The commonest cause of tricep pain near the elbow is a triceps tendonitis. If you do have triceps tendon pain, it’s important to rehab and give your body time to heal this before it turns into more permanent damage.
In this article, we’ll look at:
The triceps is a fascinating muscle. Triceps means three heads. The three heads of the triceps are at the top, where the muscle attaches to the shoulder and upper arm.
Two heads attach to the long bone of your arm – the humerus. There’s a longer head, which attaches near the top, and a shorter head which attaches lower down. The third head is runs from the back of your arm and joins into the scapular (shoulder blade.)
In the end this means the muscle runs across two joints – the shoulder joint and the elbow joint. This makes their triceps an interesting, but complex muscle.
At the top of each of these muscle heads is a tendon attaching to bone. Because they’re spreading their load out, these three top tendons tend to do okay.
However, these three heads then run down the back of the arm and join into a single muscle at the back of your arm. This larger muscle then runs down towards the point of the elbow, called the olecranon.
The olecranon (the point of your elbow) is in part of the ulna bone. Here, the triceps muscle becomes a single tendon and joins into the olecranon.
This tendon at the elbow is where all the tension produced by the muscle is concentrated. So if you have triceps tendon pain, it’s most oftes at this point where problems occur.
As the triceps muscle contracts, the elbow straightens out. We use this movement a lot. It’s used for doing pushups, closing doors, swimming, surfing, tennis, throwing ball, wielding a hammer. All of these movements, and many, many others require the triceps to contract.
These movements also require the tendon to tension up.
Tendons are a quite unique structure in our bodies. The tendon is made up of long coiled molecules of collagen, which is a very strong. Because they’re coiled, these molecules have a certain springiness to them.
They are also glistening and white, which means they don’t have lot of blood in them. The blood flow to the tendon is very limited. This means they are slow to heal.
If you try to do a big pushup or lift something that exceeds the strength of the tendon, you may get a tear in your tendon. That’s one way to injure your tendon, but that’s not the commonest.
The commonest tendon injury by a long way comes from doing recurrent movements. If you were a baseball pitcher you threw a thousand times during a week, over time you may start to get lots of little tears.
If you’re a builder and you use your hammer a lot, again, the same thing could happen. Recurrent overuse is the commonest cause of tendon injury, and this is certainly true for the triceps.
When there’s overuse, the tendon gets lots of little tears and because there isn’t a great blood supply, the tendon frantically tries to heal any way it can. So it becomes inflamed. And that is tendonitis.
Triceps tendonitis means the tendon at the back of your arm, where it joins into the tip of the elbow becomes inflamed. This is because it’s trying to heal the multiple little tears or the one big tear caused usually by overuse.
With triceps tendonitis, the area becomes exquisitely tender because your body is trying to heal through inflammation. You may feel you have a sore triceps for no reason, as even the slightest use of the muscle can cause you a lot of pain.
As part of the healing process, the area will feel warm to the touch. It may even look red and be exquisitely tender, like a burn. Your elbow may become a little bit swollen. Every time you lean it on the table, it will hurt.
Under these circumstances, with an acutely inflamed tendon, the cleverest thing anybody can do is to rest it. This means putting your arm in a sling and really resting it as much as possible to let it settle.
Rest is a very powerful anti inflammatory – the best. However, to enhance this process, you can rub lots of an anti inflammatory gel into the area – something like Voltaren or ibuprofen gel. You could also take anti inflammatory tablets, or ice the area cool it down.
These measures help to quiet the inflammation down. The most important, though, is to stop using your elbow.
Now, this kind of rest you can only do that for a certain period of time. It may be that the inflammation settles (and it should settle quite quickly.)
But supposing you now you’ve got to go back to work as a builder, or a pitcher?
If you carry on using a damaged tendon, what will happen over time is that the tendon will change from an itis to an osis. In other words, the tendonitis turns into a tendonosis.
This means parts of the tendon will heal up. Other parts of the tendon will degenerate and end up with little areas of dead tissue in them. That’s the commonest way the tendons respond to repeated injury.
Under these circumstances, the tendon itself is sore when you use it or stress it, but is not acutely inflamed. This isn’t great though, because you’ll end up with a chronically sore tendon.
What you need to do to help the tendon to heal optimally.
This is different process from when the tendon was acutely inflamed. When it’s an tendonis, you have degeneration and healing together in the tendon. In this scenario, there’s a narrow path to healing.
If you to do too much – or too little, you drift away from optimal healing.
If you do too little, for instance keeping your elbow immobile in a sling for six weeks, then the tendon heals in a suboptimal way. This is because when you’re not using the tendon at all, new collagen and scar tissue is laid down in many different directions, which will create an essentially weaker and less functional tendon.
What the tendon responds well to is a (very) small amount of stress, just enough to stimulate healing and to allow the collagen and the scar tissue to be laid down in response to the lines of force.
In this scenario, it’s important not to overdo anti-inflammatories, because you want to certain degree of inflammation to occur as part of healing.
As you rehab from a triceps tendonitis, you want to be able to stretch the tendon very gently.
The most basic triceps tendon stretch involves dropping your hand down behind your back. Lift your elbow and tuck it next to your ear. As you pull back, letting the arm drop, you will feel the whole triceps muscle and tendon stretch.
You then very gently lift your elbow up and stretch. You can do this as often as you like through the day. It shouldn’t hurt, unless everything is still acutely inflamed (in which case wait until you can do the stretch comfortably.)
Next, you can start to tension up your stretch. What tendons respond well to is what’s called eccentric contraction.
If the tendon is shortening and contracting, that’s concentric contraction. But if the tendon is being stretched, and the muscle is lengthening, then that’s eccentric contraction.
It’s the best type of loaded stretch for tendons. The tendon is being stretched, but the whole muscle is lengthening under tension.
The way you do this is to hold a weight and slowly let it drop. You hold the weight behind your head, and slowly let it drop down. Use your other hand to bring the weight holding hand back up again.
Use a small weight – about 500 grams (1-2 pounds.) This type of exercise is best done under care of a physiotherapist or physical therapist who can help you incrementally increase the weight and numbers of repetitions.
When you manage a tendonitis properly, it should settle, although it often takes a number of weeks.. Unfortunately, once you’ve damaged the tendon, it does remain vulnerable, but with proper management, it should settle and you should be able to get back to doing what you would like to do.
If you’re a baseball pitcher or a person using a hammer a lot, or someone doing something recurrently stressful to the tendon, you may find this does interfere with your ability to get back to a highly proficient level.
Lastly, look at trigger points to help relieve tension in the triceps tendon. Trigger points are micro-spasms in muscle, and can be set off by things like a damaged and sore tendon.
Active trigger points in your triceps muscle will keep the muscle tight, putting extra strain on the tendon. This can delay healing, or cause more damage.
The good news is the trigger points are simple and fast to treat. You can have a look at triceps trigger point here, or get started treating trigger points here.