The following article is published here with the permission of the author, Danny Thompson AKA “Coach” Danny
I am not a Physical Therapist (although I did stay in a Holiday Inn Express once). Through trial and error, I have found that these ideas work fairly well.
During some exercises, especially certain compound pulling, some subjects experience an uncomfortable sensation in their elbow. They feel a minor “popping” after a few repetitions. Other subjects experience a much more dramatic sensation. The elbow feels like it will actually “catch”, and the subject perceives their elbow is locking up. Many personal trainers, and even some doctors, have misconstrued that this is an indication that the subject will not be able to use that exercise. This simply isn’t true.
What exactly causes the elbow problem isn’t fully understood at this time. I have heard an explanation that does make some sense:
Between the bones of the elbow joint is a bursa sac filled with sinovial fluid that cushions and lubricates the joint. The fluid moves around the sac to cushion the joint depending on the movement. On some people, the lower arm extends out away from the upper arm at a greater angle than usual (this is termed “valgus”). When the arm is extended out in certain positions, the fluid in the bursa sac is trapped on one side of the sac. In an arm where valgus isn’t very dramatic, the elbow fluid will rush to fill the whole sac, causing the popping sound. Most often, once the elbow has popped, the elbow will not have the problem again for the rest of the exercise. In an arm where the valgus is much more dramatic, the fluid is trapped, and cannot get to the other side of the sac. This is what gives the subject the sensation that the elbow has “locked up”.
This usually occurs on the negative portion of the repetition, and usually in the first stages of a training program. As the subject strength increases, the weight becomes significant, the problem is less frequent and will usually disappear. I’ve also found that in the most dramatic cases, subjects have an imbalance in flexibility of their pronator and supinator muscles in the forearm musculature.
This condition, while surprising and alarming to some subjects (and some trainers) is not dangerous, and can usually be worked through or worked around.
To be forewarned is to be “forearmed.”
The first order of business to warn the client of what might happen, and what to do if it does. This should be done before the client learns how the exercise is to be performed. I use a format something like this:
“This is the _______ exercise.” (Have the client sit down on the exercise to explain). “Some clients experience a popping in their elbows, and possibly even a sensation of the elbow locking up. This is not dangerous, but it can be alarming. When you first feel it, you might panic, but if you do, try to immediately remember it’s not dangerous. Let me know if you do experience this, and I’ll show you how to work through it”
The first prescription for this problem is to put a pushing exercise immediately before the pulling exercise. I’ve found the Overhead Press is the best choice. Seated Dip or Self-Assisted Dip does not seem to help the problem. It is important to get into the pulling exercise as soon as possible after the pushing exercise is completed.
In this procedure, the client notes the position of the arm when the locking position is perceived. The client is instructed to continue the exercise in the range just before the sensation occurs. Have the client challenge the locking position each repetition, returning to the contracted position each time the sensation occurs. Usually within a few repetitions, the subject will be able to perform the full range with no locking sensation.
If the above solutions are not effective, the “push-through”, will usually help. Some subject become so cautious that they move too slowly in the negative, causing the “locking” sensation to feel much more intense. This procedure should be used in the initial learning stages of a program when the resistance level is not yet significant. This procedure should be explained fully before the subject begins the exercise.
Once the subject perceives the elbow locking during the negative, instruct them to return to the contracted position. As the lower the weight again, instead of resisting the weight on the locking arm, the subject will actually push on the handle. The arm will push through the locking position, and the elbow will usually pop.
This procedure is a last resort. It is used only when the other options do not help. I do not advise its use with experienced clients, as their levels of resistance would not be appropriate for this.
Once the subject perceives the locking sensation, instruct the subject return to the contracted position. Instruct the client to maintain their grasp on the bar or handles, and virtually drop the weight to the starting position.
This procedure usually works because the muscles are not contracted during the negative. It seems that the contracted musculature during the exercise forces the bones into a position that will not allow the sinovial fluid to disperse evenly in the bursa sac. Allowing the movement to occur without the musculature being contracted lets the fluid move.
I would recommend that this procedure be performed only with clients that you are confident of their coordination skills.
Long Term “Treatment”
In some clients, the forearm supinators and pronators are too tight, thereby restricting the elbow joint from moving naturally through the range of motion of some exercises. I’ve found that these simple stretches done immediately before and after the exercise for a few sessions will help. In most cases, they will instantly alleviate the problem.
90° supinator and pronator stretch
Have the client sit in the exercise seat, and raise their upper arm to about a 90° angle from the body. It doesn’t seem to be important which angle the arm is in the transverse plan, but I usually try to keep it in the same plane that the exercise will be performed in. Hold the clients lower arm at a 90° angle from the upper arm. Grasp the clients’ hand, and instruct the client to attempt to supinate the hand as far as possible. Assist the client by supinating the hand just a little further. Hold for 2-3 seconds. Repeat the stretch about 8 times, then perform the same procedure pronating the hand.
Straight-arm supinator and pronator stretch
Instruct the subject to straighten the elbow as hard as possible. Grasp the subjects upper arm bone with one hand, and the subjects’ hand with the other. Stabilize the subjects’ upper arm as best as possible, and repeat the stretches as described above.