Pull ups and chin ups, in all their variations, are great exercises when it comes to building upper body and back strength, but man can they take a toll on your forearms and elbows.
From Cross Fitters to weekend warriors, anyone who’s spent any time doing pull ups has likely experienced elbow pain from one time to another.
Sometimes this pain can be relieved by simply taking a break, but other times the pain can be a real nuisance and limit your ability to workout.
And in these cases, it’s gonna take a little work to manage that pain and get back on that pull up bar.
But no worries – as irritating as elbow pain can be, there are strategies we can implement from home to help relieve it.
It really boils down to a 3-pronged approach:
- reducing the tension going through the tendons through rest, stretching, and/or massage
- strengthening the muscles in the forearms so they can handle the repetitive stresses
- ensuring proper form to help reduce chances of pain returning
Let’s start from the beginning though and figure out what’s causing your pain to begin with.
Elbow Pain And Pull Ups – A Recipe For Disaster
Before we get too far in here, I want to make my public service announcement about seeking medical attention regarding pain that lingers and not trying anything you’re not comfortable with.
Medial (inner) and lateral (outer) elbow pain are both very common conditions and they’re usually caused by over-use from repetitive activities.
These conditions are so common, they often go by “Golfer’s Elbow” or “Tennis Elbow”, depending on which side of the elbow the pain occurs.
That said, if you have pain that lasts for months at a time or pain that’s getting worse with conservative treatment, it’s a good idea to see a physician.
And as always, never attempt any exercises or treatments you don’t feel comfortable with – again, when in doubt, seek professional guidance.
That said, the exercises and treatments I’ll be going over here are conservative and generally very safe for people to do by themselves.
As a physical therapist, I’ve had a lot of experience treating both of these elbow conditions over the years and as a home-gymer, I’ve experienced both conditions personally more than I’d like to share.
Between all the typing I do for my website, learning to play piano, and lifting weights, my forearm muscles seem like they’re always tight.
And doing pull ups with tight forearm muscles is a sure-fired way to get elbow pain.
I’ve had ongoing issues with both golfer’s elbow (medial epicondylitis) and tennis elbow (lateral epicondylitis) over the years and both conditions are usually caused by the same thing:
Repeated activity that gradually over-strains the tendons where they connect to the elbow.
Technically speaking, you could get elbow pain from a biceps or triceps tendon issue during pull ups as well, but it’s more likely to experience medial or lateral elbow discomfort from the forearm muscles.
Medial Elbow Pain
Medial, or inner, elbow pain is often caused by irritation of the forearm muscles and tendons where they attach to the inside of your elbow (the epicondyle).
The proper name for this is medial epicondylitis, but it goes by golfer’s elbow because it’s commonly seen in folks that play this sport.
I don’t play golf personally, but I can imagine how much stress is going through the elbow as you swing.
Anyway, most of the muscles that flex our wrist and fingers originate from inner side of our forearm, connecting to our inner elbow via a common tendon.
Well, if these muscles get overly tight or overused, they pull harder on that tendon, which can cause micro-tears over time.
And it’s this stress to the tendon that causes pain at the medial elbow.
In order to relieve this pain, we have to give the tendon a chance to heal – which means reducing the stresses being applied to the tendon.
Lateral Elbow Pain
Lateral, or outer, elbow pain is caused by the same thing, but just a different group of muscles.
The proper name for this is lateral epicondylitis and it goes by the name of tennis elbow because this is commonly seen in athletes playing tennis or other racquet sports.
In this case, it’s the wrist/finger extensors, or the muscles attached to the outer side of our forearms, that are to blame.
These muscles come down and have a common tendon attachment to the other side of the elbow, but the mechanism for what causes this condition is the same as mentioned above.
Treating lateral elbow pain also consists of relieving the stress to the tendon and then strengthening the forearm muscles to ensure they can handle the repeated stresses.
Pull Ups
We think of pull ups as a back strengthening exercise and they most certainly are – when it comes to targeting the lats and rhomboids, few exercises compare.
But they also work the heck out of our forearms and elbow flexors.
It takes a lot of grip strength to hang on to the bar and both our wrist flexors and extensors work together to create a strong grip.
So, that means pull ups can flare up either medial or lateral epicondylitis (or both if you’re really unlucky).
And I didn’t mention this earlier, but both sets of these muscles originate at the end of the humerus, meaning these forearm muscles technically cross the elbow joint.
This means these muscles are contracting aggressively while they’re being glided across the elbow.
Toss in a little poor form, inherent weakness, or an overly aggressive workout plan and it’s easy to see why elbow pain is so common with pull ups.
Now that we have an idea as to why we’re having pain, let’s figure out a way to relieve it.
Reducing Elbow Pain During Pull Ups
1. Reduce Strain
Ok, so if it’s an irritated tendon that’s causing the pain, the first thing we need to do is figure out a way to get him to calm down.
In other words, we need to reduce the tension going through that tendon so it’ll have a chance to heal.
Our bodies are generally really good at repairing themselves if given the chance, so we should start off by doing just that.
For starters, this means taking a break and avoiding anything that causes elbow pain – this means pull ups, but it could also mean bicep curls, deadlifts, opening a pickle jar, or anything else that requires a strong grip.
If it hurts, try to avoid it.
Depending on the severity of your medial/lateral epicondylitis, this is easier said than done.
Personally, I’ve had bouts of lateral epicondylitis so intense that it hurt every time I bent by elbow (without resistance) or opened my hand.
In these more severe cases, pretty much everything hurts, making it harder to avoid aggravating activities… but do the best you can.
Keep in mind, every time your elbow hurts with these conditions, you’re basically doing a micro-trauma to the tendons and prolonging your recovery time.
As you’re resting and avoiding anything that makes your elbow hurt, you can try icing as well for additional pain relief, but some research has shown that using ice doesn’t necessarily improve your overall outcomes.
And honestly, I’ve never noticed much improvement with icing either.
A better use of your time would be to stretch and release the muscle tension that’s likely causing the increased strain on the forearm tendons in the first place.
Because even if resting relieves your elbow pain, if the problem is still there, it’s just going to come back as you continue doing pull ups.
If you’re having inner (medial) elbow pain, you’ll want to focus on stretching your wrist flexors and if it’s lateral (outer) elbow pain, your wrist extensors.
But I can tell ya right now, it’s a lot easier to stretch your flexors than your extensors.
Even if your wrist extensors feel tight, it can be tough to feel a good stretch doing the below stretch:
It’s worthwhile to both of these stretches if you’re having elbow pain, but I’ve found it a lot more useful to manually release the tight muscles using massage.
You can stretch the heck out of a muscle, but that doesn’t mean you’re going to release those trigger points embedded in the fibers.
And as long as those irritated spots are still there, your chances of having recurring elbow pain remain pretty high.
I can tell your from experience that it can be hard to massage your own forearms, especially if both elbows are painful.
If you have a family member in the house, they might be able to help you by applying a knuckle or elbow into the tight, sore areas of your forearm muscles.
You can have them hold the pressure statically while you grin and withstand the pain (yes, it will hurt), or you can actively flex and extend your wrist as they hold the pressure to really get in there deeper.
This is effective, but if you’re by yourself, you can also use a massage gun or a roller designed specifically for forearms to release the difficult to reach muscles in the forearms.
FYI, the Rolflex which I linked to above was designed by a physical therapist and I use it to treat my ongoing medial and lateral epicondylitis and it’s been amazing.
Overall, I highly recommending using massage to release both the forearm flexors and extensors (regardless of where your elbow pain is) and I find it much more beneficial than stretching alone.
I would start with a few minutes of massage to the tight muscles 3x/day and taper from there depending on how your elbows are feeling.
Bonus tip – it’s not a bad idea to loosen up your triceps as well; from my experience, massaging the distal triceps can help a lot with improving elbow mobility and reducing pain.
2. Strengthen Grip
Ok, that was a lot, but I promise it gets easier from here.
The first focus was on reducing pain and giving the tendons a chance to heal, but now it’s time to focus on strengthening the forearm muscles to ensure they can handle the stress of doing pull ups.
Because the stronger and more conditioned our forearm muscles are, the more able they should be to handle the repeated loads pull ups apply to ’em.
And I’m talking about muscles here, but we’re conditioning those tendons too.
Anyway, there are a lot of different exercises you can use to strengthen your forearm muscles, but we want to be able to do pull ups, so we might as well train specifically to improve this activity (principle of specificity).
And during pull ups, our forearm muscles are being used to create a strong grip, so it makes sense that we should train to improve our grip specifically.
You can certainly improve your grip by squeezing one of those grippers all day, but you’ll get more bang for your buck with different exercises.
I like doing bar squeezes and dead hangs because they both involve a pull up bar (specificity) and they’re both isometric, so they can often be done fairly painlessly.
With a dead hang, you’re just grabbing a pull up bar and hanging for as long as you can and repeating for reps.
You can focus on squeezing the bar intensely as you hang, but you’re really shooting for time on this one.
It’s not written in stone anywhere, but it’s probably good practice to be able to hang for at least 1 minute before attempting to do a lot of pull ups.
The bar squeeze is similar to a dead hang, but you’ll be keeping one foot on the ground or a stool to unload some of your bodyweight (aim to be holding about 85% of your bodyweight).
Doing this makes it easy to focus on squeezing the bar as hard as you can, but against less bodyweight – which will allow you to squeeze the bar longer than with a traditional dead hang.
With the bar squeeze, shoot for a total squeeze time of 2 minutes, taking short breaks as needed.
Depending on your pain and skill levels, I would start off implementing one or both of these exercises 3x/week – but remember, they should be pain free.
3. Ensure Proper Form
The above 2 strategies can help relieve your elbow pain and get your forearms better equipped to handle pull ups, but we’ve also got to make sure we’re doing pull ups correctly.
Because poor form can put more stress through these vulnerable muscles, making it more likely for the elbow pain to return.
The goal with pull ups is to ensure that it’s the lats in your back initiating the movement and not the elbow flexors.
Not only does this work the muscles in our backs more effectively, but it also helps put less stress through the muscles crossing the elbow.
FYI, engaging the elbow flexors more during pull ups also tends to get the wrist flexors more involved, which is not what we’re going for here.
The video below offers a great tutorial on pull up form and I like how the gentleman discusses proper shoulder blade movement because that’s a biggie.
Your shoulder blades should be squeezed down and together as you pull yourself up – doing this ensures you’re engaging the correct muscles in your back.
Also play close attention to your grip width – using a wider grip tends to put less stress on the elbows, but going too wide can become uncomfortable for the shoulders (and inefficient).
Aim for slightly wider than shoulder-width and visualize the force coming by pulling your elbows down to help engage the lats.
4. Ramp Up Gradually
If you’re just starting to add pull ups to your routine or you’re coming back from elbow pain, it’s a good idea to start low and increase reps slowly.
This way you can nip any issues in the butt before they become too serious.
This is the opposite of what I did back in the day, which ultimately started my issues with elbow pain.
When I was in my early 30’s, I decided to follow one of Arnold’s classic workout routines (I know better now) and it included 4 sets of pull ups to failure at the end of the back workout.
Now at one time, I was quite good at pull ups, but that had been a few years prior.
This new workout was the first time I had done pull ups in a while and, especially doing them at the end of the workout, I can guarantee my form wasn’t on point.
My forearm muscles were also likely tight AF after doing a back workout too.
Anyway, after a couple of weeks, I started feeling medial elbow pain with pull ups, which would go away as soon as I stopped
What did I do?
Well, being in my early 30’s, I was used to minor aches and pains going away on their own, so I did the reasonable thing and ignored it.
Long-story-short, I had to eventually stop doing pull ups all together and address the issue.
These days, I know better than to jump in and start cranking out as many pull ups as I can force up and I encourage you to do the same.
Start with low rep counts and ensure your form is on point.
I would start with 2-3 sets of well below your max count and gradually add a pull up or 2 per week until you’re confident that your elbows are handling things well.
And if you’re coming off an episode of elbow pain, I’d even start with sets of assisted pull ups until you’re confident you can handle your full body weight again.
5. Warm Up Before
The last tip I want to mention is one I know we forget to do all the time, but it’s still important – warming up.
And the older I get, the more important this one gets.
It’s important to get the blood flowing and get muscles loosened up before a workout because this reduces the chance of straining or injuring a muscle.
And the same goes for our gripping muscles.
Getting your wrist flexors and extensors warmed up could be as simple as opening/closing your hands for 30 secs, doing some wrist circles in each direction, and knocking out a few forearm stretches before getting started.
You could also use the bar squeeze exercise mentioned above as a nice isometric warm up to get the forearm muscles firing a little before doing pull ups.
It wouldn’t be a bad idea to do some light bicep curls or elbow flexion/extension without resistance to get the elbows moving too.
Final Thoughts
Ok, I feel like we just went over a lot of stuff there.
I apologize if this felt overwhelming, but I’ve had a lot of personal experience with this issue and I know first hand how annoying it can be to have to halt your workouts due to elbow pain.
And to this day, I’m still dealing with bouts of both medial and lateral epicondylitis that come and go, so I’m always stretching, massaging, or otherwise working on my forearms.
I’ve also had to slow down or stop doing pull ups all together several times over the years.
As a therapist, I’m a little ashamed to confess that I’m not always that good at keeping up with my exercise plans.
When my elbow pain starts ramping up, I’ll start doing the grip strengthening exercises again and it’ll improve, but then as the pain starts going away, I usually stop.
Not a great idea.
If you’re having issues with medial or lateral epicondylitis now, odds are you’ll have it in the future as well.
These are treatable conditions, but once you get ’em, they tend to come and go periodically, so it’s a good idea to continue with your routine even after the pain has subsided.
A lot of this has to do with the kind of activities you’re doing, which, in this case, is the pull ups.
And pull ups are a great exercise, so it would be a shame to have to give ’em up – luckily, with a little time and effort, you should be able to get back to doing them pain free.
To sum things up, medial/lateral elbow pain during pull ups is often caused by irritation of the forearm muscles’ tendons where they connect to the elbow.
In order to correct this, we need to:
- take the pressure off the tendon so it can heal
- strengthen the forearm muscles so they can handle the load
- make sure we’re using correct pull up form to put less stress on forearm muscles
- increase pull up numbers gradually, as not to over-stress the forearm muscles
- warm up effectively before each workout
I hope you found this article helpful and if you have any specific questions about this topic, don’t hesitate to leave a comment below.
I’d also love to hear any suggestions or strategies you’ve used yourself to combat elbow pain with pull ups.
