A weightlifter’s elbow is often blamed on inflammation of the biceps tendon at the front of the elbow. But the triceps tendon, at the back of the elbow, is affected in weightlifters too. So what is triceps tendonitis — the forgotten weightlifter’s elbow — and how do we treat it?
What is triceps tendonitis?
The triceps muscle has three heads that start at the shoulder and shoulder blade and run down the back of the arm. Near the elbow, it forms the strong triceps tendon, which inserts onto the back of the elbow (the olecranon). The triceps contracts to straighten the elbow.
Repeated contraction — especially in sport — can overload and swell the triceps tendon, causing triceps tendonitis. Occasionally, triceps tendonitis follows trauma, such as a fall directly onto the tip of the elbow or an elbow dislocation.
How do you know you have triceps tendonitis?
Symptoms of triceps tendonitis include:
- Pain at the tip of the elbow during and after exercises that stress the triceps — bench press, shoulder press, and push-ups. The pain may warm up as you exercise but worsen afterwards, and can sometimes spread up into the middle of the triceps muscle.
- Swelling or bulging at the tip of the elbow.
- Weakness in pushing exercises — often from pain and muscle wasting.
A clinical assessment is essential. Your doctor examines the elbow: the swollen tendon is usually tender to touch, and resisted triceps movements (such as resisted elbow extension) typically reproduce the pain.
It’s important to rule out other causes of pain in the back of the elbow, including elbow arthritis, tennis elbow, golfer’s elbow, posterior elbow impingement, and olecranon bursitis — the bursitis is often painless, unlike triceps tendonitis.
Imaging confirms the diagnosis and excludes other causes. An X-ray can exclude elbow arthritis, while an ultrasound or MRI confirms triceps tendon swelling and rules out joint and other tendon problems.
Triceps tendonitis vs tennis elbow: how can you tell?
It’s usually fairly easy to tell them apart. Tennis elbow pain is on the outside of the elbow and is triggered by gripping and lifting rather than pressing exercises. On examination, the tenderness is on the outside, and pain is reproduced by forcing the wrist backwards against resistance. Where there’s any doubt, ultrasound or MRI easily distinguishes the two.
Triceps tendonitis treatment
Treatment follows the general principles of managing tendonitis: simple measures combined with targeted exercise.
Modify the load. First, the offending activity is avoided, reduced, or modified. For weightlifters, that means reducing the weight on pressing exercises such as the bench press and shoulder press, and sometimes changing the exercises — for example, moving from bench press to dumbbell flye, or shoulder press to lateral raise —to take the load off the triceps tendon.
Settle the pain. Simple measures such as a short course of ibuprofen and regular ice help reduce pain and swelling.
Add adjuncts in complex cases. GTN patches or shockwave therapy can help more stubborn cases, with evidence that they reduce pain and speed the return to full activity.
Triceps tendonitis exercises
These measures are combined with a triceps strengthening programme. We usually start with isolated triceps exercises such as triceps push-downs or extensions, then gradually increase the weight, followed by the speed. Finally, we progress to compound exercises — bench press, shoulder press — and sport-specific activities as pain and function improve.
What if rehab fails? Your options
Exercise therapy fails in only a small number of people. In those cases, an injection may help.
Options for a triceps tendon injection include cortisone, needle tenotomy, or PRP. We generally avoid cortisone because of its potentially harmful, weakening effect on tendon structure. There’s also little evidence to support the more expensive PRP for triceps tendonitis. Our preferred option is a needle tenotomy: using a diluted local anaesthetic and ultrasound, we pass a needle 10–20 times through the focal area of tendinosis. We think this needling triggers acute inflammation, healing, and remodelling.
Surgery should be avoided in almost all cases of triceps tendinosis, unless every other treatment has failed.
Torn triceps tendon: how do you know?
A triceps tendon tear is rare, but it can occur after a direct fall onto the tendon or elbow tip, or after losing balance during a heavy bench press or chest press, which stretches and tears the tendon.
People who tear the triceps tendon usually feel intense pain, sometimes with a pop or tearing sensation, and often can’t continue. The elbow swells, movement becomes excruciating, and bruising develops at the back of the elbow, sometimes spreading into the forearm.
On examination, there’s tenderness and swelling at the tear site, with pain and weakness on testing triceps strength. Ultrasound or MRI confirms the tear, and it’s essential to determine whether it’s full- or partial-thickness, as this determines whether surgery is needed. A partial-thickness tear is treated without surgery — a short period of rest in an elbow brace, graded loading, and adjuncts such as GTN patches to aid healing. A full-thickness tear usually needs surgical repair.
Frequently asked questions about triceps tendonitis
Can I keep training with triceps tendonitis?
Often yes, with modification. Reduce the weight on pressing exercises (bench press, shoulder press, push-ups) and switch some to lower-triceps-load alternatives such as flyes or lateral raises, while building the tendon with isolated triceps work. Avoid pushing into sharp or worsening pain.
How long does triceps tendonitis take to heal?
Many cases settle over several weeks to a few months with load modification and progressive strengthening. Adjuncts such as GTN patches or shockwave can help stubborn cases. Returning to heavy pressing too soon tends to prolong it.
Should I have a cortisone injection for triceps tendonitis?
We generally advise against it. Cortisone can weaken the tendon and raise the risk of rupture, so where an injection is needed, we prefer a needle tenotomy under ultrasound. The mainstay remains load modification and strengthening.
How do I tell triceps tendonitis from a triceps tear?
Tendonitis builds gradually and causes pain with triceps-loading exercises. A tear is usually sudden and dramatic — intense pain, often a pop, marked swelling and bruising, and weakness when straightening the elbow. A suspected tear needs urgent assessment and a scan, as a full-thickness tear usually needs surgery.
Is triceps tendonitis the same as tennis elbow?
No. Triceps tendonitis is at the back of the elbow and is provoked by pressing exercises; tennis elbow is on the outside of the elbow and is provoked by gripping and lifting. An examination and a scan, if needed, tell them apart.
Final word from Sport Doctor London on triceps tendonitis
Triceps tendonitis is less common than tennis or golfer’s elbow, but it’s worth considering in weightlifters and sportspeople with pain at the back of the elbow. Simple measures — load modification and strengthening — are tried first, and it’s best to avoid the quick fix of a cortisone shot, given the risk of rupture.
To book an elbow assessment with Dr Masci in London, including an ultrasound in the clinic, contact the team here or call +44 (0) 203 488 0350.
I currently have tennis elbow and my physio has told me to do all exercises to failure and to increase weight and do low reps to feel make the muscles around my elbow fatigued. one of the exercises is triceps extensions. is what i’m doing safe and correct?
Hi Cole,
We know that exercise improves tendon pain. But you can do these exercises in various ways – high repetition and low weight or low repetition and high weight. Generally, for upper limb tendon pain, most people respond to the former – high repetition, lower weight. You need to be guided by how your elbow responds to the exercise. If you develop significant pain after heavy loading, try lighter weights with higher repetition.
Lorenzo