Elbow pain is often the result of some muscles overcompensating for other muscles that aren’t doing their jobs.
In this article, you will learn how to specifically activate five hidden muscles that you’ve probably never heard of before. Activating these muscles will help restore proper function and help you eliminate your elbow pain for good – including pain from tennis elbow and golfer’s elbow.
Let’s dive in.
Dr. B says:
“We see a lot of elbow problems in the sports clinic. Specifically, lateral epicondylitis, more commonly called tennis elbow, is probably the most frequent, followed by medial epicondylitis or golfer’s elbow.
Then there are some less common elbow issues like distal biceps tendonitis, ulnar nerve irritation, or ulnar collateral ligament tears. All of these conditions can be helped with the exercises we’re going to show you today.”
But first, let’s look at why we get elbow pain in the first place. Because if you don’t address the root cause of the problem, it’ll come right back.
If you want to follow along with the exercises, watch our Elbow Pain video on YouTube with Coach E and Dr. B demonstrating.
What Causes Pain in Elbows?
Elbow pain tends to come from wear and tear injuries. If the hurt seems to come out of nowhere, there is a good chance it’s one of the reasons below.
It could also be a traumatic injury to the joint, but that’s something you could immediately point to as a reason for the damage, like falling off a bicycle.
Cause #1: Poor Technique
The first cause comes from your technique.
Inefficient or poor technique in your sport, hobby, or job can cause overuse, injury, and pain.
For example, one of the biggest causes of tennis elbow (outer elbow pain) is only swinging the arm and not taking advantage of the full kinetic chain to create power from the legs and core. In players who only swing with their arm, that tendon can become overloaded and eventually break down.
Golfer’s elbow (inner elbow pain) also comes from imperfect technique. The right muscles aren’t firing and the inner elbow pain signals that imbalance.
It’s not just tennis. Coach E and Dr. B have seen elbow pain from poor technique in everything from Brazilian jiu-jitsu to hockey. Even in the gym, people overuse their outer fingers more than the first two when doing pull-ups, resulting in elbow pain.
Cause #2: Ignoring the Performance Pyramid
The second cause stems from the performance pyramid.
The performance pyramid has four levels. Starting at the base, these are endurance, strength, power, and speed.
Endurance builds a foundation. If your body isn’t accustomed to the movement, it’ll fatigue and increase your risk of injury.
Strength starts with slow activation. You’re warmed up, but you aren’t going from zero to 100 in a fraction of a second. Think of it like doing a bench press – going too fast is dangerous.
Power is that instant, explosive strength like you see in boxing or jumps in figure skating. It’s less common in active hobbies but still an important step to consider as you work toward speed.
Basically, your body needs to prepare for explosive power and speed, i.e. stress. As you increase the intensity, your body needs to build a foundation for the muscles and nervous system to use good teamwork.
Without considering the performance pyramid, it’s easy to find yourself with injuries down the line.
Let’s look at the performance pyramid for a moment.
First, you build endurance. Your muscles learn what to do, and you build muscle memory through repetition. It’s imperative to learn good technique here.
Then you build strength. These first two pyramid levels are crucial to a strong foundation for any activity involving power or speed. Remember, crawl, walk, then run.
Finally, if you see good reason in your activities, you’ll train yourself for that split-second 0-100% activation, and finally, speed.
Cause #3: Overdoing It
The third reason is too much of anything.
It might be too much volume or too much intensity. It might also be not allowing enough time for recovery. It’s particularly common as seasons change. When spring and summer arrive, many people resume their walking or running routines with the same mindset they had when they stopped for inclement weather in the fall.
For example, if someone ran a 10k every weekend up through November, and took the winter off, then celebrating spring with a 10k run will cause damage. Starting easy is the smart thing to do here.
The performance pyramid isn’t a linear progression either. Listen to your body. If you need to take a step back to endurance and work on that for a few weeks, that’s better long-term than pushing through.
Cause #4: No Foundation
Fourth cause, a poor foundation for movement.
Coach E and Dr. B have made it their mission to educate as many people as possible on building a healthy foundation for movement. Your performance pyramid isn’t stable if you don’t have a good foundation for movement.
The foundation for movement is having good quality tissue. The muscles and the tendons should be pliable, healthy, no tears, with well-aligned joints, activating the correct muscles and keeping those muscles activated throughout the full range of motion.
The foundation for our performance pyramid is critical to prevent any kind of overuse injury.
Even if you focus on the first three reasons for injury, say you perfectly adhere to the performance pyramid, without a good foundation for movement, you can still get those wear and tear injuries. In short, chances are your body will break down at some point.
For the rest of this article, we’ll focus on the activation piece. These five muscles often get sleepy because other larger muscles tend to overcompensate, even though they aren’t as well-suited to the movements.
Next, we’ll focus on getting five elbow pain relief exercises to get those sleepy forearm muscles activated.
You can start these exercises to treat tennis elbow and golfer’s elbow right away. At the bottom we have rep modifications for if you want to work on your forearm muscles a little every day or a few days each week.
Muscles & Their Exercises for Elbow Pain Relief
The muscles we will work on today are the brachialis, supinator, flexor carpi ulnaris, pronator quadratus, flexor digitorum profundus, and flexor digitorum superficialis.
We have roughly 15 muscles in the forearm. Wear and tear happen when someone only uses two or three of these muscles, like the extensor carpi radialis brevis or the flexor carpi radialis. Those two muscles tend to pick up the slack, get overloaded, and then cause pain.
Use the exercises below to engage all 15 muscles in your forearm.
Imagine moving a piano. Would you rather have two people on the job or 15? Chances are, if you only have two, someone will throw out their back, and the other person will get crushed.
That’s exactly what happens to your muscles when they don’t work together.
Exercise #1: Brachialis
The brachialis is a deeper muscle than your bicep. It sits right along the humerus, inserting into your ulna. Its primary responsibility is flexing the elbow, but it tends to get sleepy.
When it stops activating during elbow flexion, your biceps takes over. When you think of an arm curl at the gym, most people think it’s the biceps doing all of the work. But the biceps’ primary job is elbow supination (or turning your forearm wrist-side up.)
When the biceps does both jobs (flexion and supination), it gets overworked, tired, and then the tendon can start breaking down.
A sleepy brachialis also causes lateral epicondylitis or tennis elbow. The common extensor wad (real term for the group of extensor muscles) will stick into the brachialis.
Waking up the brachialis will take the strain off of those two muscles.
Releasing the tissue:
With your arm curled (flexed elbow) and wrist facing outward (extended wrist), jab your thumb into the area just above your elbow on the outside of the tendon
Slowly uncurl your arm and flex your wrist
Repeat this for about a minute, moving your thumb to slightly different areas
Releasing the tissue is the first step to getting muscles activated. Once you release the tissue, then you have the perfect opportunity to activate it.
Brachialis curl
The biceps is powerful as a supinator. That’s the motion of turning the palm up. Making the opposite motion ( reciprocal inhibition) creates a great way to shut off the biceps. Performing an arm curl with the biceps shut off will activate the brachialis without engaging the biceps.
- Start in the supinated position
- Flex the elbow as you pronate your forearm
- Squeeze to close the angle of your elbow, maxing range of motion
- Keep your wrist pronated as you extend your elbow
- Supinate your wrist at the bottom of elbow extension
Do 6-8 slow reps.
Try to time your pronation to your elbow flexion to have a pronated wrist when you reach the top of your elbow squeeze.
You can also use weights for this exercise. A little dumbbell will do. Give yourself the best start without weights to perfect the technique. Add weight later as you feel comfortable with the movement.
You can do a shorter version of this too, keeping within the fully flexed range.
- Fully flex your elbow
- Pronate your wrist (turn your palm facing outward)
- Squeeze your elbow closed
Do 3-5 reps with 10-second holds.
Exercise #2: Supinator
The second hidden muscle we’re going to activate is the supinator. The supinator is in the upper outer aspect of the forearm. Its job, you probably guessed, is to supinate the palm. (It turns the palm upward.)
When the supinator turns off, the biceps has to work twice as hard. So let’s turn on that supinator so we can give the biceps brachii a bit of a break.
Like the exercises for the brachialis, there are two easy ways to activate the supinator.
The biceps cannot supinate when the elbow is in full extension. So this first exercise will be super easy.
- Extend your elbow to end range of motion (not painful)
- Supinate your palm and push out toward the end range (not painful)
- Hold that activation for 10 second
Do 3 to 5 reps.
The second exercise will add some resistance. You’ll need an exercise band attached to a stable point at the mid-thigh level. It will also work through the full range of motion.
- Grab the band with a pronated grip (palm toward your body)
- Externally rotate your shoulder
- Supinate and hold at the end range for 5 seconds
Perform 6 – 8 repetitions.
Ideally, you’ll do both exercises. The first one will wake up your supinator. The second will increase your strength and range of motion through the resistance.
Exercise #3: Flexor Carpi Ulnaris
The third hidden muscle is the flexor carpi ulnaris. It flexes the wrist from the ulnar side, running from the inside of your elbow to the inside of your wrist.
When this muscle gets neglected, it often leads to problems with pronator overuse and sometimes problems down in the wrist itself.
- Start off with your wrist in extension, and radial deviation (move your thumb closer to your wrist)
- Flex your wrist as you bring your pinky closer to your forearm (ulnar deviation)
- At the end range, hold for 5 seconds
- Slowly move back to wrist extension with radial deviation
Do this 4 to 6 times.
You should be able to feel the muscle on the side of your forearm fire up.
Exercise #4: Pronator Quadratus
The pronator quadratus is another hidden muscle in the forearm. It’s a rectangular muscle that is just above the wrist. It inserts on the ulna and the radius. Its job is to pronate the forearm, turn the palm down.
The importance here is that people with golfer’s elbow or pronator teres often don’t have good function of the pronator quadratus. That means another muscle is doing double-duty, which, as you know by now, leads to breakdown and pain.
Turning on the pronator quadratus means your flexor carpal radialis and our pronator teres can relax.
This exercise also follows the theme of using reciprocal inhibition to shut off the pronator teres. The pronator teres is a weak elbow flexor that crosses the elbow joint. But it’s the muscle that jumps in to pick up the slack.
Extending the elbow can shut off the pronator teres. Extending the elbow while pronating the forearm can preferentially recruit the pronator quadratus to resume doing its job.
- Begin in supination with a fully flexed elbow
- Slow work toward extension and pronation
- Hold at the end range, extending the elbow and pronating the forearm, for 10 seconds
Do 3 – 5 reps.
Alternatively, you can use a band.
- Anchor the exercise band to a solid surface at biceps level
- Grasp the band with a fully flexed elbow and your wrist toward you
- Slowly extend and pronate while holding the band
- Hold for 5 seconds at the end range of motion
Do 6-8 reps.
Exercise #5: Deep Wrist & Finger Flexors
The last of the hidden muscles are the flexor digitorum profundus and flexor digitorum superficialis. These are responsible for flexing the finger and the metacarpal joints (the wrist).
The tendons here are very long, running the length of your forearm. The muscles themselves insert on both bones of the forearms. The profundus is deep to the superficialis. They can get strained in a differential fashion, particularly if you’re doing gripping activities and tend to overuse the ring and pinky finger.
And this doesn’t just happen in the gym or during sports, although we commonly see it in sports using racquets. So think about how you grip everything from a hammer to a hairbrush.
You can also use this exercise as a test (Dr. B and Coach E do it all the time in their practices) to see if you’ve aggravated one part of the profundus or superficialis over another. Different parts of these muscles run to different parts of each finger.
The profundus runs into the tip of each of your fingers. To isolate it, you have to deactivate the superficialis.
- Hold the finger steady from the knuckle down to the middle finger bone
- Flex just the tip of your finger
- Hold for 2-3 seconds
- Work through all of the fingers on both hands
If you don’t hold your finger in place, when you flex, you can see that all of the joints will activate, not just the end.
You might feel some tension in your forearm on some of your fingers. That tells you which fingers need a little extra love.
If you want to get a little resistance on those digits (or all of your fingers) perform the exercise up against a table or edge of something else you can press against while still holding most of your finger steady.
Next, we’ll activate the superficialis and get the profundus out of the way. You may want a partner for this.
- Hold your fingers out straight with your palm supinated
- Hold 4 of your 5 fingers out straight and use your other hand (or a friend’s hand) to immobilize them
- Flex the mobile finger to the end range
- Hold for 2-3 seconds
Some people can flex the tip of their finger while doing this on one or all of their fingers. Most people can’t. Don’t worry about it either way.
You can also apply resistance here with your thumb.
If one of the fingers hurts while doing this, it could mean one of two things. First, part of the muscle might be stuck.
You can unstick the fascia in your forearm with some good old auto self-myofascial release. Start with your wrist and fingers flexed, put your thumb in your forearm where you feel the tension/tenderness, and extend your wrist and fingers. Repeat this, moving your thumb up and down the muscle.
Then go back and do the exercise.
Final Thoughts & Exercise Summary
If you want to get these muscles working right away, you can do this set of elbow pain relief exercises every day.
If you choose to do it daily over 2 or 3 times a week, then limit each exercise to 1 or 2 sets. It should only take 7 to 14 days of daily practice to wake up the five muscles we covered.
If you want a little more structure, download the Elbow Pain routine in ROM Coach. It’s free, and you can schedule it with reminders, so you don’t miss an exercise and get results faster.
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This article was reviewed and updated on September 2, 2022 by our Chief Medical Officer, Dr. Erin Boynton, MD, FRCS to include new research and information on latest surgical developments. Read more about Dr. B here.
