Elbow pain from lifting: causes and fixes

It starts as a dull ache on the inside or outside of your elbow. Maybe during squats, maybe after heavy rows, maybe the morning after bench press. You ignore it for a week or two because it’s minor. Then it gets worse. Now you feel it on every pulling movement, every time you grip the bar, sometimes when you’re just opening a door.

Elbow pain is one of the most common issues in barbell training — and one of the most frustrating because it affects nearly every one of the five compound exercises. You can’t squat without holding the bar, you can’t row or deadlift without gripping, and you can’t bench without straightening your arms.

The good news: it’s almost always tendinitis, it’s almost always fixable, and you usually don’t need to stop training entirely. Here’s how to identify what’s wrong and what to do about it.

Two types of elbow pain

Nearly all lifting-related elbow pain falls into two categories. Identifying which one you have determines the treatment.

Tennis elbow (lateral epicondylitis)

Location: outside of the elbow. The pain is centered on the bony bump on the outer side of your elbow (the lateral epicondyle).

What’s happening: the tendons of the forearm extensors — the muscles that straighten your wrist and fingers — are inflamed or degenerating at their attachment point on the outer elbow. Despite the name, it’s more common in lifters than tennis players.

Aggravated by: gripping heavy objects, wrist extension against resistance, and any movement that requires you to hold something tightly with your palm down.

Common culprits in the gym: heavy barbell rows, deadlifts, heavy dumbbell work, pull-ups with a pronated (palms-away) grip.

Golfer’s elbow (medial epicondylitis)

Location: inside of the elbow. The pain is centered on the bony bump on the inner side of your elbow (the medial epicondyle).

What’s happening: the tendons of the forearm flexors — the muscles that curl your wrist and close your fingers — are inflamed or degenerating at their attachment point on the inner elbow.

Aggravated by: pulling movements, curling, and any movement that loads the forearm flexors. Also aggravated by gripping with the wrist flexed (bent toward the palm).

Common culprits in the gym: chin-ups, barbell curls, heavy rows, and — most importantly for 5x5 lifters — the low bar squat grip.

The biggest causes in 5x5 training

Some exercises and positions are responsible for the vast majority of elbow problems in strength training. Fixing these usually resolves the pain.

Low bar squat grip

This is the number one cause of elbow pain in 5x5 and other barbell programs. And it has nothing to do with elbow loading during the squat itself.

In the low bar squat position, the bar sits across your rear delts, below the spine of the scapula. To hold the bar in place, most lifters grip the bar with their wrists bent backward (extended) and elbows driven up behind them. This puts enormous strain on the wrist extensors and the elbow, particularly the lateral epicondyle.

The problem isn’t the weight on the bar — it’s the position. Even an empty bar held with bent wrists and high elbows stresses the outer elbow tendon.

Fixes:

• Widen your grip. The narrower your hands, the more wrist extension required. Move your hands out until your wrists can stay neutral or close to it.
• Use a thumbless (false) grip. Wrapping your thumb under the bar forces wrist extension. Placing your thumb on the same side as your fingers lets your wrist stay straighter. The bar is on your back, not in your hands — your hands just keep it in place.
• Work on shoulder and thoracic mobility. If you can’t get your elbows high enough with straight wrists, your upper back and shoulder flexibility are limiting you. Daily stretching of the lats, pecs, and thoracic spine helps.
• Switch to high bar temporarily. High bar squats place the bar higher on your traps and allow a more upright grip position. This eliminates the wrist extension entirely. Use high bar while your elbows recover, then transition back to low bar with improved grip mechanics.

Heavy rows with poor wrist position

Barbell rows with bent wrists — either curling the weight toward you or letting your wrists extend under load — place constant stress on the forearm tendons. Over time, this accumulates into tendinitis.

Fix: keep your wrists neutral during rows. Think about pulling with your elbows, not your hands. The grip should be firm but the wrists should be straight. If you find yourself curling the bar, reduce the weight.

Bench press lockout

When you bench press, full lockout means your elbows straighten completely. Some lifters hyperextend their elbows at lockout — pushing beyond straight to a slightly backward bend. This puts compression stress on the lateral elbow structures.

Fix: lock out to straight arms, not beyond. If you have natural elbow hyperextension (your arms bend slightly backward when straight), be especially careful to stop at neutral.

Rapid volume increase

Tendons adapt slower than muscles. If you suddenly add heavy curls, chin-ups, and rows to your routine in the same week, your forearm tendons may not keep up even if your muscles feel fine. This is particularly common when lifters add accessories to the base 5x5 program.

Fix: add one accessory at a time. Give your tendons 2-3 weeks to adapt before adding more grip-intensive volume.

How to fix elbow tendinitis

Treatment follows a clear hierarchy. Start with the least invasive interventions and escalate only if needed.

Step 1: identify and modify the trigger

The single most important step. If you don’t remove or modify the movement causing the problem, no amount of rehab will fix it.

Go through your training program and identify which exercise or grip position triggers the pain. Modify that exercise (change grip width, use a different grip style, reduce weight) without necessarily eliminating it. Complete rest is rarely necessary and often counterproductive — tendons need load to heal, just not the load that’s injuring them.

Step 2: eccentric rehab exercises

Eccentric (lowering) exercises are the gold standard treatment for tendinitis. They stimulate collagen repair in the tendon and build tendon tolerance to load.

For tennis elbow (outside of elbow):

The Tyler Twist protocol using a TheraBand FlexBar is the most researched approach. A 2010 study in the Journal of Hand Therapy found that the Tyler Twist protocol reduced pain by 81% and improved grip strength by 72% over eight weeks.

How to do it:

1. Hold a FlexBar vertically in front of you with the affected arm on top
2. Twist the bar with the bottom hand (wrist extension)
3. Hold the twist, then slowly untwist with the top (affected) arm by letting your wrist flex downward
4. 3 sets of 15 reps, twice daily

If you don’t have a FlexBar, use eccentric wrist extensions: hold a light dumbbell (2-5 kg) with your forearm on a table, palm down. Use your other hand to lift the weight up (wrist extension), then slowly lower it down with the affected arm only. 3 sets of 15 reps.

For golfer’s elbow (inside of elbow):

Eccentric wrist curls. Sit with your forearm on your thigh, palm up, holding a light dumbbell. Use your other hand to help curl the weight up, then slowly lower it with the affected arm only. 3 sets of 15 reps, twice daily.

Also: reverse Tyler Twist (same as above but reversed direction to load the flexors eccentrically).

Step 3: manage inflammation

Ice after training (15-20 minutes) can help manage acute inflammation. Anti-inflammatory medication (ibuprofen) can provide short-term relief but shouldn’t be used chronically — it may actually slow tendon healing if used for more than a few days.

A counterforce brace (the strap you see tennis players wear just below the elbow) can reduce strain on the tendon attachment during training. It works by distributing the force across a broader area. Cheap, effective, worth trying.

Step 4: use straps temporarily

If grip-intensive exercises are aggravating your elbows, lifting straps can reduce forearm demand while you heal. This isn’t about avoiding grip training forever — it’s about reducing the load on injured tendons while the rehab work does its job.

Use straps on rows, deadlifts, and any pulling exercise that triggers pain. Remove them once the tendinitis resolves.

Step 5: gradual return to full loading

As pain decreases (typically 4-8 weeks into consistent rehab), gradually reintroduce the movements you modified. Increase weight slowly — 10% per week — and monitor for pain return. If it comes back, you progressed too fast.

Warm up your elbows

Prevention is better than treatment. If you’ve had elbow issues before (or want to avoid them), add 2-3 minutes of elbow-specific warm-up before training.

Light wrist curls and extensions: 20 reps each direction with a very light dumbbell (1-2 kg). This increases blood flow to the forearm tendons.

Wrist circles: 10 circles each direction. Loosens up the wrist joint and surrounding soft tissue.

Band pull-aparts: 20 reps with a light resistance band. Warms up the upper back and external rotators, which support healthy elbow mechanics during pressing.

Elbow flexion and extension: simply bending and straightening your arms under no load, 15-20 reps. Gets synovial fluid moving through the joint.

This takes less than three minutes and makes a meaningful difference, especially in cold gyms or early morning sessions.

When it’s more serious

Most lifting-related elbow pain is tendinitis and responds to the protocol above. But some signs indicate something more serious that warrants professional evaluation.

See a physiotherapist or sports medicine doctor if:

• Pain persists for more than 4 weeks despite consistent rehab and modification
• You experience sharp, sudden pain during a lift (as opposed to gradual onset)
• You notice weakness in your grip that isn’t explained by pain avoidance
• Pain is present at rest, especially at night
• You feel numbness or tingling in your fingers (could indicate nerve involvement — ulnar nerve compression is common at the elbow)
• The elbow is swollen, warm, or visibly different from the other side
• Pain appeared after a specific incident (a pop, a snap, a sudden sharp sensation during a rep)

These symptoms don’t necessarily mean something catastrophic, but they do mean you need a diagnosis before continuing. A physiotherapist can distinguish between tendinitis, nerve entrapment, ligament issues, and other conditions that all cause elbow pain but require different treatment.

Recovery timeline expectations

Elbow tendinitis doesn’t heal overnight. Setting realistic expectations prevents the frustration that leads people to either give up on rehab or push through pain until the injury becomes chronic.

Weeks 1-2: identify and modify the trigger exercises. Start eccentric rehab protocol. Pain during training may not change yet. This is normal — you’re not behind.

Weeks 3-4: pain during modified training should start decreasing. Eccentric exercises may still be uncomfortable but should be manageable. Daily activities (opening doors, carrying bags) should feel better.

Weeks 5-8: significant improvement in training. Most modified exercises can begin returning to normal grip and loading. Continue eccentric work as maintenance.

Weeks 8-12: most lifters are back to full training. Some residual awareness in the elbow is normal — this isn’t pain, it’s your body’s reminder to maintain good mechanics. Continue warming up the elbows before training.

Chronic cases (pain present for months before treatment): add 4-8 weeks to the timeline above. Tendons that have been irritated for a long time develop degenerative changes (tendinosis rather than tendinitis) that take longer to reverse. The rehab protocol is the same — it just takes more patience.

The biggest mistake lifters make: feeling better at week 3, dropping the rehab exercises, returning to full loading, and re-injuring the tendon. Stick with the protocol for the full duration even if the pain resolves early. Tendon healing continues after pain subsides.

Preventing recurrence

Once elbow tendinitis resolves, it has a frustrating tendency to come back if the original causes aren’t addressed permanently.

Maintain good squat grip mechanics. If low bar squat grip caused the problem, don’t slip back to narrow grip with bent wrists. The wider, thumbless grip is your long-term setup.

Keep eccentric work in your routine. Even after full recovery, 1-2 sets of eccentric wrist curls/extensions twice per week as maintenance prevents re-injury. It takes two minutes.

Warm up your elbows every session. The 2-3 minute warm-up protocol described above should become permanent. Cold tendons are more vulnerable to re-injury.

Progress accessories gradually. When adding new grip-intensive exercises, give your tendons time to adapt. One new exercise every 2-3 weeks, not three new exercises in one session.

Monitor early warning signs. If you feel that familiar ache returning, don’t wait for it to become a full-blown problem. Increase eccentric rehab volume, modify the aggravating exercise, and address it while it’s still minor. Early intervention resolves tendinitis in days. Late intervention takes months.

For more on keeping your training sustainable, see the full guide on how to prevent injuries in strength training. And for proper grip and form cues on every lift, review the complete exercise guide.

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