The best triceps tendonitis treatment is to give your tendon a break without totally resting it (relative rest) and then to strengthen it with exercises that don’t make your injury worse. This article explains the principles behind this approach. It also covers the anatomy involved and the causes of triceps tendonitis – understanding these will help you to understand the rehab process better. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.
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Anatomy of the triceps tendon
The triceps muscle has three heads that run down the back of your upper arm and fuse together into one tendon, the triceps tendon. You use your triceps mainly to straighten your arm, for example when doing push-ups or throwing a ball. It also supports the shoulder muscles with movements like adduction (bringing your arm closer to your body) and with general shoulder stability.
The triceps tendon attaches the lower end of your triceps muscle to several parts of your elbow. It mainly attaches to the top of the ulna (one of the two bones in your forearm) and to the capsule of your elbow joint (a sinewy sac that you find around most joints).
Tendons are made up of many collagen fibres arranged parallel to each other, and these fibres are arranged in bundles, also parallel to each other. This configuration makes a tendon quite strong, in the same way that a cable or rope is stronger than the sum of the strength of its individual strands.
Causes of triceps tendonitis
Most commonly, you get triceps tendonitis when you overwork the tendon; this is known as an overload injury.
An overload injury can happen in several ways. It’s usually movements involving weight, for example gym exercises such as skull crushes or triceps dips, and, less often, fast movements such as throwing a ball or javelin repetitively.
Triceps tendonitis can be due to acute overload, where you overdid it in a single exercise session, or it can be chronic overload, when you don’t give your tendon enough time to recover and repair between sessions over a period of time.
In some cases triceps tendonitis can develop after:
Taking fluoroquinolone antibiotics - Ciprofloxacin is a commonly prescribed one that has detrimental effects on tendons and other tissues.
Getting hit on the tendon.
Triceps tendonitis symptoms
The pain when you have triceps tendonitis is mainly located at the back of your elbow and in the lower portion of your triceps. The triceps muscle may also feel stiff and sore, and you can get some referral into the forearm.
You typically first notice the pain several hours after a hard training session or the next morning. Your elbow may feel stiff, and keeping it bent for long periods of time may make it hurt more.
Any activity where you have to extend your elbow against resistance will usually increase your pain. Sometimes, you may not feel pain while doing the exercise or activity, but then it hurts more several hours later. Tendons are known for having a delayed pain response to exercise.
Triceps tendon tear vs. tendonitis
You’ll usually know when you’ve torn your tendon, because you’ll feel a sudden, sharp pain when you injure it. If this happened, go see a doctor as soon as possible.
What happens when you get triceps tendonitis?
Triceps tendonitis usually only affects one bundle of fibres or a few of them at most. That injured part loses its parallel configuration, which causes it to lose some strength, whereas the rest of the tendon is still fine.
Contrary to a widely held belief, there’s very little, if any, inflammation in a tendon that is injured in this way. So the term “triceps tendinopathy” is actually more correct than “triceps tendonitis” (which implies inflammation), but we use the latter here because that is how most people refer to it.
The injured tendon is painful because, in its weakened state, it can’t cope with the loads that it used to be able to cope with when you straighten your arm. Another common source of pain is when the tendon is stretched and/or compressed against the bones in your elbow as you bend your arm. Injured tendons don’t like being stretched or compressed – it’s a bit like pressing on a new bruise.
Triceps tendonitis treatment
Let’s start with one commonly prescribed treatment that you shouldn’t do.
Triceps tendonitis stretches
When your tendon is injured, it can often make your tricep muscles feel tight and sore, and it is natural to want to stretch them. It can also feel quite satisfying while you’re stretching it. But in my experience, this often just ends up irritating the tendon further because it causes it to compress against the bone and can prevent the pain from settling down.
If you have been doing triceps stretches for an injured tendon and it hasn’t been getting any better, see what happens if you leave them out for two weeks: Are you starting to see any improvement?
Some alternatives to doing triceps stretches are massaging the muscle and stretching your arm across your body with a straight elbow - this stretches part of the top of the triceps but avoids compressing the tendon over the elbow.
Take care not to stretch your triceps tendon too much unintentionally. For example, try to change your sleeping position if you usually sleep with a deeply bent elbow, and check whether you have a habit of resting your chin in your hand while your elbow is resting on a table or desk.
Reduce the load on your injured triceps tendon
One of the first questions many of my triceps tendonitis patients ask me is, “Can I still work out with triceps tendonitis?” The short answer is yes, but there is a BUT.
This is an overload injury, so you can’t continue with business-as-usual; it will just keep on overloading your tendon, and the pain cycle will persist. For your tendon to recover, you have to reduce the load you put through it to a level that it is currently able to tolerate. This is called relative rest; as opposed to complete rest, it does not require you to drop all activities.
Identify those activities that really aggravate your injury and either cut them out (for now) or reduce them (for now) to the point where your tendon pain doesn’t get any worse.
For some athletes, it may be that they need to avoid all exercise that involves the triceps action, so no push-ups, bench presses, overhead presses, etc.
But for others it will just be that they need to reduce the load that they put through their tendon and perhaps increase the recovery time between exercises and also between training sessions. It may be that you have to bring the weight right down and really start with baby weights to find a level that doesn't actually aggravate it, or do your push-ups on your knees and not in the usual full plank position.
Also, especially at the beginning, go for exercises that do not cause your elbow to bend past 90 degrees, to avoid compressing the tendon against the elbow bone. So, just working it from 90 degrees to straight rather than from a fully bent position.
Tendons are sneaky things, and they sometimes only complain the next day if you’ve worked them too hard. So, the trick is to figure out what is the most you can do with it without increasing your pain during the session or in the 24 hours afterwards.
Exercises for triceps tendonitis
However, to make your tendon as strong as before, your exercises should increase in weight and difficulty as you recover. Tendons need strength exercises that gradually increase in difficulty to:
stimulate the production of new, healthy collagen fibres,
align the newly formed collagen fibres into that strong, parallel structure,
and then make them as robust as before you got injured.
You can play with three things to manage this, two of which you’ll be familiar with if you’ve been doing weight training for some time: You can increase the weight, and you can increase the sets and reps. For injury rehab, it’s better to increase only one of these two factors at a time. And thirdly, you can (and should) increase the range of motion of your arm so that you can eventually straighten it against resistance from a fully bent position.
The process of increasing the difficulty of your strength exercises should happen very gradually. Use pain as your guide. An exercise is at the right level:
if you don’t feel pain at more than a niggle level (about 3 out of 10) while you're doing it,
if there’s no flare-up or increase in pain in the hours afterwards,
and if it’s not more painful the next day.
If you get a delayed pain response that lasts for more than just an hour or two and it's more uncomfortable the next day, what you did the previous day wasn't right for it, and you need to dial things down a bit.
Massage for triceps tendonitis
Massage can make your injury feel less stiff and reduce the pain for a few hours, but it will contribute nothing to the healing process because it won’t make your tendon any stronger.
Make sure that whoever is doing the massage doesn’t grind your tendon against your elbow bones, because that will just irritate the tendon further and cause more pain. Let them concentrate on the triceps muscle belly rather than the tendon.
The very little research that has been done on this doesn’t indicate that it’s very useful. However, if you’ve tried rehabbing your tendon with strength exercises as described above for at least 12 weeks and it has not worked, it's something you could consider.
Again, there's not a lot of research out there about it yet, so I can't really say whether it works or not. But if you've tried rehab properly and it hasn't really worked, it's always worth trying this. Here’s our article about PRP injections for sports injuries.
How we can help
Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
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