Triceps Tendinopathy: Overview and Evidence Summary

Condition Overview

Triceps tendinopathy is a relatively uncommon but clinically important cause of posterior elbow pain, involving degenerative and overload-related changes at the triceps tendon, typically near its insertion on the olecranon. Unlike lateral epicondylalgia (tennis elbow), which most therapists see every week, triceps tendinopathy tends to appear in very specific populations: weightlifters, throwing athletes, gymnasts, bodybuilders, manual workers who frequently push or extend against resistance, and sometimes individuals who have had prior elbow trauma or surgery.

The triceps is the primary elbow extensor and a key contributor to load transfer through the upper limb. Whether you’re pushing a door, completing a push-up, performing a dip, or decelerating a throw, the triceps is working—often eccentrically and at high force. Over time, repeated high-load extension, especially at end range or under fatigue, can exceed the tendon’s adaptive capacity. Instead of healing fully between sessions, the tendon begins to accumulate microscopic damage.

Modern understanding of tendinopathy suggests that this is not a simple “inflammation” but a complex, graded process involving disorganization of collagen fibers, neovascularization, changes in tendon cell behaviour, and altered pain processing. In triceps tendinopathy, this process tends to center at the enthesis—the point where tendon blends into bone at the olecranon—but can also involve the myotendinous junction higher up.

Patients typically describe a deep, localized ache or sharp pain at the back of the elbow, aggravated by resisted extension, pressing movements, or pushing up from a chair. Locking out at end-range extension, bench press variations, dips, triceps pushdowns, overhead pressing, and pushing activities such as heavy doors or wheelbarrows are common aggravators. Symptoms may start as a post-workout soreness that lingers longer than expected, then gradually progress to persistent pain with daily tasks.

Over time, if loading remains unchanged, athletes may find they can no longer train at previous intensity, and non-athletes may find even simple tasks like pushing themselves up from bed or the floor becoming painful. In more advanced cases, local tenderness, thickening, or a palpable nodule may be felt along the tendon.

The good news is that, as with most tendinopathies, the triceps tendon can respond extremely well to appropriately dosed, progressive loading. The challenge is that many individuals with triceps pain simply keep “training through it” or rest completely, oscillating between overload and underload without ever giving the tendon a clear, structured stimulus to remodel.

Summary of Current Evidence for Triceps Tendinopathy

Evidence-Based Management Discussion

Tendon Pathology and the “Too Much, Too Soon, Too Often” Problem

Triceps tendinopathy typically develops in the context of load error: training too heavy, too often, or too quickly after a period of rest. For example, an athlete might increase bench press volume aggressively, add dips or skull crushers on top, and then notice a sharp pain at the back of the elbow when locking out. A manual worker might suddenly take on more physically demanding tasks, working long days pushing heavy loads or using tools that require repetitive extension.

Tendon cells (tenocytes) respond to load by remodeling collagen and maintaining a robust extracellular matrix—as long as the load is within an adaptive window. When the load is repeatedly excessive, particularly in eccentric or end-range positions, the tendon enters a maladaptive cycle: microdamage outpaces repair, collagen fibrils lose their organized alignment, and the tendon gradually becomes thicker, less elastic, and more sensitive.

In the past, this process was labeled “tendinitis,” suggesting inflammation as the key driver. We now understand that while inflammatory mediators may play a role early on, chronic triceps tendinopathy is better conceptualized as a failed healing response, not a simple acute inflammatory event. This is crucial for therapists: long-term success rarely comes from simply dampening inflammation; it comes from re-educating the tendon through progressive loading.

Clinical Presentation and Differential Diagnosis

Triceps tendinopathy most commonly presents with:

• Localized tenderness at the triceps insertion on the olecranon, or slightly proximal along the tendon

• Pain during resisted elbow extension, particularly against heavy load or near full extension

• Discomfort with closed-chain loading (press-ups, planks, dips)

• Aggravation after pressing sessions (bench, overhead press, push-ups, dips, triceps isolation work)

Night pain is less prominent than in rotator cuff or frozen shoulder, but patients may complain of discomfort if they lie on the arm in a way that compresses the tendon.

Key differentials include:

• Olecranon bursitis (more focal swelling, boggy texture, often, but not always, with visible enlargement over the olecranon)

• Posterior impingement of the elbow (pain at terminal extension, often with throwing/extension snap)

• Referred pain from the cervical spine or upper thoracic region

• Ulnar nerve pathology (paresthesia, medial elbow pain, rather than localized triceps insertion pain)

• Partial triceps tear or avulsion (more acute, sometimes bruising, notable loss of strength)

Good assessment looks beyond just the elbow. Postural issues, scapular stability deficits, shoulder internal rotation tightness, thoracic stiffness, and core control all influence how force is transmitted through the upper limb.

Exercise Therapy: The Central Pillar of Treatment

A triceps tendon won’t remodel with rest alone. Symptoms may temporarily settle if the person stops training, but the tendon doesn’t become stronger or more resilient—so symptoms often return when normal activity resumes. Exercise, specifically progressive, well-dosed tendon loading, is the primary evidence-based treatment.

Phase 1: Calm Things Down Without Switching Them Off

In the early stage, the goal is to reduce pain and irritability while keeping some degree of load through the tendon.

Typical strategies include:

• Reducing or temporarily removing high-load and high-velocity extension (e.g. heavy presses, jerky dips, explosive push-ups)

• Maintaining general cardiovascular and non-aggravating strength work

• Introducing low-load isometric triceps exercises (e.g. gentle holds at mid-range extension against resistance) to reduce pain and maintain tendon engagement

Isometrics may help with pain modulation and provide a safe way to introduce tension without significant movement.

Phase 2: Rebuild Load Tolerance with Slow, Controlled Strength Work

Once irritability is down and the tendon tolerates isometric loading well, the focus shifts to slow, progressive loading:

• Eccentric elbow extension (e.g. lowering phase of cable pressdowns or skull crushers, with assistance on the way up if needed)

• Heavy slow resistance (within tolerance) using dumbbells, cables, or machines—prioritizing form and avoiding end-range snapping or locking

• Combining open-chain and closed-chain exercises (e.g. modified press-ups against a wall or bench, gradually lowering incline over time)

The key principles:

• Progress gradually: increase load, volume, or range slowly

• Keep pain within acceptable limits (commonly “mild and settles within 24 hours” as a practical rule of thumb)

• Monitor response rather than chasing arbitrary numbers

Phase 3: Restore Power, Speed, and Real-World Function

For athletes or heavy manual workers, late-stage rehab must reflect real-world demands:

• Plyometric or faster pressing variations (e.g. controlled medicine ball passes, explosive push-ups within tolerance)

• Sport-specific patterns (throwing mechanics, grappling, climbing, etc.)

• Progressive exposure to end-range extension under load

For non-athletes, late rehab may focus more on repetitive tasks, load carriage, and pushing tasks they actually perform at work or home.

Throughout all phases, the rest of the kinetic chain must be addressed: shoulder strength, scapular stability, trunk control, and grip strength all matter.

Manual Therapy: Supportive, Not Primary

Manual therapy does not fix tendons, but it can make rehab easier and more effective. Useful roles include:

• Reducing protective tone in the triceps, forearm extensors/flexors, and surrounding musculature

• Addressing stiffness in the elbow joint itself, especially if there is a history of trauma or surgery

• Improving mobility in the shoulder girdle, particularly if altered biomechanics are overloading the triceps

Manual work around the cervicothoracic region and scapula can also improve overall movement patterns, reducing unnecessary strain on the elbow during pushing.

Crucially, manual therapy should almost always be paired with a clear loading plan; otherwise, its benefits tend to be short-lived.

Pharmacological Management and Injections

NSAIDs and simple analgesics may be helpful early on, especially if irritation is high and interfering with sleep or basic function. However, their role is supportive, not curative.

Corticosteroid injections may offer short-term pain relief but are generally used with caution around weightbearing tendons like the triceps due to:

• Potential weakening of tendon structure

• Increased theoretical risk of partial or complete rupture

• Tendency to encourage patients back into heavy loading before the tendon has genuinely adapted

Biologic approaches such as PRP (platelet-rich plasma) have been trialled for some tendinopathies with mixed results; evidence specific to triceps tendinopathy is sparse and not strong enough to recommend routinely. They may be reserved for stubborn, chronic cases under specialist care.

Surgical Considerations

Surgery for triceps tendinopathy is rare and usually reserved for:

• High-grade partial tears that fail to respond to lengthy, well-structured rehabilitation

• Tendon avulsions from the olecranon

• High-performance athletes with persistent functional deficits despite best conservative care

Procedures may involve debridement, repair, or reattachment of the tendon. Postoperative rehab closely mirrors tendinopathy protocols but starts with a longer protection phase to respect surgical healing.

Clinical Considerations for Therapists

For therapists, triceps tendinopathy is an opportunity to:

• Demonstrate the power of load-based rehab

• Educate patients that pain doesn’t equal “damage getting worse” as long as load is thoughtfully controlled

• Correct training and technique errors (bench press groove, grip width, bar path, dip depth, lock-out style, etc.)

• Address whole-chain contributors: thoracic mobility, scapular positioning, shoulder rotation, and trunk stability

Clear communication is vital—particularly with strength athletes who may have strong opinions about training and “working through pain.” Framing rehab as a structured way to get them back to heavier, safer training, not as a long-term restriction, improves adherence and outcomes.

References

Mair, S., et al. “Triceps Tendon Injuries in Athletes: Mechanisms, Diagnosis, and Treatment.” American Journal of Sports Medicine.

van der Worp, H., et al. “Tendinopathy: Principles of Load Management and Rehabilitation.” Sports Medicine.

Rees, J., et al. “Current Concepts in the Management of Tendinopathy.” Rheumatology.

Khan, K., et al. “Overuse Tendinopathies: A Review of the Evidence for Load-Based Treatment.” Clinical Sports Medicine.

Barnes, D., et al. “Posterior Elbow Pain in Strength Athletes: Differentiating Triceps Tendinopathy from Other Pathology.” Journal of Shoulder and Elbow Surgery.

Disclaimer

The information in this article is intended for educational purposes and is designed for qualified massage therapists, manual therapists, and rehabilitation professionals. It is not a substitute for medical advice, diagnosis, or treatment. Practitioners must work within their legal scope of practice and regional regulations. Hands-on techniques should only be performed by appropriately trained and licensed individuals. Niel Asher Education is not responsible for any injury, loss, or damage resulting from the use of this content.