As a sports physician, I can’t tell you the number of times I’ve had patients ask me about how many bicep curls they should be doing to help strengthen their arms. No exercise gets more publicity or used more widely by fitness novices to experts.
However, doing too many curls or doing them incorrectly can lead to elbow pain.
In this post we’ll discuss the reasons you get elbow pain during bicep curls and how to fix it so that you can get back to training your arms.
The 4 reasons you get elbow pain are:
Using a weight that’s too heavy
Not using varying forms of bicep curls
Gripping onto the bar too hard
Not keeping your wrists in a neutral position while curling
Before we make a deep dive into the reasons behind elbow pain during bicep curls, let’s take a look at the basic anatomy of the elbow and its relation to the bicep curl.
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Basic Elbow Anatomy & How It Functions During Bicep Curls
Anatomy of the elbow. Picture courtesy of Wikipedia.
The elbow joint is formed by the connection of the arm bone (humerus) with the forearm bones (radius and ulna).
The basic movements of the elbow include flexion, extension, supination, and pronation. For the sake of the bicep curl let’s just focus on flexion and extension.
Flexion (bending the hand towards the shoulder).
Extension (straightening out the arm).
The bicep curl typically begins with the elbow in full extension (straightened out) while standing with the weight gripped in the hand. The palm faces forward and your wrist is in a neutral position (not bent forward or bent back).
The elbow is then flexed with the weight in hand until it reaches the front of the shoulder, then brought back down into the original position.
Reasons You Get Elbow Pain During Bicep Curls
Why you get elbow pain during bicep curls
Here are the four main reasons why you get elbow pain when doing bicep curls.
1. USING TOO MUCH WEIGHT
Your hand and forearm may not be strong enough to stabilize the weight in your grip which could affect your wrist position.
If your wrist position is not neutral, it can displace the force into your forearm, which increases the load on the elbow. As a result, it can lead to elbow pain while bicep curling.
2. NOT USING VARYING FORMS OF THE BICEP CURL
If you’re always doing the same type of bicep curl it may lead to an overuse injury. This can be a result of the structures in the arm and elbow undergoing the same forces over and over again.
By varying your technique to, let’s say, concentration curls (bicep curls with your elbows braced against the insides of your knees) or preacher curls (bicep curls with your elbows resting on a sloped bench), you can change up the forces in the arm and elbow to limit the chances of an overuse injury.
3. GRIPPING ONTO THE BARBELL TOO HARD
If you’re holding onto the barbell too tightly, it can activate the flexor tendons (helps to bend your wrist forward) in your wrist which can lead to inner elbow pain during bicep curls. This is because the tendons attaches to the inner part of the elbow.
Note: This is NOT the same as tennis elbow, which causes pain in the outer elbow.
Related Article: How To Hook Grip
4. NOT KEEPING YOUR WRIST IN A NEUTRAL POSITION WHEN CURLING
If you’re bending your wrists too far forward, it can have the same effect on your inner elbow as gripping onto your weight too tightly. Bending your wrist forward can activate the flexor tendons that attach to the inner part of the elbow, which can cause pain.
On the other hand, if you’re bending your wrist backwards, it can activate the extension tendons in the wrist which attach to the outer elbow. This can then lead to outer elbow pain.
Elbow Pain Diagnosis
Now that we’ve discussed the reasons you get elbow pain during bicep curls, let’s discuss the potential elbow diagnoses that could cause issues.
Remember to always consult a medical provider for an actual diagnosis for your elbow pain. Don’t be that person that self-diagnoses themselves off an article on the internet.
Here are the most common diagnoses for elbow pain when related to bicep curls:
1. GENERALIZED ELBOW PAIN
This is when someone asks where your elbow hurts and you can’t point to one specific spot on the inside or outside.
This can be linked to:
Distal Bicep Tendon Rupture – This is when the far end of the biceps close to your elbow completely breaks apart from the rest of the biceps. You may be thinking that this is probably rare, and you’re right, it’s rare, but has been seen in people doing bicep curls. There are certain special physical exam tests your medical provider can do to consider this diagnosis in the office.
Triceps Tendinopathy – This can cause elbow pain during bicep curls with repetitive straightening of the elbow with a weight in hand. Patients can commonly have pain when feeling the back of their elbow.
Osteoarthritis – This is also known as general “arthritis.” This is really rare to happen in the elbow since it’s not common to put weight through it repetitively, day in and day out, like the knee joint. But, it can happen if you’re doing bicep curls frequently throughout your life. Sometimes this can be a sign of another type of arthritis that requires a referral to a Rheumatologist.
2. INNER ELBOW PAIN
This is when someone asks where your elbow hurts and you point to the inside of the elbow closest to the rest of your body.
This can be linked to:
Medial Epicondylitis – This can occur with repetitive use of your wrist flexors (muscles that help bend your wrist forward) if you’re not using a neutral position while doing bicep curls
Referred Pain – Sometimes pain in the inner elbow can be caused by issues in the neck or shoulder. This can happen due to overlapping areas for nerves which can get signals from multiple areas in the body.
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3. OUTER ELBOW PAIN
This is when someone asks where your elbow hurts you point to the outside of the elbow, away from the rest of your body.
This can be linked to:
Lateral Epicondylitis – Also known as “golfer’s elbow.” This is often worsened with repetitive use of the wrist extensors (bending the wrist backwards). This can happen when your wrist isn’t in a neutral position, especially with repetitive bicep curls.
Referred Pain – As I said before, sometimes pain in the outer elbow can be caused by issues in the neck or shoulder.
Ulnar neuropathy – This can cause numbness, tingling, or even burning on the outer part of the elbow due to injury to the ulnar nerve which can potentially be irritated with incorrect bicep curl form.
What Should You Do When Your Elbow Hurts When Bicep Curling?
There are numerous treatment options for elbow pain during bicep curls. The following are treatment options for acute elbow pain (within the last 4 weeks) and is not a result of a trauma (AKA not because you dropped a barbell on your forearm and hurt your elbow).
DID YOU LOSE ANY SENSATION?
Before we go into treatment options for your elbow pain, be sure you haven’t lost feeling (sensation) in your forearm, elbow, wrist, hand, or fingers.
Also, make sure you aren’t experiencing any new weakness in the arm (especially grip strength). If you do have any sensation loss or new weakness, go see a medical provider immediately. These can be signs of a more serious injury.
USE THE RULE OF TWOS
One concept that I love to use when treating patients is using the rule of twos.
It’s when you rate your pain on a scale from zero to ten (zero being no pain and ten being the worst pain possible) and then track the pain level in your elbow during bicep curls.
If your elbow pain, for example, increases by two levels (on a scale from one to ten on the pain scale) for more than two hours, you’re doing “too” much and need to either back down or be evaluated by a medical professional in person.
USE “RICE”, USE “PRICE” INSTEAD
A lot of people know what RICE is (rest, ice, compress and elevate). However few individuals know what PRICE is. It just involves adding “protection” to the acronym.
This protection can involve a compression wrap or brace to control swelling and add support. Sometimes you’ll use protection before being evaluated by a medical professional to protect the elbow from further injury.
DECREASE INFLAMMATION
One the cheapest (usually free), oldest, non-prescription anti-inflammatories that you can get your hands on is ice.
I love recommending it to patients, and generally tell them to keep ice on the elbow for five minutes and take it off for ten minutes to avoid injuring the skin.
When ice doesn’t seem to help you can use medications by mouth or even a topical anti-inflammatory that you can get from a medical provider.
The Inflammation should be controlled before pushing through any exercises or rehab as you don’t want to further irritate a painful elbow. This will only cause more inflammation (the reason you get the pain) and makes things way worse.
USE TRAINING MODIFICATIONS
If your elbow hurts during bicep curls or any other activities, you should back down and avoid those activities to give yourself a chance to heal.
If you’re having trouble with continuous pain despite rest (and you haven’t been diagnosed with any other conditions by a medical provider) you should consider lower weights with higher repetition during your bicep curls.
Frequently Asked Questions
These are some frequently asked questions that I get from patients.
SHOULD I USE A RESISTANCE BAND OR A CABLE MACHINE?
The difference between using free weights versus resistance bands or a cable machine is that with free weights the resistance from the weight is active during the bicep curl as you bring the weight up towards the shoulder. On the way back down (straightening your elbow) the bicep is under tension to release the curl.
With resistance bands or a cable machine the resistance is constant throughout the entire bicep curl exercise. This is important as more injuries occur to tissues under tension while bringing the weight down to the starting position of the bicep curl.
Another advantage of resistance bands or cable machines is that they also allow for a wider range of motion, therefore giving you a better overall workout to surrounding structures in the elbow.
SHOULD I USE A WRIST IMMOBILIZATION BRACE?
By using a wrist immobilization brace you can further guarantee a neutral wrist position during a bicep curl which would limit any improper form and potential injuries.
Final Thoughts
Be sure to make the small adjustments suggested above, including the treatment options, and soon you’ll be on your way to be elbow pain free while performing bicep curls. Good luck getting back into the gym.
About The Author
Dr. Niraj Patel
Dr. Niraj Patel is a physician and assistant professor of family medicine and sports medicine at the University of North Texas Health Science Center. He completed his family medicine residency training through Cleveland Clinic Akron General where he served as the Chief Resident and House Staff President. He completed his sports medicine fellowship through Ohio Health Riverside Methodist Hospital; team physicians of the Columbus Blue Jackets (NHL) and the Columbus Crew (MLS). In addition, he has completed a Certificate in The Principles of Aviation & Space Medicine through NASA / The University of Texas Medical Branch where his final project was on the topic of “Muscle Loss in Spaceflight.” Niraj has been published in the Clinical Journal of Sports Medicine as well as Current Sports Medicine Reports, the official review journal of the American College of Sports Medicine. In his spare time, Niraj enjoys reading, working out, watching sports (especially hockey), and spending time with his family.
