Pain guide · Elbow pain
Pain at the back of the elbow that is worse when you straighten your arm against resistance, in dips, close-grip presses, skull crushers or push-ups, can come from the triceps tendon where it attaches to the point of the elbow. Triceps (or tricep) tendonitis is uncommon and has hardly been studied, so the loading plan here is borrowed from tendons that have been, and it keeps you training while the tendon settles.
A tear is rarer still but time-sensitive. A pop at the back of the elbow with weakness straightening your arm, bruising or a gap above the point of the elbow needs checking within days, because a full tear in an active person is usually repaired early. This guide covers those signs, what raises the risk, partial tears and surgery, and a staged plan with 3D demos.
Exercise is for pain that has been checked or is clearly mild and settling.
Location narrows the likely causes; it does not diagnose.
Tender at or just above the point of the elbow, worse straightening against resistance: possibly triceps tendonitis, which this guide covers.
Bruising, swelling or a gap above the point of the elbow: a possible tear. Get help from NHS 111 the same day.
Often after leaning on it: olecranon bursitis. If it's hot, red and painful, or you feel unwell, it needs a same-day check.
Read: Elbow bursitis →Back of the elbow in a thrower, as the arm straightens at releaseBone spurs or a stress fracture at the tip of the elbow. Get it assessed.
Read: UCL injury (thrower's elbow) →A snap on the inner side as the elbow bends, sometimes with tinglingUsually the ulnar nerve slipping, sometimes with part of the triceps (a snapping triceps).
Read: Ulnar nerve entrapment →Front of the elbow, in the creaseThe biceps tendon, or occasionally the brachialis.
Read: Front of the elbow (biceps tendon) →Outside of the elbowUsually tennis elbow.
Read: Tennis elbow →The triceps runs down the back of the upper arm, and its three heads join into one tendon that attaches to the point of the elbow (the olecranon); it straightens the elbow. Triceps tendinopathy, often called triceps tendonitis, is a gradual ache at the back of the elbow, worse straightening it against resistance. A tear can be partial, with some of the tendon still attached, or complete.
Tears are rare. In US emergency departments over 20 years, triceps tendon ruptures were about 0.5% of the tendon ruptures seen, about 1 in 200, at 0.02 per 100,000 people a year, with men at 12 times the rate of women and an average age of 44. Not everyone with a tear goes to an emergency department, so this probably undercounts them. In US active-duty military personnel the rate was 1.1 per 100,000 a year, and in a region of Slovakia 0.46 per 100,000.
The tendon has a broad, strong attachment, so it tears less often than other tendons, and reviews call tears rare or exceedingly rare. Triceps tendinopathy without a tear is described as very rare, with little published about it.
Most tears come from pushing a heavy load, in lifting or sport, or from a fall onto an outstretched hand, often as the triceps contracts while being forced to bend. In the US National Football League, 37 tears needed repair over 10 seasons, 86% of them in linemen, who missed 165 days on average. In another series of 19 professional players, 7 had warning pain before the tear.
Some things weaken the tendon: anabolic steroids, steroid injections, kidney disease, diabetes, an overactive parathyroid gland and a bursitis at the point of the elbow. In a review of 262 operated tears, kidney disease (10%) and anabolic steroid use (7%) were the commonest conditions, and 5 of the 19 football players had had a cortisone injection. These are links, not proof that each one caused the tear.
The UK's Medicines and Healthcare products Regulatory Agency (MHRA) warns that fluoroquinolone antibiotics can damage tendons, especially the Achilles tendon but also others, within 48 hours of starting or months after stopping, more often over 60, with kidney problems, after an organ transplant or when taken with steroid tablets. A UK study found the link only for Achilles ruptures (about 3 times the usual rate, and about 19 times with steroid tablets too), with no link to ruptures of the biceps or other tendons. No study looked at the triceps.
An examination tells these apart. These are the usual patterns.
With a suspected tear, an X-ray can show a small fleck of bone pulled off with the tendon (in 61% to 88% of operated tears in one review), and an ultrasound or magnetic resonance imaging (MRI) scan confirms the tear and how much of the tendon is involved, which guides treatment.
For tendon pain without a tear, a scan is rarely needed, and pain-free elbows often look abnormal: in 205 MRI scans every triceps tendon showed a line of bright signal, which the authors think is normal, and 9 of 26 pain-free professional baseball pitchers had changes where the triceps attaches.
There are no studies of how triceps tendonitis settles. In a case report, a climber's back-of-elbow pain went from 4 to 0 out of 10 over 10 weeks of shoulder-blade and triceps exercises, and she returned to her previous level. Of 10 partial tears in professional American football players, 6 healed without surgery, 1 later tore completely and 3 had repairs after the season for ongoing pain and weakness. The American Academy of Orthopaedic Surgeons (AAOS) says results without surgery are often satisfactory when less than half the tendon is torn, while bigger tears usually leave some lasting weakness.
No trial has tested any treatment for triceps tendonitis, so this guide borrows from tendons that have been studied, and says so. In 76 people with patellar tendinopathy, a progressive tendon-loading programme improved a 100-point symptom score by 28 points at 24 weeks, against 18 for slow lowering exercises alone. In 39 men with patellar tendinopathy, heavy, slow lifting and lowering kept its benefit at 6 months, while a steroid injection's early benefit faded. A review of Achilles and patellar programmes found little evidence for doing only the lowering phase.
Still holds were no better than lifting and lowering in a review of 10 trials, but can be a first step for some people. In 38 people with Achilles tendinopathy, carrying on running and jumping under a pain-monitoring rule did as well at 12 months as stopping for 6 weeks.
The AAOS recommends surgery for active people with a complete tear, and for pain or weakness that doesn't respond to other treatment; the tendon is reattached to the bone with strong stitches, usually as a day case. In one series of 22 people, a direct repair was always possible within 3 weeks of the injury, while later repairs needed a more complex reconstruction with a slower recovery. That, with expert guidance, is why a suspected tear needs checking within days. Reviews agree that most complete tears in fit people are repaired.
The AAOS considers non-surgical care for tears of less than half the tendon's width, for people with enough strength for what they need, or for those who can't safely have surgery: usually several weeks in a splint, then exercises. Full movement usually returns in about 3 months, and strength takes several months longer. A review says incomplete tears in people who can still straighten the arm against resistance are managed without surgery. In a small series of professional players, 6 of 10 partial tears healed this way.
In a review of 262 operated tears (average age 46), 89% returned to their previous activity and 6% tore again. In 16 studies, 92% regained their previous function and 95% were satisfied, with complications in 15%, including retears in 5%. In 277 athletes, 93% returned to sport at about 5 months on average, 64% at their previous level or higher, with 4.4% retears. In 48 military personnel, 94% returned to duty. In 107 repairs at one group of hospitals, 14% had a complication and 13% needed another operation. These are mostly case series.
No study has tested steroid or platelet-rich plasma injections for triceps tendonitis. Steroid injections are listed as a risk factor for tears, and 5 of 19 professional football players with tears had had a cortisone injection. In other tendons, a steroid injection's early benefit faded: in patellar tendinopathy it had worn off by 6 months while heavy, slow exercise kept its benefit, and in tennis elbow fewer had recovered at a year (83% against 96% with a placebo injection). This guide doesn't suggest an injection near the triceps tendon.
Some discomfort during the exercises is fine. Keep it mild, no more than about 3 to 4 out of 10, settling within an hour, with the elbow no worse the next morning. If it's worse, go lighter next time, not to nothing; when a set no longer causes any discomfort, it's time to progress. The 3 to 4 out of 10 figure is our elbow rule, which is editorial; a UK physiotherapy consensus for tennis elbow allows exercise into "acceptable" levels of pain.
For holds, keep the load below the level that makes the pain climb during the hold: in tennis elbow, holds above a person's pain threshold left more pain half an hour later, while holds below it didn't. This is borrowed, as is the support for a little discomfort: in chronic muscle and joint pain, exercise into some pain gave a small short-term benefit, and in Achilles tendinopathy, training under a pain-monitoring rule did no harm.
Soreness rules help with the gym sessions: soreness that carries on through the warm-up, or comes back during the session, means 2 days off and a step back; soreness the next day (other than muscle soreness) means a day off and no progress. A suspected tear is different: stop and get it checked.
Start at the first stage. Each move opens a full guide with a 3D demo.
Keep the arm working, settle the pain with holds below the pain threshold, and keep pulling, legs and trunk going. The loading is borrowed from other tendons; no trial has tested it for the triceps. Doses are editorial unless marked as the move page's.
3D demoTriceps pushdownBeginner · A cable machineAs a hold: 5 holds of 30 to 45 s at a moderate effort, once a day · Push the bar to about halfway down and hold still. The same holds as our tennis and golfer's elbow guides, below the level that makes pain climb
3D demoElbow bend and straighten (elbow range of motion)Beginner · No equipment10 slow repetitions, up to 4 times a day · The move page's dose
Harder: Dumbbell biceps curl
3D demoBand rowBeginner · A band + An anchor point3 sets of 10 to 15, stopping 2 to 3 reps short of failure, with 60 to 90 seconds' rest · The move page's dose. Pulling keeps training
3D demoStanding band external rotationBeginner · A band + An anchor point2 to 3 sets of 12 to 15 · Shoulder and shoulder-blade work helped in one climber's case
Easier: Stick-assisted external rotation (lying) · Harder: Side-lying external rotation
3D demoProne Y-T-W raisesBeginner · No equipment2 sets of 5 of each shape
Easier: Wall angel · Harder: Bent-over reverse fly
Move on when: The holds and daily life pass the elbow pain rule, the elbow is no worse the next morning for a week, and light pushdowns are comfortable (our suggestion).
Lift and lower through a growing range, 2 to 3 times a week, adding load gradually, borrowed from heavy, slow loading in other tendons. Doses are editorial unless marked as the move page's.
3D demoTriceps pushdownBeginner · A cable machine3 sets of 10 to 15, lowering over 3 s, 2 to 3 times a week
3D demoDumbbell triceps kickbackBeginner · A dumbbell2 to 3 sets of 10 to 15, light · As in our elbow arthritis guide
3D demoClose-grip incline push-upBeginner · Other / check instructions2 to 3 sets of 8 to 12
Easier: Wall push-up · Harder: Push-up
3D demoDumbbell floor pressIntermediate · A dumbbell2 to 3 sets of 8 to 12, stopping with 2 or 3 reps in reserve · The floor shortens the range
Easier: Chest press machine · Harder: Bench press with chains
3D demoBand rowBeginner · A band + An anchor point3 sets of 10 to 15, stopping 2 to 3 reps short of failure, with 60 to 90 seconds' rest · The move page's dose
Move on when: 3 sets of 15 slow pushdowns at a moderate weight pass the pain rule, with the elbow fine the next morning, for a week (our suggestion).
Heavier, slow triceps work, then the presses and dips you want back. Starting at about half your old working weight and adding load in steps of 2 to 10% when you have reps to spare is our suggestion, using the American College of Sports Medicine's steps for healthy adults; no trial has tested them for a sore tendon. Doses are editorial.
3D demoDumbbell skull crusher (lying triceps extension)Intermediate · A dumbbell + A bench or box3 sets of 8 to 10, lowering over 3 s
Easier: Dumbbell triceps kickback · Harder: Triceps dip (upright)
3D demoStanding overhead dumbbell triceps extensionIntermediate · A dumbbell3 sets of 8 to 12 · As its page says, skip it with shoulder pain or finger tingling
Easier: Dumbbell triceps kickback · Harder: Triceps dip (upright)
3D demoClose-grip barbell bench pressIntermediate · A barbell + A bench or box3 sets of 6 to 10, starting at about half your old working weight
Easier: Chest press machine · Harder: Dumbbell bench press
3D demoPush-upIntermediate · No equipment3 sets of 8 to 15
Easier: Wall push-up · Harder: Close-grip push-up (close triceps position)
3D demoParallel bar dipAdvanced · Pull-up bar2 to 3 sets of 5 to 8 · To about a right angle at the elbow, as our dips guide suggests
Move on when: Your usual sessions pass the pain rule for 2 weeks. Keeping one heavier, slow triceps exercise in your week for a few months is our suggestion. After a repair, follow your surgeon's plan instead.
These are our suggestions; no trial has tested them for the triceps.
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Follow your surgeon's plan. The AAOS describes about 2 weeks in a splint or brace, then a brace that lets you bend the elbow a little further each week until full movement returns over several weeks, physiotherapy for movement and strength, and limits on what you lift for about the first 12 weeks; about 6% of repairs tear again, so keep to the limits. In a review, athletes returned to sport at about 5 months on average.
| Habit or position | Why it matters | Instead |
|---|---|---|
| Deep dips below a right angle | Our dips guide stops at about a right angle at the elbow; deeper dips take the shoulder closer to its limit under your body weight. | Triceps pushdowns now, and dips to a right angle in the last stage.Try: Triceps pushdown |
| Heavy skull crushers early on | They load the tendon in a lengthened position (editorial). | Kickbacks with the arm at your side.Try: Dumbbell triceps kickback |
| Heavy close-grip bench press | A narrow grip moves more of the work onto the triceps. | A lighter dumbbell floor press, with a shorter range.Try: Dumbbell floor press |
| Bench dips | They load the triceps heavily, and they take the shoulder furthest back of the dips. | Close-grip incline push-ups.Try: Close-grip incline push-up |
| Complete rest until it stops hurting | Borrowed evidence from other tendons favours keeping the tendon loaded under a pain rule. | The stage 1 holds and light work.Try: Triceps pushdown |
| A steroid injection near the tendon | Steroid injections are a risk factor for tears, and their help is short-lived in other tendons. | Exercise first; ask about the risks before any injection. |
| Carrying on with a fluoroquinolone antibiotic once a tendon hurts | The MHRA says stop and contact your doctor straight away. | Contact your doctor before the next dose. |
| Leaning on the point of the elbow | It can irritate the bursa there. | Pad it, or keep your weight off it. |
An upper body workout at home with no gym: push-ups, band rows, pike push-ups, face pulls, close-grip push-ups and Y-T-W raises, with dumbbell options.
30 minIntermediate13 movesA band, An anchor pointWork up to full push-ups: wall, incline and knee push-ups, then the floor push-up and harder variations.
15 minBeginner8 movesA wall, A bench or boxWork up to bar dips: bent-knee and straight-leg bench dips, a support hold, slow lowering and assisted dips, then full dips and ring dips.
20 minBeginner9 movesA band, A bench or boxBiceps, triceps and forearms: curls, hammer curls, skull crushers, pushdowns, concentration curls and dips.
35 minBeginner7 movesA dumbbell, A bench or boxA pop at the back of the elbow during a push or a fall, then pain, swelling, bruising, a gap above the point of the elbow, and weakness straightening the arm, especially overhead. Get help from NHS 111 the same day: tears are often missed at first, and expert guidance favours repairing a full tear early.
A partial tear of less than half the tendon often heals with a splint and rehab. A complete tear in an active person is usually repaired, and bigger tears left alone usually leave some lasting weakness.
There are no studies of the triceps to say. The loading programmes tested in other tendons ran for 12 to 24 weeks, so expect weeks to months rather than days, and no one can promise a time.
Usually, with the changes we suggest: lighter, with a shorter range, such as a floor press, and dips only to about a right angle at the elbow, within the elbow pain rule. Build back to full pressing over the stages.
Go by where it hurts. Tennis elbow is on the outside of the elbow; the triceps tendon is at the back, worse straightening against resistance. Triceps tendon problems are much rarer.
Anabolic steroids and steroid injections are linked with tears, as are kidney disease and some other conditions. Fluoroquinolone antibiotics carry a warning for tendon damage, mostly in the Achilles: if a tendon hurts while you're taking one, stop and contact your doctor.
Usually about 2 weeks in a splint, then a brace that lets the elbow bend a little further each week, with limits on lifting for about the first 12 weeks. In a review, athletes returned to sport at about 5 months on average, and about 4 to 6% of repairs tore again.
For tendon pain without a tear, usually not, and pain-free elbows often show signal in the tendon on MRI. A suspected tear needs an X-ray and usually an ultrasound or MRI scan, which guide treatment.
Muscle soreness after new or heavy work is normal and fades, especially with lighter sessions repeated over the next week or two. Pain at the tendon near the point of the elbow that comes back with every push is more likely the tendon.
We found no study of a brace or strap for triceps tendonitis. After a tear, a splint or a hinged brace is part of the treatment your team prescribes.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
