Have you experienced elbow pain during the bench press? It’s common for people to experience it during one of three major time points – unracking the bar, the bottom of the lift, or during the lock out/racking the bar. For the lifter, it’s extremely frustrating and can be very limiting. In this article we will go through different factors that could be contributing, highlight what might be going on, and what you can do for it.
The bench press is often regarded as the king of exercises, a movement that many will utilize to measure the level of physical acumen of others with. This movement can be an excellent option for developing the pectorals, triceps, and delts, helping to build a strong upper body. While these things are great, many struggle with the bench press secondary to pain or discomfort with it – particularly for the shoulders, elbows, or forearms.
The barbell bench press – the most commonly performed kind – is particularly demanding on these joints and body parts due to the constraints the bar places on the task. When we use the barbell, we have our hands fixed together, being provided a greater degree of stability than if we did a dumbbell bench press. While that stability is great for allowing us to use more weight and create a higher systemic challenge to our body, it also can encourage us to be in positions that challenge us in ways that exceed our capacity. This can be compounded if the individual is also performing other gym based movements that stress these areas, such as low bar squats or skull crushers. As well, if the person has a job that is highly challenging to the elbow, such as a carpenter or desk worker, it can add up to a challenge that the elbow just cannot tolerate.
If you spend time around experienced gym goers who regularly bench press, it’s common to hear about elbow issues that many struggle with – often giving up bench press. While this is understandable, we can often find solutions to get back to it when implemented appropriately.
To start off, let’s check out the major locations individuals will report dealing with elbow pain:
The posterior portion of the elbow
This is approximately the distal triceps tendon where the muscle inserts to the olecranon of the ulna, but it could be other structures.
The lateral portion of the elbow
This is around the area that many would categorize as tennis elbow
The medial portion of the elbow
This is around the area that many would categorize as golfer’s elbow
The reason we say “many would categorize as ____” is that while the location is similar and there can be many signs and symptoms that match with tennis or golfer’s elbow, it’s been our experience that these are not quite the same cases and in the case of lifter’s respond better to a slightly different management. For anyone who would like a break down on tennis and golfer’s elbow, we did a recent video that went through these, discussing the general conditions, their similarities, and their differences.
Let’s dig into each of these further! First up, the posterior elbow.
When we look at the back side of the elbow, we have a lot of structures there – the triceps, the triceps tendon, the olecranon, the olecranon bursa, the anconeus, and more. Our current body of research would indicate that we can’t really blame any one structure for the pain experienced, but we can utilize anatomical knowledge to help guide some of our detective work and interventions.
The structures on the back of the elbow have one primary function, extending the elbow. The triceps do have a second function, extending the shoulder. This is important to consider when we start to look when someone people are experiencing posterior elbow pain vs other times.
If someone is having elbow pain on the back side, it is most likely occurring during at least one of three time points – during the unrack, during the bottom of the bench press, or during the lock out.
When people are experiencing posterior elbow pain during the unrack, this commonly occurs along side with unracking a heavy weight without assistance, or having the pins set too low, where they need to press the weight out of the rack, and pull it over into the starting position. This combination challenges the triceps to do both actions, under a heavy load, which can be more than some people’s elbow can tolerate.
For these people, the first thing to do is check the height of the rack and dial in the unracking. When we unrack a barbell with proficiency, we should have a relatively extended elbow, that way we aren’t needing to press the barbell up and out and instead can just act more like a lever and do shoulder extension from a flexed position. If we can clean up the unracking process, then many people will report having less issues with it during this process.
In the case of experiencing posterior elbow pain in the bottom of the bench press, this may be occurring secondary to the distal triceps tendon being irritated from compression. This can compound when you factor in eccentrically contracting the triceps during the lowering portion of the lift, which will increase tension and compression. Combining these can exceed the tolerance of the distal triceps tendon.
Grip width is another factor to consider as the degree of our hand placement can affect the relative demand on our triceps. For instance, if someone has a more narrow grip, it will challenge the triceps to a higher degree. Having a look at grip width is often over-looked but can be an easy one to adjust and see benefit from.
This can be exacerbated as well if someone tucks their elbows and has a more superior placement of the bar in relation to the elbow in the bottom of the lift. Getting an aerial view of the bar path can give a lot of insight to this. Should you notice that the person has a tendency to have the bar really superior to the elbows, then it can be quickly addressed by altering the placement of the bar in the bottom of the lift, shifting their contact point.
If you continue to have posterior elbow pain in the bottom of the lift regardless of having a cleaned up bar path, then we can try to implement two changes: slowing down the tempo and reducing range of motion. For the tempo, usually reducing the speed during the descent will facilitate benefit for this. Most of the time this will encourage a reduced weight as well, which can allow for less total stress on the region. Reducing the range of motion will take away some of the compression that occurs in the bottom. You can do this through using either a roller or boards, or a floor press to alter range of motion.
In the last situation of posterior elbow pain, having it during lock out. This can be annoying but usually the easiest to manage for people. The first thing to do is get an aerial view to let us know if the bar path is lined up well. Some people may be doing a pseudo skull crusher and press combo, excessively loading up the posterior elbow. Adjusting their bar parth to keep the elbows under the bar is going to allow better stress management.
If the person continues to have posterior elbow pain with these adjustments, implementing some kind of tricep strengthening is ideal to help increase the capacity for load that the triceps have. We can do this through targeted loading such as pressdowns.
The medial elbow has a lot of structures in this region between ligaments, tendons, and muscles. Most of them are responsible for either resisting or creating movements about the elbow and forearm. Usually if someone is experiencing pain here, it’ll be during the unracking or at the bottom of the bench press.
Similar to the posterior elbow, the medial elbow may get stressed during the unracking for a range of issues. When we unrack the bar, usually our medial elbow will pointed down towards our hips. As you take the bar out of the rack, this may impart a valgus force to the elbow. This force can stress many of the muscles and ligaments around the medial elbow.
This will be exacerbated if the bar is set too low and the person is taking out the bar with flexed elbows. It can also be problematic if the person is too far down the bench press during the unracking and causes a long moment arm on the structures, creating a high force on them. The further down the bench someone is, the greater the distance is between the point of load and their elbow during the unracking.
These two situations both create some degree of valgus stress, which can possibly be excessively stressful for these tissues. By addressing the unracking and dialing in your technique for it, we can modify the load placed on these structures and often get it less problematic.
For the case of having medial elbow pain in the bottom position of the press, this is another time where getting an aerial view is really beneficial. If we look straight down at individuals’ bar path and where their elbows are in relation to the bar, it’s common to see individuals have an excessive elbow tuck. In most cases, we want the elbow directly under the wrist at the bottom of the lift. When the elbow is more medial to the wrist, there will be a degree of valgus stress placed on the elbow.
An aerial view will quickly tell us if this is something to address or not. For those that have it occurring, we can start by either moving the hands inwards, or by having them try to not to tuck so significantly in the bottom of the press.
If you make these adjustments and find that the issue doesn’t resolve, you may need to spend some time with reduced loads and volume to let things calm down. It might also be beneficial to perform some exercises with a focus on the region, which we will have an upcoming video on to show some top suggestions.
In the case of having lateral elbow pain, this region is very similar to the medial elbow, having a significant amount of tissues between tendons, ligaments, and muscle. While it’s usually called tennis elbow when someone complains about having issues here, we’ve seen it benefit from more of a focus on technical changes and having a faster turn around than standard tennis elbow.
Experiencing lateral elbow pain at the bottom of the lift is a common issue for many trainees. This can occur for a few reasons, but the more predominant one is associated with positioning and bar path. Looking downwards at the person’s position during the lift we can look to see the relationship of their elbow to the bar. In stark contrast to the prior situation where the elbow was excessively tucked, here it’s often excessively flared with the bar not in line with it. Getting a snap shot of your bar path from that aerial view (you’ll notice we like the aerial view) can help use identify if your issue might be stemming from this. By adjusting your elbow position or bar position, we can often improve this quickly, either altering the bar placement or the degree of flare.
Typically we will see lateral elbow pain present primarily at the bottom of the lift, though some may report issues with it during the racking phase. If this is the issue someone is experiencing, it’s usually associated more with being too far down on the bench, which we can fix relatively easily. Scoot up and make sure you’re in a good position to rack and unrack.
If these don’t address your issue, then you may need to temporarily lower your volume and intensity, allowing this to calm down. For some it may be beneficial to also perform some degree of additional strengthening work – which we will have an upcoming video on tennis elbow exercises.
Thanks for reading, and we have a supplemental video that goes through all of this!