By Marc Darrow, MD, JD
“I get bad pain in my elbows when doing heavy resistance training. It has become limiting, and I would like to see if I can do anything about it.”
The first question is where the pain comes from. Elbow pain during lifting can involve the tendons used for gripping, the biceps or triceps tendon, the elbow joint, or a nearby nerve. The treatment that makes sense for one of these problems may be inappropriate for another.
I would begin with the painful movement and the exact location of the pain. Does it happen when you grip the bar, curl the weight, or straighten the elbow? Did it develop gradually, or did you feel something tear during a repetition? Those details help determine whether the next step should be rehabilitation, further imaging, or prompt evaluation of an injury.
Where does your elbow hurt?
The familiar names “tennis elbow” and “golfer’s elbow” describe tendon problems that also occur in people who never play either sport. Heavy gripping can load these tendon attachments during weight training.
| Location of pain | A possible source | Symptoms worth discussing during an examination |
|---|---|---|
| Outside of the elbow | Common wrist-extensor tendon, often called tennis elbow | Pain with gripping or resisted wrist extension |
| Inside of the elbow | Common flexor-pronator tendon, often called golfer’s elbow | Pain with resisted wrist flexion or forearm rotation |
| Front of the elbow | Distal biceps tendon | Pain with curls or turning the palm upward against resistance |
| Back of the elbow | Distal triceps tendon | Pain when straightening the elbow against resistance |
These are clues, not a diagnosis. The medial elbow, biceps, and triceps each require their own assessment; tendon disease at one site does not establish what is happening at another. (1)
Tingling into the ring and little fingers, persistent weakness, swelling, or joint locking adds another concern. Chronic elbow pain can also arise from nerve, cartilage, and bone disorders. It should not automatically be labeled tendinitis simply because it appears during exercise. (2)
A sudden injury needs a different response
A pop during a lift followed by bruising, a change in the contour of the arm, or substantial loss of strength deserves prompt medical assessment. A complete biceps or triceps rupture can require surgical repair. An injection should not delay that evaluation. (3)
This distinction matters when someone asks whether stem cells can help. Gradual tendon pain and a tendon that has completely detached are different problems, even if both started in the gym.
What should be examined before choosing treatment?
The useful evaluation connects your symptoms to a structure. It includes the location of tenderness, elbow and wrist motion, grip strength, resisted movements, and nerve symptoms. Bring a description of the exercises that provoke pain, including changes in training volume, weight, frequency, and grip.
Imaging should answer a specific question. X-rays can help assess the joint and bone; ultrasound or MRI may help evaluate a suspected tendon injury or another soft-tissue problem. The choice depends on the examination and clinical circumstances. (2)
If an injection is proposed, ask which structure it will target. “Treating the elbow” is less informative than identifying a symptomatic tendon attachment or joint abnormality.
Rehabilitation is part of the treatment
For persistent lateral elbow tendinopathy, clinical practice guidelines recommend therapeutic resistance exercise and a phased approach to restoring function. Depending on the assessment, exercises may include controlled wrist-extensor holds, lifting, and lowering. The program should match the person’s symptoms and capacity. (4)
For a weight lifter, this means discussing how to adjust the movements that repeatedly provoke pain while rebuilding tolerance. Useful questions include whether to reduce the load or number of hard sets, change a grip or exercise, or temporarily remove a particularly painful movement. These decisions should be individualized rather than taken from a universal elbow routine.
Resting until an elbow feels better does not establish that it can tolerate the same heavy workout again. The practical goal is to build a progression back to the activity you want to perform.
What does research say about PRP for tennis elbow?
Platelet-rich plasma, or PRP, is prepared from your blood. It is a platelet preparation, not a stem cell treatment. The site’s PRP overview discusses its use for tendon and joint conditions.
Some research supports PRP compared with corticosteroid injection. A randomized study of 100 patients with chronic tennis elbow reported better treatment success with PRP at two years. Its success measure included improvement in pain or arm function without another intervention. (5)
However, comparing PRP with a steroid does not answer whether it works better than a placebo. A 2026 meta-analysis of six randomized trials involving 355 patients found no statistically significant advantage over placebo in pain or function at the assessed follow-ups through approximately six months. Its authors did not support recommending PRP for lateral epicondylitis on that evidence. (6)
Both findings belong in the discussion. PRP cannot be presented as a reliably effective treatment for every painful elbow. If it is considered after persistent symptoms, the decision should include this uncertainty, the alternatives, the cost, and what would count as a useful improvement.
What about bone marrow treatment?
Bone marrow aspirate concentrate, sometimes called BMAC or BMC, is prepared from the patient’s own marrow. It is a mixed preparation rather than a purified stem cell injection. Evidence for a particular marrow preparation should be considered separately from evidence for PRP.
A prospective study treated 30 patients with tennis elbow using a centrifuged marrow preparation containing platelet-rich plasma and mononuclear cells. Average Patient-Rated Tennis Elbow Evaluation scores improved from approximately 73 before treatment to 15 at 12 weeks. Lower scores indicate less pain and disability. (7)
Those results are encouraging, but the study had no comparison group and only short follow-up. It cannot establish how much improvement came from the injection, whether it outperformed rehabilitation, or whether it restored heavy lifting capacity. It also does not prove that stem cells were responsible for the observed changes.
The appropriate description is preliminary clinical evidence. This study does not establish that marrow treatment is superior to PRP, rebuilds an elbow tendon, or provides a predictable return to unrestricted resistance training.
Can tennis elbow research be applied to biceps or triceps pain?
Not automatically. Most elbow PRP research concerns the common extensor tendon on the outside of the elbow.
For distal biceps tendinopathy, one small study reported improvement after ultrasound-guided PRP in six patients. Pain with movement and elbow function improved, but there was no control group. The authors called for a randomized trial. (8)
That finding offers a reason for further investigation, not proof that PRP will resolve pain during curls. It cannot establish treatment effectiveness for a triceps injury or a complete tendon rupture either. The diagnosis must come before applying research from a different tendon.
How should progress be judged?
For someone whose main concern is training, improvement should include the ability to perform relevant tasks. Less pain at rest is helpful, but it does not answer whether gripping, curling, or pressing has become tolerable.
Before treatment, agree on a few practical measures: which movements hurt, how they affect everyday activities, and what level of exercise is currently comfortable. Reassess those measures during rehabilitation. Avoid treating early pain relief as permission to test a maximum lift.
If progress stalls, reconsider the diagnosis and the loading plan rather than assuming another injection is automatically needed. Persistent nerve symptoms, a significant tear, and joint disease may require different management.
Summary
Limiting elbow pain during heavy training is a reason to get a focused assessment. There may be useful changes to your training and rehabilitation, but the plan should address the structure responsible for the symptoms.
PRP has mixed evidence for tennis elbow. Marrow-based injection research is more limited. Neither provides a guarantee that a painful tendon has healed or that you can immediately return to your previous weights.
The questions to bring to the appointment are straightforward: What is causing the pain? Is there a tear or nerve problem? What can I safely train now? If an injection is suggested, what evidence supports it for this particular diagnosis, and how will we judge whether it helped?
References
- Donaldson O, Vannet N, Gosens T, Kulkarni R. Tendinopathies around the elbow part 2: medial elbow, distal biceps and triceps tendinopathies. Shoulder Elbow. 2014;6(1):47–56. doi:10.1111/sae.12022.
- Expert Panel on Musculoskeletal Imaging; Thomas JM, Chang EY, Ha AS, Bartolotta RJ, Bucknor MD, Caracciolo JT, Chen KC, Flug J, Kumaravel M, Raizman NM, Ross AB, Silvis ML, Surasi DS, Beaman FD. ACR Appropriateness Criteria® Chronic Elbow Pain. J Am Coll Radiol. 2022;19(11S):S256–S265. doi:10.1016/j.jacr.2022.09.022.
- Taylor SA, Hannafin JA. Evaluation and management of elbow tendinopathy. Sports Health. 2012;4(5):384–393. doi:10.1177/1941738112454651.
- Lucado AM, Day JM, Vincent JI, MacDermid JC, Fedorczyk J, Grewal R, Martin RL. Lateral Elbow Pain and Muscle Function Impairments. J Orthop Sports Phys Ther. 2022;52(12):CPG1–CPG111. doi:10.2519/jospt.2022.0302.
- Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med. 2011;39(6):1200–1208. doi:10.1177/0363546510397173.
- Antunes Júnior CR, Santos RSS, Barreto ESR, Azevedo GN, Lima EBS, Lara PHS, Pochini AC, Andreoli CV, Ejnisman B, Belangero PS. Platelet-Rich Plasma Does Not Improve Pain or Function in Patients With Lateral Epicondylitis as Compared With Placebo: A Meta-analysis of Randomized Clinical Trials. Am J Sports Med. 2026;54(5):1247–1257. doi:10.1177/03635465251383039.
- Singh A, Gangwar DS, Singh S. Bone marrow injection: A novel treatment for tennis elbow. J Nat Sci Biol Med. 2014;5(2):389–391. doi:10.4103/0976-9668.136198.
- Barker SL, Bell SN, Connell D, Coghlan JA. Ultrasound-guided platelet-rich plasma injection for distal biceps tendinopathy. Shoulder Elbow. 2015;7(2):110–114. doi:10.1177/1758573214567558.
