Triceps tendinopathy also known as “Weightlifters Elbow”, refers to an inflammation or irritation of the tendon connecting your triceps to your elbow. It is a rare injury in the upper body and is twice as common in males than in females. In sports, it is most common in weight lifters followed by throwing athletes due to the constant elbow extension movements involved. In severe cases, triceps tendinopathy with a full tendon rupture will likely require surgical intervention; but in most cases, it can be treated with physiotherapy.
Let’s go through a guide of how we help you manage triceps tendinopathy here at Breathe using our Roadmap to Recovery:
Step 1: Pain Reduction
Step 2: Activation
Step 3: Movement
Step 4: Strengthening / Sports Performance
To manage and reduce symptoms, it is important to understand these four concepts:
Movement strategies + gradual loading
Triceps tendinopathy is like any other tendinopathy – repetitive use of a tendon leads to inflammation, which may degrade a tendon’s integrity, which causes weakness and pain.
Typical symptoms of triceps tendinopathy include:
Pain upon resisted elbow extension
Pain and weakness when doing activities involving elbow extension e.g. bench press, push ups, triceps extensions
Possible swelling around the elbow
Now that we understand what causes triceps tendinopathy, physiotherapy management first starts with de-loading the triceps tendon and activity modification. It is important that you reduce the amount of load to your tendon’s capacity. For most people, this might mean you need to lessen the weight on lifts.
For athletes, your physiotherapist will advise you what should be done to modify your training and play. Some examples of this may be:
less intensity e.g. weight
less frequency e.g. sets, reps, training sessions
less stretching of the tendon
For some people, you may have to avoid all exercise involving triceps action e.g. bench press, push ups, etc.
Hands-on treatment such as massage and ice will be effective with pain-relief however will not increase your tendon’s capacity.
A large contributor to developing triceps tendinopathy is lifting technique. The mechanism of injury of triceps tendinopathy is overloading the triceps muscles due to them dominating the movement. Activation exercises and creating a better ‘mind-muscle’ connection for other muscle groups is crucial. For example, the dominant muscles group in a bench press should be the pectoralis major & minor (chest) and anterior deltoid (front shoulder) – not the triceps.
Although important to also do during the pain reduction phase, activation of other muscle groups becomes crucial when the triceps tendon has recovered. Physiotherapy aims to maintain strength in surrounding muscle groups e.g. chest, shoulder, etc. to prevent pain-inhibition and deconditioning. Pressing movements should be modified to allow developing mind-muscle connection much easier. Below are some examples:
Pec fly: Allows isolation of the pectoralis major muscle to allow more efficient activation resultantly of a better mind-muscle connection.
Y-raises: Allows activation of lower traps to properly engage shoulder blades back and down (retraction and depression)
Seated external rotations: Rotator cuff stability is crucial for open-kinetic chain exercises due to the requirement of stabilising the weight in space.
Triceps extensions: Great exercise to isolate and gradually load the triceps for multiple purposes e.g. strength, endurance
Once we’ve learnt to activate the correct muscles in an exercise or activity, it’s time to progressively load the tricep muscles. We know that the more elbow flexion that occurs – the more triceps activation or involvement in a movement. Therefore, a gradual progression of triceps activation should be adopted to build strong, healthy triceps. The following exercises are examples of mid and late-stage triceps rehabilitation exercises.
Wide grip bench press Allows less mechanical tension through the triceps, progressed by narrowing grip width to place more load through the triceps
Dips Great body-weight exercise that may be progressed and regressed with ease.
Progressing loading of the triceps tendon will depend on 3 main factors which you can monitor yourself:
No more than 4/10 pain during the activity
No increase in pain following activity
No increase in pain on the next day.
If you experience delayed pain that lasts for more than an hour, this is your triceps tendon’s way of saying that you may have overdone it the previous day.
Strengthening/ Sports Performance
In later stages of rehabilitation, you will be able to return to your normal gym routine pain-free. This stage for triceps tendinopathy focuses on gradual loading within your initial programmed exercises such as bench press, shoulder press, etc. Furthermore, the triceps should be conditioned in various triceps lengths e.g. overhead triceps extension (lengthened position) vs triceps pushdown (mid position) vs triceps extension (shortened position). To prevent further injury, it is important that you apply progressive overload to your training and condition your triceps by training them in multiple positions and exercises.
Programming your rehabilitation according to the Roadmap will put you on the right track towards getting back to the gym as soon as you can. However, all triceps tendon injuries may be variable, thus it is highly recommended that you consult with a physiotherapist about your injury.
Donaldson, O., Vannet, N., Gosens, T., & Kulkarni, R. (n.d.). Tendinopathies Around the Elbow Part 2: Medial Elbow, Distal Biceps and Triceps Tendinopathies. Shoulder & Elbow, 6(1), 47-56. DOI:10.1111/sae.12022.
Healthwise Staff. (2022, March 9). Triceps Tendinitis: Exercises. MyHealth.Alberta.ca. https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zp4524
Tom, J. A., Kumar, N. S., Cerynik, D. L., Mashru, R., & Parrella, M. S. (2014). Diagnosis and Treatment of Triceps Tendon Injuries. Clinical Journal of Sport Medicine, 24(3), 197-204. DOI: 10.1097/JSM.0000000000000010.