Flatmattersonline - Health Matters: Flatland and Elbow Pain by Scott Hagnas

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Probably more Flatlanders have had their careers cut short by elbow pain than any other ailment. It’s almost epidemic in older riders it seems. I know how debilitating this can be firsthand – chronic elbow pain that started in 2003 eventually pushed me into semi-retirement around 2008. I rode infrequently from 2008 until 2015, but the elbow pain was always there even though I’d go weeks or months between sessions. In late 2015, I finally unlocked how to recover my elbows and in early 2016 began riding nearly every day once again. Now, nearly 5 years later and still riding regularly, I still have no pain.

I’ve shared what I did with numerous riders since then, and in every case, I’ve heard back how much it’s helped. If you aren’t into long articles and just want to jump to the #1 thing, scroll down to point #4 and do that. However, I’d suggest reading all of this if your elbows are not 100%!

So, why do riders develop elbow pain? Like with low back pain, it isn’t just one thing. Clearly, gripping the bars for hours and the specific stress Flatland puts on the elbow is a big factor. But, even though the elbow is what hurts, often the main cause is another nearby body part.

We’ll look at 5 main factors:
1) Stiff ribcage
2) Immobile shoulder blades and weak muscles controlling them
3) Nerve & fascial restrictions
4) Strength imbalances
5) Tight shoulders

1) If your ribcage is stiff, the shoulder blades don’t have as stable of a base as they should. This then makes the elbow joint carry more of the load, eventually causing problems.

The ribcage gets stiff because we typically stop moving it in all of it’s possible directions at a young age. Modern life with lots of sitting stiffens it up, and even most things commonly done for exercise actually make it worse over time as well.

I didn’t include a self-test for this one as it’s a little more complicated to do. Instead, try this routine of using your breath and movement to open up some movement in the spine and ribcage. Go slow and pay attention to where you are tight or having trouble expanding with your breath.

Do 2-3 sets of 5 big breaths in each of the 3 positions – bent forward, then bent and rotated to each side. Your upper body should feel better in general after doing this.

2) If your shoulder blades are immobile or unstable, it transfers the forces to other joints, like the elbow. With the ribcage moving a little better, the shoulder blades are more free to move. But, you’ll need to train them to move independently. Even the professional dancers I work with aren’t always able to do this at first!

Scapula (shoulder blade) Circles are the first step in the process. We’ll do two kinds – one with the hands held out front and circling front to back, the other circling to the side. Make sure that just the shoulder blades move – the hands should mostly stay in place, elbows stay locked, and be sure to tighten your midsection as if bracing to take a punch. Watch yourself in a mirror of film yourself for best results. If you keep trying to bend your elbows, this is a big clue that lack of shoulder control is contributing to your elbow trouble. 10 each direction of both, done daily, works well.

Eventually, you’d need to move to strengthening this movement. The first step in the process is to develop a stronger ability to keep the shoulder blade retracted. The video below shows step one. You’ll need a set of rings or a TRX strap, or you can put an empty bar in a rack at the needed height. Even things like a hand rail can work. You want to hold an inverted plank, pulling your shoulders back as far as possible with straight arms. Tighten everything up and release one hand, not tilting away or letting the shoulder slip forward. Hold for time, re-set, then do the other side.

3) Nerves can become restricted and not gliding inside their sheaths. This can cause the nervous system to tighten the muscles as a protective mechanism. I believe that this is one of the main causes of elbow pain in Flatlanders. If you only try one thing, make it this!

I have shared this with dozens for riders and it’s helped every one, and quickly too. You typically see improvement in just a few days, which is pretty amazing. You’ll need a dowel, broomstick, or PVC pipe about 1.5 meters long (5 feet).

Test yourself with the 2 armed version shown, then use the single arm version to stretch. A set will be done as follows:

• get into the stretch slowly for about 20 seconds, trying to relax into it.
• do 10 slow pulses – use your helping hand to push the stretch side away for 3 seconds, then come back out of the stretch slightly for each rep. Try to read in deeper. You can also flex your tricep muscle at the end to deepen the stretch.
• On the last rep, hold for 10-30 seconds.
• repeat on other side.

I’d do this stretch 1-2 x daily, and before and after riding sessions. Once your elbows feel better, you need to do it much less frequently.

4) Strength imbalances that develop over time end up causing excessive strain on the weaker tissues. This is true all through our body. Think of it like this: if someone were to only train their biceps by doing curls all the time, but never did anything at all for the triceps, what would happen most likely?

At some point, with one side of the elbow joint being strong and the other weak, the elbow joint won’t work properly anymore and pain is very likely. Also, the body will start to limit how strong the biceps can get to prevent more damage.

The same is true of the forearm muscles. The flexing (gripping) side gets strong from holding the handlebars all the time, but the wrist & finger extensors on the other side don’t get worked at all!

Test yourself in the Dumbbell Reverse Wrist Curl, or if you have access to an EZ curl bar, you can use that. Perform a set as shown, holding at the top for a strict 3 seconds, and lowering to full stretch each rep. I’ve found you’ll need to get 8 solid reps like this using 10% of your bodyweight in each hand to keep balance around your wrist & elbow strength.

5) Tight shoulders also send more stress to the elbow. The shoulder is complex and can move in many directions, but the biggest bang-for-your-buck shoulder stretch is without a doubt the Bar Hang. There is an entire progression of hangs I use, but we start with the shoulder width, double overhand hang. Many need to start with the feet still on the ground or some sort of box so they aren’t supporting full bodyweight – especially if you’ve also had shoulder injuries.

There are 2 methods here – the active hang, where you keep the shoulder blades strong and pulled back and down thru the whole hang, and the passive hang, where you relax into the hang and let everything stretch out and elongate. If you have shoulder instability, dislocations, etc – definitely do the active version. Otherwise, mix between which style you do. Shoot for eventually hanging for 2 minutes straight!

Also, use the same breathing pattern here as in the ribcage mobilizations and you can also improve ribcage mobility at the same time!

These are some starting points to get those elbows back working better on the bike. I’d really suggest digging back to the Back Pain article I did for Flatmatters last year and work some of those exercises also, as the body is very interconnected and improving any issues there will also help the elbows.

Here’s a simple elbow program you can try:

• Rib Expansion Breathing – 2 x 5 breaths per each of the 3 positions
• Scap Circles to the front – 10/direction, slowly
• Scap Circles to the sides – 10/direction, slowly
• Elbow Pronation Stretch w/Dowel – 2-3 x 10 pulses + 10-20 sec hold each side

3-4 days/week:
• Elbow Pronation Stretch w/Dowel – 2-3 x 10 pulses + 10-20 sec hold each side (extra sets)
• Bar Hang – accumulate 2-5 minutes hanging, resting as needed. (you can build this time thru your day if you have a bar close by)
• Reverse Wrist Curl – 3 x 7-10 reps with a 3 sec hold at the top each rep.

If you have any questions or are interested in an individualized program specific to your needs, don’t hesitate to reach out! I’m also launching a new wellness coaching service specifically for Flatlanders and BMXers in the coming weeks.


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