Strengthen and Stretch to Alleviate “Clicking Elbow”



Do Your Elbows Click When Lifting Weights?

Does your elbow click when you lift weights? Causes of “clicking elbow” can range from ligamentous sprains to muscular strains, which can create nerve irritation that leads to numbness, tingling and decreased strength at the elbow, wrist and hand. “Clicking elbow” may also stem from a systemic origin such as hormonal imbalance or even antibiotic use.

Unfortunately, it’s often a cycle of poor biomechanics leading to greater muscular strain or ligamentous sprains, which then contributes back to the poor biomechanics. To stop this cycle, rest and conservative management techniques such as medicine or physical therapy are recommended. In some cases, surgical intervention is needed. Since many of the elbow muscles originate or insert at the shoulder, wrist and/or hand, it is important to look at the entire upper body. Thus, physical therapy that focuses on stretching and strengthening from the shoulder to the hand can be beneficial. The use of an elbow brace can also alleviate strain to corresponding muscle(s). If pain and clicking continue, seek a trained medical professional.

As a therapist treating elbow pain or clicking, it is important to assess the cause of the symptoms – typically, poor technique and decreased strength and flexibility of the muscles surrounding the elbow and the shoulder. Shoulder strength is important part of treatment, as well as prevention.

Workouts that focus on strengthening the shoulders and upper body are a good way to counteract “clicking elbow.” The Total Gym is a great tool for these workouts because the adjustability of the incline allows for gradual increases in upper body weight bearing exercises (such as push-ups and planks). Also, the use of the pulleys can provide more variability in directions of movement, to accommodate pain and progress toward more functional movement.

There is no specific workout designed for the elbow since all upper body exercises can help build strength and mobility. The key is proper technique and awareness of how the body feels during a movement to avoid greater strain to the muscles and ligaments, even the nerves. Remember to keep all movements pain free. Here are some tips to consider:

1. Shoulder Alignment

a. If the shoulders are rounding forward, the biomechanics at the elbow can be compromised. Note that the bicep and tricep muscles cross not only at the shoulder but also at the elbow. Ideally, the shoulders should align with the ears and hips. The shoulder blades should gently glide together and down, and the chest should be open. Visualizing the collarbones widening can help create just the right amount of muscle activation needed to align the shoulders.

b. Increase your upper back muscles to help with shoulder blade positioning. Transform exercises such as a row, chest press, external rotation and internal rotation by decreasing your range of motion and keeping the shoulder blades pulled together and down throughout the exercise. As soon as the shoulder blades move apart from one another, then you have gone too far. Focus on 20-30 reps, but stop if form is compromised.

2. Planks

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a. When facing the tower, higher inclines are easier to perform. Focus on form and alignment prior to decreasing the incline.

b. If pain occurs with weight bearing through the hands, then transition onto your forearms. Ensure you are pressing through the entire forearm and not placing a lot of weight through elbows.

c. Progress your plank by shifting your body weight forward and back, side-to-side, and then letting your hips rotate. Moving a leg can also change stability and strength demands to the upper body. Bringing a knee in to the side, toward the chest, to the same side or opposite elbow are some examples of movement patterns that you can try.

3. Pulleys

a. Ensure you are holding the handle firmly but not clenching. Clenching can lead to greater stress to the forearm muscles and cause pain.

b. Note the proper wrist alignment with all pulley exercises. Most of the muscles crossing the wrist originate from the elbow region, hence keeping a neutral wrist alignment is key. Ideally the wrist and elbow remain in one straight line.

c. Take time in your workouts to slow down and really observe what is happening in the wrists during the following exercises: chest press, rowing, pullovers, biceps curl, and triceps extension.

4. Stretch the wrist and shoulders to stretch the elbow muscles

a. Biceps: Keep the shoulders lengthening away from the ears. To ease the stretch, the arm is in front of the body, to intensify the arm can be reaching behind the body.

b. Triceps: Pull the shoulder blades down the back.

c. Wrist Flexors: Non-weight bearing is easier than weight bearing. When performing the kneeling wrist flexor stretch, the more you lean your weight back toward your heels, the harder the exercise.

d. Wrist Extensor: Non-weight bearing is easier than weight bearing. When performing the kneeling wrist extensor stretch, the more you lean your weight back toward your heels, the harder the exercise.

5. Strengthening the elbow

a. Biceps: Ensure the elbow and shoulder are aligned to start, and that the shoulders are pulling away from the ears. With fatigue or poor form, the wrists will start to “kink” (loose neutral positioning) and the elbows will move with each repetition rather than remaining steady.

b. Triceps: Lying on your belly or back are the easiest positions to assist with ideal alignment and activation of the triceps. Moving into a seated position will be more challenging not only for strength but also for flexibility. Watch for compensatory shoulder movement and /or decreased range of motion at the elbow.

c. Wrist Flexors: Start lightly for this exercise. Focus on slowing down your return to the start position, in other words the eccentric phase of the routine. The eccentric phase is thought to promote greater strength gains.

d. Wrist Extensor: Start lightly for this exercise. Focus on slowing down your return to the start position, in other words the eccentric phase of the routine. The eccentric phase is thought to promote greater strength gains.

Elizabeth Leeds, DPT

Elizabeth Leeds, owner of Seaside Fitness and Wellness, combines her background in physical therapy, personal training, and Pilates in her practice and teaching. As a pelvic floor physical therapist working at Comprehensive Therapy Services in San Diego, her passion for pregnancy and postpartum is seen in her mission to empower women with knowledge and understanding of their physical changes, and how to address them to prevent future issues.Additionally, Elizabeth is a Master Trainer and developer for Total Gym’s GRAVITY education.

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