Craig Ballard
(MSc (Sports & Exercise Nutrition), BSc, BTEC (Sports & Exercise Sciences), CYQ/QCF (Personal training and Instruction)
The triceps brachii is a crucial muscle for upper body strength, playing a key role in pressing movements. However, various issues can arise due to
- improper training
- overuse
- poor mechanics
Understanding these problems can help prevent setbacks and improve training efficiency.
Like any other muscle, triceps and their connective tissues lead to overuse injuries. Smaller muscle groups with one joint function, including the triceps, are more prone to these issues as they are used in the majority of movement patterns.
The most common of these issues are tendonitis and muscle strains.
What is Tendonitis?
Tendonitis is the inflammation or irritation of a tendon, which is the thick cord that connects muscle to bone. It commonly occurs due to repetitive movements, overuse, or excessive strain on the tendon.
In the case of the triceps, this is almost always caused by excessive pressing exercises. This relates to high repetitive use, both in horizontal and vertical presses, for example, the popular bench press or overhead press.
How Do You Know If You Have Tricep Tendonitis?
Triceps tendonitis is a relatively rare condition, accounting for less than 1% of all tendon injuries seen in sports medicine settings.[1] It most often affects weightlifters and throwing athletes, typically resulting from sudden increases in training load or improper technique.[2]
Symptoms usually present as pain, stiffness, or inflammation around the back of the elbow, near the insertion of the triceps tendon at the olecranon. It is uncommon for symptoms to originate near the shoulder where the triceps begin.
Compared to other upper limb tendinopathies, such as rotator cuff injuries or lateral and medial epicondylitis, that is tennis and golfer’s elbow in the common tongue, triceps tendonitis is much less frequently diagnosed. MRI studies in patients with chronic elbow pain have shown triceps tendinopathy in only 1–2% of cases.[3]
So if you are experiencing elbow pain, it is more likely to be related to the forearm extensors or flexors, rather than the triceps tendon.
How to Prevent Tricep Tendonitis?
Ideally, you should undertake a specific warmup that targets the workout muscles, not just walking on a treadmill for 5-10 minutes. This will raise your core temperature, but does very little for the triceps themselves.
Example
Perform your programmed exercises for 1-2 warmup sets. This involves using a lighter weight and a full range of motion to ensure you are directing more blood to the working muscle and producing heat in the desired area, which allows a greater level of durability of the tissue and increasing overall mobility at the local joints.
Once you have the warm up covered, be aware of the total volume you perform for the triceps. Make sure not to perform more than is required for your desired outcome i.e., 6-10 sets of pressing per session is adequate to elicit muscle growth, with a training intensity around 60%–80% of your one repetition maximum.[4,5]
Excessive volume will increase chances of tendonitis and muscle strain
Mobility work can help to keep the shoulder and elbow joint healthy, which in turn can reduce the potential of injury.[6,7] If you are performing a full range of motion for your warmup and working sets you will incorporate this to a large degree and extra mobility work may not be necessary; however, if you are prone to shoulder and elbow issues this may be a worthwhile consideration for you.
Like any exercise you perform in the gym, good form should always be the core of any training program. It is unrealistic to perform an exercise with perfect form for the whole duration of a working set. Therefore, there is an acceptable range where the majority of tension is placed purely on the targeted muscle group or groups and not placed on supporting muscles.
The main takeaway should be to control the eccentric (negative or down phase) and concentric movement (initial push or pull phase); in layman terms this means no jerking the weight around or ego lifting. Select an appropriate weight you can control for your desired repetition range and intensity.
Muscle Strains
Muscle strains occur in a similar fashion to tendonitis, though by predominantly overloading the muscle either with too much volume or load, i.e., putting too much on the bar. This paired with poor technique, or inadequate recovery is a recipe for disaster.
You might experience a sharp pain or weakness in the triceps, shortly followed by swelling. As you might be aware, there are different degrees of strain, though all can cause you to take time off from the gym and negatively impact your day-to-day life.
The key to prevent muscle strains, specifically in the triceps, is to focus on gradual progressive overload, increasing weight and or repetitions over time, as well as proper form, and adequate rest, ideally 48-72 hours between training the same muscle group.[8]
Imbalances and Weakness
An improper training program can also be a cause for concern when we are thinking about injury reduction. With the arms, this means focusing on one, more than the other, favouring unilateral work or perhaps partaking in a sport which targets your dominant arm. This can result in poor activation of the triceps, or neglecting specific tricep exercises.
RELATED — Exercise Guide to: Horseshoe Triceps
Inevitably, this can lead to inefficiencies in pressing movements like the bench press and overhead press, which can result in relying on other muscle groups to help support the uneven technique, further increasing risk of injury.
How should you resolve this?
Focus on unilateral exercises, varied grip positions, and full range of motion. Ideally, your non-dominant arm will be able to perform exercises with the same load and within the same repetition range as your dominant arm. If not, this should be your goal.
While there isn’t a large body of research focused specifically on the triceps and elbow, insights from other muscle groups, particularly those related to the knee and hamstring, offer valuable parallels. Since both the knee and elbow are synovial hinge joints, findings related to one can often inform our understanding of the other.[9,10]
In the case of knee injuries, imbalances caused by weak hamstrings and dominant quadriceps are a common issue.
This suggests that similar muscular imbalances around the elbow, such as neglecting the biceps while overtraining the triceps, or vice versa, could potentially lead to injury. In short, don’t skip your biceps training if you want to keep your triceps healthy.[9,10]
High Risk Exercises
Any exercise you perform that promotes a large range of motion at the shoulder and elbow under load will increase your chance of injury and reward.
For example, dips are a common exercise for tricep injuries, not necessarily because of the exercise itself, more so because of the nature of the exercise, which causes individuals to use their whole body weight and if they are not strong enough to control the descent. Dips can place a great amount of load on the triceps and tendons in a stretched and lengthened position.
A safe alternative would be to use an assisted dip machine to reduce load, allowing for more control and the ability to improve the mobility and range of motion over time.
Free weight exercises will always have a higher chance of injury, as they require more control and stabilisation from accompanying muscle groups, and often call for a greater range of motion at the shoulder and elbow.
Free weight exercises will always have a higher chance of injury
Isolated or machine exercises provide a more stable platform to perform the exercise, thus reducing risk. For example, a seated tricep press or cable tricep extension limits the amount of complexity and load needed to create a similar stimulus for muscle growth, e.g., in comparison to a close arm bench press variation.
Practical Take Aways
- Adjusting Load and Volume: Avoid excessive high-intensity work without adequate recovery.
- Exercise Selection: Incorporate variations of compound and isolation exercises which target different shoulder positions like close-grip bench press, dips, and overhead extensions to target different heads of the triceps.
- Proper Recovery: Consider implementing stretching, soft tissue work, and structured rest days.
References
(1) Waterman, B. R., Dean, R. S., Veera, S., Cole, B. J., Romeo, A. A., Wysocki, R. W., Cohen, M. S., Fernandez, J. J., & Verma, N. N. (2019). Surgical Repair of Distal Triceps Tendon Injuries: Short-term to Midterm Clinical Outcomes and Risk Factors for Perioperative Complications. Orthopaedic journal of sports medicine, 7(4), 2325967119839998. https://doi.org/10.1177/2325967119839998
(2) Sierra, R. J., Weiss, N. G., Shrader, M. W., & Steinmann, S. P. (2006). Acute triceps ruptures: case report and retrospective chart review. Journal of shoulder and elbow surgery, 15(1), 130–134.
(3) Valgaeren, B., Van Snick, E., & Claikens, B. (2024). Tendinous Signal Alterations on MRI in the Asymptomatic Elbow: A Retrospective Cross-Sectional Study. Journal of the Belgian Society of Radiology, 108(1), 69. https://doi.org/10.5334/jbsr.3651
(4) Carvalho, L., Junior, R. M., Barreira, J., Schoenfeld, B. J., Orazem, J., & Barroso, R. (2022). Muscle hypertrophy and strength gains after resistance training with different volume-matched loads: A systematic review and meta-analysis. Applied Physiology, Nutrition, and Metabolism, 47(4), 357–368. https://doi.org/10.1139/apnm-2021-0515
(5) Baz-Valle, E., Fontes-Villalba, M., & Santos-Concejero, J. (2021). Total number of sets as a training volume quantification method for muscle hypertrophy: A systematic review. Journal of Strength and Conditioning Research, 35(3), 870–878. https://doi.org/10.1519/JSC.0000000000002776
(6) Fradkin, A. J., Gabbe, B. J., & Cameron, P. A. (2006). Does warming up prevent injury in sport? Journal of Science and Medicine in Sport, 9(3), 214–220.
(7) McCrary, J. M., Ackermann, B. J., & Halaki, M. (2015). A systematic review of the effects of upper body warm-up on performance and injury. British Journal of Sports Medicine, 49(14), 935–942. https://doi.org/10.1136/bjsports-2014-094228
(8) Soares, S., Ferreira-Junior, J. B., Pereira, M. C., Cleto, V. A., Castanheira, R. P., Cadore, E. L., Brown, L. E., Gentil, P., Bemben, M. G., & Bottaro, M. (2015). Dissociated time course of muscle damage recovery between single- and multi-joint exercises in highly resistance-trained men. Journal of Strength and Conditioning Research, 29(9), 2594–2599. https://doi.org/10.1519/JSC.0000000000000899
(9) Rudisill, S. S., Varady, N. H., Kucharik, M. P., Eberlin, C. T., & Martin, S. D. (2023). Evidence-based hamstring injury prevention and risk factor management: A systematic review and meta-analysis of randomized controlled trials. American Journal of Sports Medicine, 51(7), 1927–1942.
(10) Opar, D. A., Williams, M. D., & Shield, A. J. (2012). Hamstring strain injuries: Factors that lead to injury and re-injury. Sports Medicine, 42(3), 209–226.
