Ep. 300 Tennis Elbow & Elbow Pain Solved

Elbow pain stealing your lifts and your grip? We dig into a clear, no-BS plan to calm lateral elbow pain and build tendons that can handle real training. Drawing on rehab science and practical coaching, we explain what’s actually going on at the wrist extensors, why sudden volume spikes overload tissue capacity, and how to fix the problem with targeted soft tissue work, mobility, and progressive loading that sticks.

We start by simplifying the anatomy and the timelines you can realistically expect for tendons versus muscles and ligaments. From there, we tackle the myths: why cortisone and menthol creams feel good but miss the mark, when a brace helps short term, and how icing can delay healing. Then we map out the core routine—forearm soft tissue on the extensors, wrist mobility with prayer drills, and isometric holds followed by slow eccentrics and concentrics. You’ll hear how to scale sets, reps, and tempo, and how to test farmer’s carries without lighting up your symptoms.

Because the elbow rarely acts alone, we zoom out to scapular mechanics and nerve considerations. Foam roller push-ups and a downward dog flow help restore scapular motion before pressing, while pec minor work reduces anterior tilt and nerve irritation. We share guardrails for load progressions, the Goldilocks approach to volume, and how to keep gains once pain fades so the tendon stays strong. If numbness or shooting pain shows up, we outline when to call in your physical therapist and how a team approach elevates your coaching and your results.

Ready to get your grip back and keep training hard? Hit follow, share this with a friend who’s battling elbow pain, and leave a review telling us which drill made the biggest difference.

Want to become a SUCCESSFUL personal trainer? SUF-CPT is the FASTEST growing personal training certification in the world!

Want to ask us a question? Email info@showupfitness.com with the subject line PODCAST QUESTION to get your question answered live on the show!

Website: https://www.showupfitness.com/
Become a Successful Personal Trainer Book Vol. 2 (Amazon): https://a.co/d/1aoRnqA
NASM / ACE / ISSA study guide: https://www.showupfitness.com

Transcript

Welcome & Resources

SPEAKER_00 0:00

Welcome to the Show Up Fitness Podcast, where great personal trainers are made. We are changing the fitness industry one qualified trainer at a time with our in-person and online personal training certification. If you want to become an elite personal trainer, head on over to showupfitness.com. Also make sure to check out my book, How to Become a Successful Personal Trainer. Don't forget to subscribe, rate, and review. Have a great day and keep showing up. Howdy y'all. Welcome back to the Show Up Fitness Podcast. Today is episode number 300, and we're gonna have a special episode talking about tennis elbow, also referred to as lateral epicondylagia, typically gonna be affecting that ECRB, as physical therapists would say, which is the extensor carpi radialis brevis muscle. We'll go over some protocols. And just a reminder, I'm not a physical therapist, but we do have a great team. I'm gonna be referencing some information from Dr. Tom Walter's book, Rehab Science, as well as our partners over at the Prehab Guys. They have an amazing exercise library. Use that code SHOWUP and you're gonna get special access to material and videos that you can send to your clients. Really just levels up you as the trainer because you have a great team. One of the things that we emphasize within the SUF STM certification, soft tissue mobilization cert for trainers, is the team building. Having a physical therapist on your team separates you from the average textbook trainer. Level up your network, and you're definitely going to be able to make a lot more money because you are the professional who can refer out when in doubt. So let's talk about injuries first. As a teacher of trainers for 15 years, trainer for 20 years, I worked at a rehab facility for five years interning. I did that while I was in college, also a little bit in high school, gained a lot of experience. And pain is multifactorial. That's what we talk about within the biopsychosocial model of pain. But if you're a meat head and you just want your elbows to feel better, let's get a little bit into the science-y stuff. But most importantly, give you a protocol that you can implement so you can get out of that discomfort. Nothing sucks when you're trying to bench press and you're dropping 20, 30 pounds because you cannot grip the bar, or you can't even pick up a cup of coffee. Very, very discouraging. So you go to some form and you type in how to get rid of tennis elbow, and you have 15 bros giving you 15 different things to do. This is at least a scientific evidence approach where we're going to be looking at what physical therapists would suggest. Now, is it a muscle injury? Is it a tendon? Is it a ligament? We are not therapists, we're not diagnosing, but just to give you a little background on that, if it's gonna be a muscle injury, typically a grade one, one to three weeks, you're looking at grade two, four to six weeks, grade three, three to six months for recovery, because that's probably the most common question that people will ask. When's it gonna get better? It depends. Sleep matters, hydration matters, nutrition, a lot goes into it, but just to give someone a ballpark, I think it helps with the recovery process. If it's more of a tendon injury, you're gonna see two to 12 weeks with tendinapathies, tendinosis will be three to six months, and a rupture can take anywhere from three to twelve months for recovery. If it's a ligament, which would be bone to bone, that connected tissue, you're looking at grade one, one to three weeks, grade two, four to six weeks, grade three can be as long as two to twelve months. It depends on the severity of the issue. Now, for the most part, what we're gonna see, we're gripping, it's a tissue capacity thing, and you have pushed it too far. Think about a boat. The capacity is 400 pounds. You put 410 pounds in there, it doesn't just sink automatically. You're gonna slowly have water build up and it's gonna start to sink. It's the same thing with an injury, it typically just doesn't happen overnight. You wake up and you're like, wow, where did this come from? It's a gradual process. It starts getting a little achy, and then you work out and you push through it and it goes away. That's that lovely hormone cortisol, which is going to blunt the pain response. It's a great hormone. It's anti-inflammatory. We like to blame it. Should you get a cortisone shot? Probably not, because that's going to probably deteriorate the tendon or ligament long term. You will get immediate reprieve, but long term it can make it worse. Same thing with like a brace and putting like ben gay, I saw that in the comment. Putting bengay on the ben gay is just a deterrent. It's just sending a signal to your brain that nothing is wrong. It's burning your skin literally. It does nothing to the affected area or the injury, it just takes away the discomfort. A brace is just going to be a crutch. I don't suggest using those unless someone said that's what you need to do. It's a crutch for long term. It's not fixing it. If you work every single day and you need to have that grip strength, and a brace will help temporarily, so be it. But we need to be implementing the soft tissue work as well as the overloading to strengthen it long term. So again, the lateral side of the elbow is referred to tennis elbow, but you probably don't play tennis and you have discomfort on that lateral side. I want you to picture the following scenario. If I were to grab your hand and just shake it up and down like battle ropes, where are you going to eventually feel discomfort? At your shoulder. But the shoulder isn't the issue. It's me yanking on your hand. It's the same thing with those lateral muscles. You're going to feel it on that lateral epicondyle, that bone. The elbow itself is the olocronin process of the ulna. It's not the bone that it's affected, just like in the scenario of me shaking your hand like battle ropes. It's the affected area. So you're going to have a really tender hot spot on that lateral bone, but it's the muscles that are overused. And that's going to be typically your extensor carpi radialis brevis. It could be your carpi radialis longus or the carpi ulnaris. There's a bunch of extensor muscles, but it's the muscles that are going to extend your wrist. So if my hand is straight out in front of me, if you bring your wrist up, that's called extension. Flexion is the opposite way, which is going to be more golfer's elbow. Same protocol will take place if you do have that medial discomfort, but we're going to be referencing lateral discomfort. So if you have someone or if you use your opposite hand and you feel that tender area and it's just hot, it's the muscles that are going down towards your wrist that are causing it. So we need to get into those muscles as well as strengthen them. But we're going to take more of a global approach as well because it could be somewhere else. It could be because you have protraction of your scapula. It could be nerve roots in the C7T1 area because you have a big plexus that comes out of the spine, drops down immediately right where that pec minor is. So that's why we want to do some pec minor work as well as scapular work to complement it. I'm just giving general suggestions here. Again, if you're a trainer working with a client, talk to your therapist. You can implement these exercises part of the accessory, part of the warm-up, andor cool down, and it's going to help them over time. With shoulder discomfort, when we do our screens and we eliminate red flags, we can implement the soft tissue. And a lot of times the discomfort will go away and they'll be good for that workout. But when it comes to the lateral discomfort, it's not typically going to go away just from one session. You could do some flossing protocols that we teach with our seminars. We're going to be in Atlanta and Phoenix in January, February, Red Bank and Dumbo, New York, and March, Houston, and California. So you will learn about upper body soft tissue protocols, lower body soft tissue protocols. So for the upper body one, we address the elbow. And we'll go through flossing and we'll show you what that looks like. That can help temporarily because you're cutting off blood supply to an avascular area, and that's what those tendons and ligaments are. They're avascular, meaning they don't have a lot of blood supply. If you look at like a chicken wing and you have the white stuff, it means there's not a lot of blood supply. That's avascular. So by doing some flossing techniques and you take the floss off, you get a perfusion of blood that just rushes great nutrients in there to help it feel better and recover faster or more optimally. So you have some damage to some tissue in there. Then we need to eliminate some red flags. And one of the screens to determine if it truly is tennis slash golfer's elbow is that tenderness right on that bone. If it's shooting down the arm and you get numbness in the pinky or your index finger, it could be more nerve stuff, it's definitely more nerve stuff. But we need to have a therapist take a look at that. So I'm specifically referencing the lateral epicondyle of the humerus, that discomfort, aka tennis elbow. We want to get into that soft tissue for those extensors. So if you have a trainer who can use a thumb, that's gonna be the best. But if you're at the bro at the gym, you could use the barbell and just kind of smash the muscles, not the bone. The bone's gonna hurt like holy hell. So you're getting into that tissue. You can work with some extensions and flexions, hold through that tender spot for a good 30 seconds to a minute, get it up to a six or seven discomfort, breathe through it. You don't want to have a grimace because what that's showing to your nervous system, it's sympathetic. We want to calm down the nervous system, get some good blood flow in there, and then we're gonna incorporate some isometric exercises. So you grab a dumbbell and just put your forearm over your knee and hold a five or 10 pound dumbbell isometrically. Your wrist will be neutral. And if you want to incorporate some super slow eccentrics, which is coming down, and some super slow concentrics, like a three to three ratio is usually optimal. Three seconds down, three seconds up, pause in the middle, do anywhere from eight to twelve repetitions, do it before your workout, do it after, and ideally one or two more times during the day, but you need to be consistent. What happens with people is they do some flossing or a grass stone technique and it feels better just for that day, and they don't incorporate the strengthening exercises. That's the most important part. Talking to one of the trainers up in Sacramento, experiencing some shin splints, not fun, but it's typically because of overuse. Same thing with the wrist. We're doing too much and we're not strengthening by doing these wrist curl isometric exercises. When I've experienced lateral pain in the past, it's because I start doing something that I haven't been doing and I do a lot of it. So, for example, I start doing a ton of pull-ups. The bar is fixed, and I go from doing zero and to doing hundreds per week. And then the lateral side starts aching up in about two or three weeks, and I'm like, ah shit, you meathead, what are you doing, dumbass? I know I should have done some prehab rehab stuff, but I'm a meathead and I didn't, and now I have to suffer the consequences, which can be anywhere from two to four weeks of rehabbing it. So if you look at your protocol of what you're doing, implement these prehab rehab exercises, A, you can decrease the discomfort and get out of pain, but B, you can prevent it. So if you have a client that comes to you and they want to start doing a lot more pull-ups, or they've never been able to do a pull-up and they want to get that first pull-up with you, and you go from doing, you know, maybe 30 or 40 reps on an assisted pull-up machine, now you're doing a lot of eccentrics and banded pull-ups concentrically for 100, 200 reps, you've doubled or tripled that volume. So that's why they call it a tissue capacity issue. They say 10 to 20% increase for mileage with running. So if you ran 10 miles last week, the next week's appropriate volume increase would be 12 to maybe 14. So what we do is we go from five miles to 10 miles to 20 miles to 100 miles, and the body breaks down. Well, it's the same thing with the upper body. You go from being inactive to superactive. Oh, all of a sudden you have a goal for 2026, you want to bench 315. The bar is fixed, so it's not allowing for optimal radial ulnar deviation. So then you fix it in play and you start doing tons of repetitions, it could be a mobility issue. So that's why when you incorporate this system, address the soft tissue first, incorporate some mobility drills to complement it, which I call like the prayer. So if you put your hands together in a prayer position, you point your hand out and then you bring it back towards your chest. That's gonna show optimal radio ulnar deviation and also wrist health. So then that's gonna free up your elbow and take some of that discomfort away. That's where you can look at the joint-by-joint approach, look at the shoulder mechanics, look at the wrist mechanics. Just doing these exercises can help, but a great trainer or coach can look at the global system to see if it's something else up the chain. So when I talked about the scapular, a lot of bros do a ton of pressing. So if we get some protraction, some anterior tilt, some depression of the scapula, that's gonna start to potentially compress that nerve root. So that's why getting into the pec minor will just help complement this. So you can do that by smashing your chest. If you put your arms out to the side and then you bring and you flex your elbow and you point at your chest, that's where your pec minor is. So then you can put that area onto the end of a barbell and then just work with bringing your arm back behind your body, which is extension, and then bringing it forward, which is flexion. And that's just gonna get some blood flow into that area because as we know, the pec minor is a protractor. So maybe that elbow discomfort could be a global issue with more of the scapula. I don't know. You have to look at the individual, but I'm going to do this global approach. So if you're listening, do the soft tissues first, incorporate some mobility drills to complement it second, and then do the strengthening exercises. But I also want to take a look at your scapula. Are we doing things that free up the scapula with all eight of those actions? Protraction, retraction, elevation, depression, upward and downward rotation, anterior and posterior tilt. And I would be willing to bet my belt buckle, we're not doing all those optimally. So we get some muscles that are just overworked. So by getting into the pec minor to calm it down, and I love doing foam roller push-ups for the warm-up because a lot of times what we do is we go straight to the barbell, which is fixed. When I say fixed, just compare it to a dumbbell. The dumbbell allows for rotation, so that's just gonna be healthier stereotypically for that shoulder or that glenohumeral joint. So by doing a foam roller push-up, you're gonna get protraction, but then you go into a downward dog, which is upward and downward rotation. You're taking that scapula through a better range of motion. I'm not saying that if you don't, you're gonna have pain. It doesn't work like that. But a lot of times we don't do an optimal warm-up. So you do that, you're gonna free up the scapula because when we bench press, we just lock it down, which is optimal for heavy pressing, but not optimal for overall mechanics and well-being. Do a few of those push-ups to free up the scap, get into the pec minor, and then get into the wrist protocols with the soft tissue, and then incorporate those strengthening drills. Some progressions that you can do would be going heavier with the load. You don't want to do so much where it's irritated after. So, what I mean by that is if you're a meathead like me, you go and you grab a 25-pound dumbbell and you start doing 20 to 30 eccentrics and concentrics, and then it's numb afterwards, that's too much. Keep the volume within, you know, six to 12 repetitions. Slow and controlled is the name of the game. Incorporate some isometric holds. So if you were to hold it and you feel a little bit of discomfort, see how long you can push that 30 seconds, 45 seconds, up to a minute, and then when you are resting, it should settle down and come back down to zero or limit to discomfort. Doing a couple of those isometrics, you can do it between sets. You can also do it within the accessories that we teach within our certification and the programming protocols. Some additional progressions would be going heavier eccentrically. So as you start to have the discomfort go away, so maybe you're in weeks two or three, and maybe it's even gone away completely. You don't want to just stop the protocol. Just like if you have bronchitis and they give you a ZPAC, you don't take it for three days because your cold's gone. You have to take the remainder of the pills to make sure it doesn't come back. You completely kill the infection that you have. Same thing with the rehabbing process. When it gets better and it's gone, don't stop. Incorporate the stuff regularly so it never comes back. Get that tissue stronger. So in the beginning, you're probably gonna be using five, seven and a half, ten pounds, but as you progress, get up into 20, 25 pound wrist curls and hold isometrically for prolonged periods. You could get like a dowel and work on supination and pronation. So pronation is where your knuckles are up, supination is like you're holding a cup of soup. So you'd hold that dowel and you have someone resist pushing it down and then pulling it back up. That's a drill that they'll use for a lot of baseball players to strengthen their forearm muscles. But doing that exercise with the trainer engagement can really help strengthen the supination and pronation or radio ulnar deviations, which are great for long-term wrist and elbow health. And then you can progress into doing some farmer's carries if that doesn't make it hot. It's always, it depends because you don't want to incorporate 15 new exercises to help with that elbow rehabbing and it just makes it worse. For some people, holding something prolonged can irritate it. So, for example, farmers walks. You have to just test to see what you're capable of. If you walk with half your body weight for 60 seconds and it's fine, great, progress. If you walk for 15, 30 seconds and you feel it get a little wonky, then you're gonna want to use that as your goal time. Meaning 30 seconds it gets hot, we'll do a couple sets of 20 seconds or 25. So then you can work on that overloading process. It's finding that Goldilocks approach, not too hot or too aggressive, which typically is what we do. We do too much too fast, but we don't want to underload it where it's not going to allow for the optimal remodeling with the rehab process. Because we have those phases of healing. The first part is the inflammatory phase, which is natural. For 72 hours or so, it's going to be a little inflamed, a little swollen. Let that process do its role. I don't want to be incorporating the soft tissue andor rehabbing exercises if that area is swollen. That healing process, the inflammatory response, is very natural. If you do some icing, it may help just feel better. That burning sensation is going to go down, but that's all it's going to do. It's actually delaying the healing process. So we do not want to ice, it's going to delay the inflammatory response. The inflammatory process is part of the phases of healing. And then phase two is going to be maturation where the cells are going to start repairing the tissue, making it stronger. And phase three is the remodeling. That's the natural process that we go through. But if we're constantly irritating it so it's inflamed, we're not allowing the body to do its natural recourse. So again, just to reiterate, there's a lot that goes into it. We can't just make a blanket statement. Oh, you have lateral elbow pain, it's tennis elbow, do these exercises. We got to look at a more global approach. When did it start? How does it feel? Is it just on that lateral side? Is there numbness? Is it more neural shooting into the wrist? Maybe it's coming from the spine or the scapula. Take a global approach to look at the individual. When in doubt, refer out to your team, physical therapist, and they can do a better analysis to figure out the root cause of it. But for the most part, the process is going to be identifying where it started and how it started. And if it's because we've been doing a lot too fast or too much that tissue overload, then let's get into the soft tissue, 30 seconds to a minute, get into some mobility drills, strengthen via isometrics and then slow and controlled eccentrics and concentrics. Work on mobility drills of the scapula as well. And you're gonna find anywhere from two to 12 weeks it's gonna get better. If you want to throw in some flossing or more aggressive techniques, that's fine. Just make sure you're competent. In those modalities, and you're not doing too much, too aggressive, because we don't want to make it worse. Having a physical therapist on your team is really going to be the differentiator between the average trainer and what great trainers have on their team. So then you can level up your knowledge, but also your clients are going to respect the hell out of you because of that team. Implement those drills. Check out the Prehab Guys app, Dr. Walter's book, Rehab Science is an amazing one as well. Throw this into your story if you have tennis elbow or if you know anyone that's struggling with it. Post it into a Facebook or Reddit group. And remember, big extensor carpi radialis brevis muscles are better than small ones, and keep showing up.