Medial Elbow Pain & Shoulder Impingement Improved with Physical Therapy

What is your story about?
After 10 years of fitness training, I found myself unable to do a pushup without elbow pain. I surmised that the pain was connected to my shoulder impingement, and focused heavily on muscle activation and proper movement mechanics. This approach has helped me significantly resolve my pain.
What symptoms did you experience and how did they progress over time?
I had this elbow pain that was within the medial side and was not due to any exercise since I've been nursing a shoulder impingement problem for a while now. I believe my ulnar nerve somehow got impinged causing me chronic elbow pain from no real strenuous movement. The pain in my elbow would come any time I would try to do any pulling or pushing movements with my elbow. It would also happen when I contracted my flexor carpi radialis muscle and triceps muscle. It could get pretty bad when I was around the midway point in elbow flexion.
What exercises have improved your condition?
I’ve recently been working on a lot of serratus anterior work and external rotation of the humerus. It has helped decrease the pain in my elbow and also improve my shoulder impingement, such that I am able to workout again. Currently, I'm doing pushups and pull-ups again and remaining consistent, but I am more focused on the rehab than anything else. My understanding is that by focusing on the shoulder and external rotation, the humerus is now jamming less into the acromion thereby decreasing the strain on the supraspinatus muscle and tendon. Same with the serratus anterior and also lower trap ...(more)
What volume and intensity have you used in your rehab?
I think that with this type of chronic issue you will need higher volume work along with strengthening of the rotator cuff. So that means high reps with band work using different positions of your arm such as by your side in 90 degree position and also shoulder level with same 90 degree position. Trying to activate the rotator cuff is the most important part of the rehab. While strengthening is one of the goals, another is to wake those muscles up so that they hold the humerus in the correct position permanently. That may take much more volume. (Think overall goal of 30-50 reps for 3-5sets w ...(more)
Do you have a favorite exercise for the serratus anterior?
Serratus anterior wall slides won’t be enough to really make a large difference. They are a great starting point. I used them, but realized that they do not activate or build enough strength in the serratus anterior to improve the issue. View them as a warmup after you can do 10 or so. After that you can work on the other movements. I have been doing plank to pike exercises. I start in a plank position with scapula protracted and arms straight and I raise my hips up to pike until I reach an overhead position with my arms. I always maintain protraction of the scapula throughout the movement a ...(more)
What advice would you give others with this condition who are struggling to stay motivated?
Don’t give up. I know the feeling. I know it’s discouraging, but honestly I was in the same boat and many times felt the same. I was really into fitness for more than a decade now, and ended up not even able to do pushups without feeling elbow pain. I just kept searching and trying to understand the issue. I started seeing that the mechanics of the body are really not that complicated once you understand the anatomy and movements produced by the muscles. I know not everyone can solve their issues, but damn we just can’t quit. This life is our one chance to reach our potential, don’t give up ...(more)
Do you have any other recommendations for how to approach rehab?
Remember, don’t think in terms of raw strength development, think in terms of activation of muscle groups to allow you to move joints with the correct muscular activation and contraction. Also, for maintaining the correct positioning of joints such as the shoulder joint with regards to the scapula and humerus. We want to avoid compensations by making sure the muscles needed to begin a movement and those that are needed to stabilize joints are active and strong.