What type of elbow pain did you have? 35:59 - What type of exercises cause golfer’s elbow? 37:54 - What’s the difference in form between chin ups and pull ups? 48:54 - Is the bench press commonly associated with elbow issues? Want to get my best advice on how to gain muscle and strength and lose fat faster? Sign up for my free newsletter! Click here: https://www.muscleforlife.com/signup/

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. Hey, Mike Matthews here from Muscle for Life and the 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 Ripito is a buddy of mine and he has some answers. So I invited him on the show to shed some light on this common nuisance. Now, Mark has worked with thousands and thousands and thousands of lifters over the years and thus has dealt with many, many, many weightlifting injuries and actually had quite a bit to say about how to deal with elbow pain in particular. So 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. This is where I would normally plug a sponsor to pay the bills, but I'm not big on promoting stuff that I don't personally use and believe in. So instead, I'm just going to quickly tell you about something of mine, specifically my 100% natural whey protein powder, Whey Plus. Now, this is a naturally sweetened and flavored whey isolate protein powder made from exceptionally high

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why my supplements have thousands of rave reviews all over the internet. And if for whatever reason, they're just not for you, contact us and we will give you a reviews all over the internet. And if for whatever reason, they're just not for you, contact us and we will give you a full refund on the spot. All righty, that is enough shameless plugging for now at least. Let's get to the show. Mr. Mark Ripito, thank you for returning once again to grace all of us with your wisdom. Well, I appreciate the invite, Michael. I've always enjoyed talking to you.

Those of you who don't understand, Michael and I have wonderful private conversations that you guys don't get to hear. And we enjoy each other's company. So anytime, man. Glad to be here. And one day that might flower into something public. Who knows? Yeah, could be.

Could very well be. So we're here to talk about Gillette versus Schick, right? 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. I actually shave my chest and my stomach, which is probably a little bit weird, but they get hairy and I get rid

of the hair. It's real weird. You're girlier than I am. I haven't shaved anything but my face in a long time. I've got five-inch long hair on my traps. It's distressing, isn't it? That's very weird.

It's like something out of a movie. Yeah, it really is. Altered states. If you remember that. I may have Gillette at home. That's going to be my last one. Go throw that away, man. Don't let it touch you.

I mean, these people choosing upsides, man. And that's fine. This is what it means to choose upsides. Fun times, fun times. You know, for anyone listening, interestingly, I think Mark and I were talking about this before we got on. I think that Procter & Gamble could care less about social justice or really the political climate. I think they'll go in whatever direction is going to make their shareholders the happiest. Ironically, I'm sure P&G 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. Or the actual message. 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 even the headlines or the articles or even watch the video, they just hear Gillette, Gillette, Gillette around the water cooler, Gillette, 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 and over for

whatever, for the last month or at a point it'll die off, but it's in Gillette's interest to try to keep this thing – 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. That's good for people out there 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 – well, they had better hope that that's the case, A. 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 yeah definitely i mean 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 you know 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. Right.

Elbow pain we hear about all the time. That's true. 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. For people who have trained for any length of time, at one point or another, their elbows hurt. And, you know, 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 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. Triceps 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. This is a difficult type of tendonitis 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, lying tricep extensions on the bench. Yeah, I felt it.

We're going to take French presses. Skull crushers, I've noticed it. 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 because it really is stupid. You know, 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.

Yeah. Yeah. I mean, I now, even now 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, from heavy pressing. And that's generally what I recommend. 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.

You know, 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 it'll heal. And just to be specific on so people understand, this would be higher up on your arm, not lower, right? Right. This is the posterior proximal side of the olecranon process. Even that term proximal, many people listening wouldn't even know what that means, which I understand. Proximal to the, well, 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 say 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 can see the confusion between

proximal and distal in the way I used it. It's on the distal end of the humerus, but it is above proximal to the olecranon process, which is the bone of the elbow. 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. Yeah. And also, anybody listening, you could just pull up, you know, just look at some images online and So just learn it. All right. Yeah. And also anybody listening, you could just pull up, you know, just, just, just look at some images online.

Right. 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 tendinitis.

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 tendinitis 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? Yeah, you can even feel the tension. You can feel the tension along. Remember, normal anatomical position is a supine palm. So, if you're standing up, point your palms or your hands forward. Now we're in normal anatomical position, and that means that the forearm extensors in that position are on the back, their 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? A condyle is 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, you know, with a dog bone, you see the bony ends are round. Well, 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 with 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 elbow is inflamed. Tennis elbow is terribly common, and it's probably more common among people that don't lift weights than it is among people that do lift weights. And it can get very, very painful if it's not dealt with, and it is an inflammation right at the bone, the changeover at that particular location from the muscle to the tendinous 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 musculotendinous juncture that goes right into the bone. That insertion point of the tendon, the little short piece of tendon that's left there 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 whole mass of muscle insertion on the bone is right on the inside of the elbow joint, right underneath the elbow articulation itself. And this is forearm flexor. This is forearm flexor tendinitis. Elbow, tennis elbow is extensor tendinitis and golfer's elbow is flexor

tendinitis. And the different points of insertion of the extensors and the flexors determine the difference in the location of the paint. Yeah, I had a bit of golfer's elbow back when I first started golfing. And for anybody listening, 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. Oh, it's a real 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 tendinosis, 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 has been performed on a lot of people's elbows.

And typically, it doesn't make them any better after the surgery. You know, you'll, you'll know what I mean. Yeah. That's right in line with, I had Dr. Stuart McGill on for an interview regarding back pain and just, just spine mechanics. And, and that's right in line with what he was saying that he doesn't believe in the term like degenerative disc disease he just kind of 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 well that's that's dead now that's good that tendon's gone your body and the body can can't do anything with that anymore yeah and that's just you, 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, it's not. Yeah, and I like also his take, which is very much in line with yours, which is it's very practical and functional in that can we get people to be able to live their lives without back pain and exercise without back pain? And yes, we can. Well, 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. 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 reeducate 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 kind of the same thing in that the medical community regards both golfer's 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, well, 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 them to do it because most people don't do it the way you tell them to do it. 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 well they saw that they saw this one guy on instagram and, you know, he had abs. Right. He had abs. So if you do what he does, you'll have abs too.

And that's, you know, like I told you earlier, you know, people, average IQ is 100. 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 a long time ago, and I've 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 horses that are worked real hard to develop flexor tendon pathology,

especially in their front legs. Now, a horse walks and runs on his middle finger, 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, oh, it happens by accident, a horse steps 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. lock joint and he can't heal it he's pretty much useless horses are livestock and they're not really our friends except you know some some you know middle-aged ladies keep a horse in a barn and love the horse and all this other stuff and you have guy what was it who is that internet guy the mr the mr hands mr hands i think it was did you ever hear about that no i don't know him

just some internet shit some dude that got plowed by a horse and died no i Did you ever hear about that? No, I don't know him. Just some internet shit. Some dude that got plowed by a horse and died. No, I didn't know about that. But, you know, these ladies treat their horses like pets and stuff. And so this process for healing the flexor tendon 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, very interesting.

The process is called pin firing, pin firing. And formerly it was accomplished with a pointed piece of iron, you know, 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. 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 of the leg, 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 and it's not just the subsequent rest i mean no can't no it's not because the horse has been

rested he's lame okay i mean i don't know i don't know shit about the world of horse he's already resting because he's lame he's not good for anything he's lame. Okay. I mean, I don't know. I don't know shit about the world of horses. He's already resting because 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 important to the economy than they obviously are now, we needed to save our investment. And, you know, it's a, 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, but enables him to hang around another 20 years, well, what do you do? You know, you do what's necessary. So I got thinking about this and I thought, you know, my elbows been kind of 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, 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 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, my hundred chins and next day I'm predictably very, very sore. Everything is sore. My biceps, my lats, my scapula 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. What kind of elbow pain was it? It was golfer's elbow. Okay. And I'd had it for a very, very long time.

And, you know, 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, you know. 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. But 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 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 block 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 rompum 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 turn into white hair. So if you see white hairs on the back of a horse's foreleg, even though 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. Yeah, that's what I 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. Right, right. 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 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 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 pushes through the problems. Now, what about training would cause golfer's elbow? Well, 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 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 golfer's elbow and if you're squatting and you've got golfer's elbow get somebody to video a set of squats and see what you're doing with your hands because you can't always tell yeah especially when you know the weight's heavy and you are working at a pretty high RPE, your wrists are really the,

you're not even aware 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, you're just not, yeah, you're just not babysitting your wrist like you need to be. And if you don't put your wrists in the right place, they're going to inflame your elbows. And if you don't put your wrists in the right place, they're going to inflame your elbows. So look at that. I don't know what about the squat would cause tennis elbow. Usually the problems associated with the squat are 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 facing you or each other. Palms facing in is a chin. Palms facing out is a pull-up. I know, but you have the middle, you know, where you have the little handles. People will ask me, is that a chin-up or is that a pull-up? What is 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 would be another way of not doing exactly this recommendation.

You know, you want to do it your way. Well, 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. 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. And for people listening, because inflammation these days is always associated with bad things. 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 healing process, of every healing process. It starts with the prostaglandin cascade. healing process. It starts with the prostaglandin cascade. Healing is facilitated by inflammation. Look it up. There's a lot been written on this. Look up inflammation on Wikipedia and learn about the mechanism by which I'm suggesting that you can heal your elbows out. 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, you know, lifting heavy weight and then outside of the gym doing as much as you can to reduce inflammation in the body. You know, isn't that also why I think one of the reasons why the old rice therapy has been kind of rethought and that. You know, it's the application of going ahead and realizing that inflammation is a normal part of this process.

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, you know, and those of you that have iced a sore elbow or a sore knee know as well as I do that it doesn't work. It never works. Why do we do it then? Well, because physical therapists tell us to. Okay. Well, 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. I mean, if you're just honest with yourself, you realize it doesn't change a damn thing, you know? So, yeah, rice is going out of style finally. And with it, a 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. Yeah, and it also then opens the door to actual resolutions as opposed to prolonging a condition doing something that isn't effective.

Right, exactly. So what about the bench press? Unless there's something else you want to say specifically. That's my next question. No, there's one more thing. 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 ulno-humeral ligament, I believe is what it's called. The radio-humeral 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 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 hands 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. But 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. 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 squat's 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 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 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 kind of just went away.

I just kind of 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 I've seemed to remember working with a number of people over the years where it was kind of 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 with that. super helpful but i was just curious as to your experience with that well uh 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.

You know, 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. You know, it's kind of weird sometimes. And, uh, tried all kinds of things, tried the golf ball, you know, the massage, nothing worked. Well, we got through with the ladder and the thing still hurt. And, uh, 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. You know, just one day resolved. I don't know, man. It's, some things are just wonderful like that. Most of the time they're not, but sometimes,

sometimes it's just wonderful. It just goes away and just spontaneously heals. Or, you know, one day you, you know, one day 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. Yep. Yep. I just wanted to throw that out there for anybody might be dealing with it. It may just go away for no even particular reason. No apparent reason. It went away for a reason, but it may not be apparent to you why.

Typically, a 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 in 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. Makes sense. Question on the bench press. Has that been something that's commonly associated with elbow issues? 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 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 elbows hurt when I'm benching. But I figured I would ask. Of course, it's more common that it's over. I haven't had it. I'm thinking 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 elbow pain caused by the squat that I referred to earlier, both golfer's elbow and that deep, sheer 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 a good point to make, though, because a person may not know what once it sets in, it sets in and they feel it when they bench they feel it when they squat you know what i mean and they don't know yeah feel it when they wipe their butt i mean 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, 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 – I remember there was like a forearm – there was a strap with a shock absorber of sorts. And that, that ended up helping that I was specific for golf because of the impact into the ground over and over and over. Sure. And yeah, kind of 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 hadn't ever seen one of those for golfers elbow, 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'd work too. 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 elbow just resolve one day?

Yeah. Yeah, it didn't get too bad either. It was like mild. You're doing enough forearm work in your training to where it wasn't a strength issue it was just a you know the shock of of the divots you're slamming your club into the into the ground and it you know 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. You know, it's even – I think it happens probably even among good golfers because the impact is what it is. I mean, there's no getting away from it.

No, it's going to happen, you know. 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. Right, for sure. You're still hitting the ball. And you're still going into the ground. Right. You're still at that moment. So, all right. Well, I think then, I mean, those are all the questions that I had.

Is there anything that is floating around? 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 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 the part of the elbow that needs to be worked on or stopping doing the thing wrong that's causing it to hurt. But in an embedded case, I think that elbow tendinitis, bad elbow tendinitis has led to a bunch of unnecessary NSAID use.

You can't treat it with NSAIDs 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, 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 startingstrength.com. We have a forum over there.

I have a Q&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 and years over there, and there's a giant amount of data on the boards about all these types of injuries. People much smarter than myself are talking about this all the time because 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 startstrength.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 in 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 injuries are your concern, if you're hurt, or if you're a trainer who 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 first weekend in 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 StrengthCon, right? StrengthCon. 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 at this advertising thing. I can segue into an ad. I certainly can. I wonder what your ad might look like if we were to envision the Mark Robito shaving ad look like. There's a viral video.

I wouldn't be shaving my chest, Mike. You're going to fuck up and cut your nipple off one of these days. Just keep that in mind. You heard it here first. You got to be real careful. You're going to 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 funny.

I've only got one nipple. That'd be pretty funny though, actually. Yeah, it would be really. All right, brother. Well, thanks as always. Really appreciate you taking the time and we will figure out what the next talk will be and line it up.

Yeah. We'll announce it in the upcoming days. All right, man. Enjoyed it as usual. Thanks. Same. Thank you. Hey there.

It is Mike again. I hope you enjoyed this episode and found it interesting and helpful. And if you did and don't mind doing me a favor and want to help me make this the most popular health and fitness podcast on the internet, then please leave a quick review of it on iTunes or wherever you're listening from. This not only convinces people that they should check the show out, it also increases its search visibility and thus helps more people find their way to me and learn how to build their best bodies ever too. And of course, if you want to be notified when

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