Elbow Tendonitis and Long Cycle

Long Cycle Elbow Tendonitis- My Thoughts

 Steve Mathews

It is fairly common that athletes who compete in the long cycle kettlebell sport event are prone to developing elbow tendonitis.  Just as certain overuse injuries seem to plague runners or tennis players, the repetitive motion of the clean and jerk seems to aggravate the tendons surrounding the elbow joint, particularly the biceps tendon.

I’ll start by saying that I’m not a physiologist in any sense, other than having read all of Pavel Tsatsouline’s books.  I’m not qualified to give medical advice, and the observations I offer here are the product of my discussions with therapists and athletes who have been tremendously helpful to me.  The great author C. S. Lewis noted that he was the least original author he knew of.  Likewise, my observations are not original to myself, but are the synthesis of what I have gained from others.  Yes, I’m a doctor.  No, I’m not that kind of doctor, so caveat emptor.

My Theory

Why do long cycle athletes tend to get elbow tendonitis? 

I believe that uneven tension in the musculature surrounding the elbow joint throughout the range of motion of the clean and jerk is a primary cause of tendonitis.  With each rep, the elbow joint goes through a complete range of motion, the angle of the humrus to the bones of the forearm closing with the clean, and opening with the jerk.  In other words, the arm bends, and then it straightens.  So far so good- this is as it should be.  However, the elbow was not designed simply to bend, but to be moved by the muscles of the arm- the biceps, brachialis, triceps, and, to a lesser extent, the muscles of the forearm.  Think about a barbell curl.  Thinking about it in a squat rack is optional.  You stand with the bar in your hands and, contracting the biceps, you bend the elbow, raising the weight.  Muscles on both sides of the elbow are under tension: the biceps as they contract, and the forearm flexor muscles as they grip the bar and stabilize the arm and wrist.  Likewise with a skull crusher or a French press: The stress on either side of the elbow is not equal, but it is mechanically proportional, so balance occurs in accordance with the biomechanics of the elbow joint, so the movement should not cause pain to the elbow or its tendons.  Plus, you get swole gunz, brah.

Now think about what happens when you perform the long cycle clean and jerk.  Let’s start at the bottom.  The bells are between your knees, arms are straight.  Using leg and hip power, you drive the bells up, and guide them into place in the rack position using the momentum you generated with the hips, assisted by the lats and rear delts as you “tame the arc”.  The elbow joint went from fully straight to fully (or almost fully) bent, but the biceps were barely involved at all.  The musculature above the elbow joint was hardly working, but the forearm flexors were working hard to grip the handles through the backswing and ascent of the bells.  The result is disproportionate tension throughout the range of motion. Tension below the elbow, but not above it.

The same thing happens with the jerk.  You launch the bells from your hips, rather than pressing with the deltoids and triceps.  The arm muscles are loose as the bell rises, then the triceps kick in at the very top to lock out the bells and stabilize the elbow joint.  Again, you have a lot of motion in the elbow joint, but very little, and very disproportionate, muscular tension surrounding the elbow.  It is my theory that this uneven distribution contributes to tendonitis in the elbow.

In the lower arm, the grip flexor muscles work hard, but the extensor muscles hardly work.  In the upper arm the triceps do some work, through a short range of motion, while the biceps and brachialis hardly work.  The ballistic nature of the clean and jerk is a shortcut around the natural harmony of muscular agonists, and as a result, the elbow joint suffers.

Why is this not a problem for Olympic lifters who clean and jerk barbells?  Two reasons come to mind.  The first is the load.  Olympic lifters move much heavier loads, so the muscles do not relax while supporting the weight the way a girevik’s do.  The isometric contraction, both in the rack and in the lockout, contributes enough muscular tension to counteract the imbalances I have described.  The second reason is volume.  Olympic lifters might do dozens of repetitions per week, whereas a single kettlebell sport session might get into triple digit reps.  It adds up over time.

As a secondary piece of evidence, I point the reader to a certain fitness movement which is renowned for ugly knee-high socks, lots of ballistic lifts with few grinds, and a slew of overuse injuries.

My Experience

I got tendonitis in my left elbow early in 2015.  I was increasing my long cycle volume with the 20k bells, and had discontinued my bodyweight regimen of dips and chins to focus on long cycle and cardio.  I immediately stopped training, and implemented the RICE protocol of Rest, Ice, Compression, and (sometimes) Elevation.  The pain and inflammation were acute for several weeks, and I took a layoff from training.  When it subsided, I resumed running to maintain my cardio, and to practice rehabilitation exercises I learned from a physical therapist. The exercises included mobility of the elbow joint, internal and external rotation of the wrists with a light Indian club, and single joint isolation exercises- curls and French presses- with light dumbbells.  As comfort allowed, I began training single clean and jerks with 12k about a month after the first onset of pain. This was in early April.  I am writing this in late June of the same year, and just finished a long cycle set with 18k bells: 72 reps in 9 minutes with no pain.

As my pain subsided, I devised a routine of dumbbell training which has kept me pain-free for several months.  I started with 8 pound dumbbells, but have now graduated to 12 pounds.  The routine consists of 12-20 reps of each of the following exercises:

·         Curl

·         French press

·         Lateral raise

·         Wrist Curl

·         Reverse Wrist Curl

·         Fly

·         Reverse fly

·         Shrug

·         Front raise or military press

·         Finger extensions with a rubber band

Yes, these are bodybuilding isolation lifts.  Yes, these are very light weights.  Yes, these sets are very easy.  In spite of this, I’ve seen some hypertrophy in my arms, shoulders, and chest, and have pain-free elbows and shoulders for the first time in years.  My elbow tendonitis has not returned (so far- it may be too soon to tell if it will return later.  Tendonitis tends to recur, I understand).   Nagging soreness and stiffness in these joints, which I had simply learned to live with, have gone away.

I believe that these easy exercises provide sufficient stimulus to do several things.  First, they allow each of the major skeletal muscles of the shoulder and upper arm to contract in isolation, strengthening its connection to its corresponding tendon.  Second, the “pump” flushes toxins from the muscles and brings in oxygen-rich blood, which aids in growth and healing.  Third, these exercises provide a minimum effective dose of stimulation for some hypertrophy in the hormonal environment produced by long cycle, squats, and running- rather like the pullovers in the old 20-rep squat program. 

A routine consisting of only lightweight isolation lifts such as these would not be very effective in producing high levels of strength and hypertrophy- you can’t get very big and strong with only a pair of 12 pound dumbbells- but for me, they have been the icing on the cake. Since the long cycle athlete is doing hard work in his or her clean and jerks, the body is producing growth hormone.  These dumbbell lifts seem to provide enough stimulus to direct some of the body’s healing and hypertrophy activity to the arm, shoulder, chest, and upper back muscles surrounding the elbow and shoulder joints.  The results for me have been very positive.  

The result is that the arms and shoulders get stronger, a little bigger, and a lot healthier.  These easy grinds provide a counter-balance to the ballistic clean and jerks.  Because the weights are light, there is minimal impact on recovery.  I do this 5-7 days a week.

Programming

On days when I will do long cycle, I usually wait and do these dumbbell exercises immediately after my clean and jerks.  The long cycle set is a sort of “pre-exhaust” for the isolation movements.  Afterward, sometimes I’ll add cardio.  Other days, cardio stands alone.  If I’m not lifting, then I’ll usually do these dumbbell lifts early in the morning.  These are not lifts, they are exercises, so the lifter should not be concerned with progression, or with increasing weight.  These exercises are done because they are good for the lifter, not to break records.

Of course, these isolation lifts are not the only way to produce the results I have described.  Other athletes use bodyweight movements. Rudnev is a proponent of bodyweight circuits. Berbenychuk does high rep bench presses.  Morozov incorporates powerlifting into his routine, and if I’m not mistaken, Rachinsky comes from a bodybuilding background.  Everything that rises must converge, and there are many ways to achieve what I’m going after.  However, there are some general principles I think must be present for this to work.

The first is that slow grinds are imperative.  The press is no longer a part of official kettlebell competition, so the girevik has to brew his own grinds. Many kettlebell lifters favor the getup.  As great as the getup is, it does not fit the bill for our purposes- we need tension throughout the full range of movement of the elbow and shoulder joint.  Swings and getups are a great combination for strength and conditioning, but for the kind of rehab or prehab that the long cycle athlete needs, they won’t do it.

Second, these grinds need to be performed in the hypertrophy/strength endurance range of 12-20 reps.  Working on one’s 5 rep max will not give the kind of results we want in terms of pain-free movement (how many powerlifters do you know whose shoulders and elbows don’t hurt?).  Heavy barbell training also stimulates the central nervous system in a way that is not conducive to recovery and progress in long cycle.  Years ago I asked Pavel Tsatsouline for guidance on how I could increase my deadlift to a competitive level while also bringing up my numbers in long  cycle.  His advice? Don’t.   Pick one or the other, but don’t do both. 

Third, these sets should be relatively easy.  These are just rehab/prehab exercises added to a progressive lifting routine.  They should contribute to, rather than taking away from, your progress in long cycle.  You can use pushups, dips, and chins if you want, but be honest about what they take out of you.  Rudnev does his dips and chins in sets of 35.  If you can get 12-20 reps of these exercises without excessive strain, then go for it.  If not, choose an easier exercise for this purpose.  These exercises should give more than they take.

These concepts do not preclude the idea of doing other strength training as an accessory to long cycle training.  My thought is simply this: by incorporating some easy isolation lifts, we can produce balance in our upper body musculature that may help prevent or correct the tendon inflammation that can be generated by long cycle training.  A well-rounded training routine will include long cycle training, cardio, mobility and flexibility, and strength training, in addition to the kind of training I have described.

Conclusion

As I said, I’m not professionally qualified to give medical or therapeutic advice.  These are my observations, results, and conclusions, and your mileage may vary.  If you are a long cycle athlete, however, it seems prudent to incorporate easy grinds to counterbalance the high repetition ballistic lifts, even if you don't have elbow or shoulder pain.  

I’m going to leave the comments section open below, and would appreciate input from those more qualified than myself.  I’m not staking out a claim and defending it, but merely contributing my experience to the ongoing dialogue about how we can enjoy years of pain-free lifting.  Comments and criticism that are useful, productive, and PG-13 rated or below will be welcome.

Steve Mathews is a pastor and professor in North Carolina.  He earned his kettlebell instructor certification from the Association of Tactical Strength and Conditioning Instructors, and earned the rank of Candidate for Master of Sport in the single clean and jerk from USA Kettlebell Lifting (this event is no longer contested for men).