Understanding and Overcoming Inner Elbow Pain During Squats: A Comprehensive Guide from Physiotherapists
Squatting is a cornerstone exercise for building strength and power, but for some lifters, it can come with an unwelcome guest: inner elbow pain. Often described as "squatter's elbow," this condition, which sometimes is misdiagnosed as medial epicondylalgia or golfers elbow is actually due to stress on the ligament of your inner elbow called your ulnar collateral ligament. This injury can be frustrating to deal with as it can be persistent if not properly managed. Understanding its causes and applying targeted strategies can help you get back to squatting pain-free.
What is Inner Elbow Pain During Squats?
When we talk about inner elbow pain during squats, we're primarily referring to ulnar collateral ligament or UCL. The UCL is a ligament that provides stabilization to the elbow joint keeping it functioning as a lever and preventing the elbow from being bent outward. When forces are applied on the elbow that repeated try to cause the elbow to bow outward such as during a squat or in overhead athletes, this structure can become inflamed or damaged. Fans of baseball are very familiar with this injury as it can lead to the infamous Tommy John surgery. Thankfully, the forces placed on the elbow during squatting can be a lot more easily managed then in professional baseball players so surgery is rarely necessary.
During squats, specific bar positions, wrist angles, and upper body mechanics can place excessive strain on the ligament, leading to irritation and pain. We are going to cover these issues below.
A crucial aspect of any rehabilitation process is eliminating the factors that cause irritation or pain. If you're squatting with the bar positioned too low on your back (“Low low” Bar Squat), the first adjustment you should do is raising it slightly (Low Bar Squat).
Common Causes of Inner Elbow Pain During Squats
Several factors can contribute to this nagging discomfort. Physiotherapists and experts highlight key biomechanical issues that often lead to elbow strain:
The "Low Low" Bar Squat Position:
In an optimal low bar squat, the barbell should rest on a "shelf" created by the rear deltoids, shoulder blades and traps. However, a common form fault is carrying the bar lower than this, actually on the rear deltoids.
This "low low" bar position demands a significant amount of shoulder external rotation mobility. If your shoulder mobility is limited, your arms will be forced to compensate and "carry" the weight, putting excessive strain on the medial (inside) aspect of the elbow. This is a primary contributing factor to inner elbow pain in squatters.
If the barbell starts out of position or rolls out of position during reps, your arms will also be forced to work overtime to maintain proper form and stability.
While there may not be discomfort initially in the ligament, repeated irritation of this structure will cause it to slowly become more inflamed and ultimately painful.
Suboptimal Wrist Position:
Maintaining a neutral wrist position is crucial for optimally dispersing the barbell's load across your upper back during a squat.
If you squat with an extended wrist (wrist bent backward), especially during higher rep sets, this can put your forearm flexors (the muscles that attach to the inside of your elbow) in a state of continuous loaded stretch. For an elbow that is already sensitive or "cranky," this position is often poorly tolerated and can keep the pain lingering.
Excessively bent wrists in either direction can also place more strain on the elbows.
Suboptimal Grip Width:
A narrow grip can increase stress on your elbows as it requires greater shoulder outward rotation and increased stretch on the ulnar collateral ligment. Furthermore, this is often tied to the wrist position, as a narrow grip might prevent you from achieving a neutral wrist.
Lack of Upper Back Tension and Stability:
Upper back tension is foundational for a great squat. If your upper back maintains a suboptimal position, such as rounding, other parts of your body will need to compensate, especially as the weight increases.
The arms are meant to hold the barbell in place, but they should not be responsible for holding significant weight during the setup or reps. If your shoulders and elbows are out of position (e.g., elbows excessively high, shoulders extended), they are likely bearing more weight and tension than necessary.
Ultimately, "keeping your arms out of the squat" boils down to achieving a strong upper back position and a comfortable grip.
Instead, use your arms to guide the position of the bar but let your back take the load of the bar.
Excessive Load or Frequency:
Squatting too high a frequency of heavy squat sessions (multiple times per week) might not allow enough recovery for the stressed tissues.
This can be further irritated by combining with frequent bouts of bench press, which is another movement that can place significant strain on the UCL if and when the elbows are in front of the bar near the bottom of a bench press.
These issues can occur in isolation, but they often happen together, frequently stemming from a core problem of unstable bar positioning due to poor bar positioning, upper back engagement or mobility limitations of the shoulders, spine, hips or ankles.
If your shoulders and elbows are misaligned—such as having your elbows too high and your shoulders overly extended—they're probably bearing more weight and tension than needed.
Physiotherapist-Approved Tips and Tricks to Address Elbow Pain
Once you understand the potential causes, you can implement targeted strategies to alleviate and prevent elbow pain. The rehabilitative process always begins with removing the aggravating factors.
Adjust Your Barbell Position:
If you're using a low bar squat and the bar is positioned too low on your back, the first step is to move it up a few inches. This adjustment can significantly reduce elbow pain.
Consider transitioning to a high bar squat for 3-6 weeks. By moving the bar further up your back (resting on the upper traps instead of the rear deltoids), you'll reduce the shoulder flexibility demands, thus decreasing the strain on your inner elbow. The high bar squat is an excellent variation that allows you to continue training effectively while reducing symptoms.
Always ensure the bar is stable and in an optimal position from the start.
Achieve and Maintain Optimal Upper Back Tension:
This is critical for securing the bar and preventing your arms from having to "carry" the load.
To find a solid position: Secure your grip on the bar, then actively push back and up into the bar as if you're trying to pull it apart. This action should engage your lats and upper back, making them feel tight and secure to hold the bar in place.
Once you feel this tension, unrack the bar and maintain it throughout your walkout, descent, and ascent. Push your upper back – not your arms – into the bar during the ascent to hold your position until you're standing upright. Doing this correctly will make your squat feel stronger and ensure your upper back remains tight throughout the entire movement.
Optimize Your Wrist Position:
Strive to maintain a neutral wrist position. This prevents the continuous loaded stretch on your forearm flexors, which are often involved in inner elbow pain.
Be mindful if your wrists are excessively bent in either direction, as this can add strain.
Alter Your Grip Width:
Experiment with your grip. Many times, moving your grip out a little wider can help you achieve a more neutral wrist position and offload the painful part of your elbow.
However, a wider grip isn't always the solution for everyone. It's recommended to try moving your grip both in and out to discover the position that feels most comfortable and reduces your elbow pain during squats.
Moderate Your Load and Frequency:
If you're experiencing pain, try reducing the weight you're squatting. This lessens the immediate stress on your elbows.
You might also consider reducing the frequency of your heavy squat sessions if you're squatting multiple times per week. This gives your tissues more time to recover and adapt. The goal is to moderate loads and intensity to allow for healing.
Directly Load and Strengthen the Elbow:
Once you've made the necessary form adjustments, it's crucial to directly load the structures around the inside of the elbow.
Build up your wrist flexors muscles and tendons:
Slow wrist curls are highly recommended for progressively loading the wrist flexors. Perform 2-3 sets of 10-15 repetitions every other day using a 3:0:3 tempo. This means you should lower the weight slowly for 3 seconds and raise it slowly for 3 seconds. Gradually increase the weight as you get stronger. This step is often neglected but is vital for building tendon strength.
Build tolerance to the UCL
Banded or cable shoulder inward rotation with elbow at shoulder height. This exercise will look like throwing and will directly challenge the capacity of your UCL. Start with 3 sets of 8 reps with a similar tempo pattern as above, 3 seconds up and 3 seconds down.
Behind back overhead press. Aiming to start from the back rack position press the bar overhead. This will work on shoulder control through the rack position as well as challenge the ligament under load.
As a bonus, incorporating bicep curls, triceps extension exercises, farmer carries and other direct forearm exercises can also be beneficial for building overall elbow strength and capacity, while allowing you to maintain your training goals.
Consider an Elbow Brace (Temporary Measure):
While not a long-term solution for eradicating pain, an elbow brace can be a worthwhile consideration if you have an upcoming competition or need to get through a heavy squat session without flaring up your elbows. It offers some support and compression.
Consult a Physiotherapist:
If you've tried the above strategies and are still experiencing persistent elbow pain when squatting, it's highly recommended to see a physiotherapist.
A physiotherapist can conduct a thorough assessment to identify the underlying cause of your pain and develop a tailored treatment plan. Performance physical therapists specifically work with barbell athletes like powerlifters, weightlifters, and CrossFitters, helping them return to training pain-free. They can provide professional guidance to get you back to squatting confidently and without discomfort.
Conclusion: Elbow Pain
Elbow pain during squats, or "squatter's elbow," can be an annoying obstacle, but it is manageable. By paying close attention to your form, especially barbell and wrist positioning, optimizing upper back tension, and implementing specific strengthening exercises, you can significantly reduce and even eliminate this pain. Remember to listen to your body, moderate your training loads, and don't hesitate to seek professional help from a physiotherapist if the pain persists. With the right approach, you can continue to build strength and power while keeping your elbows healthy.
