Is your recovery window still open? Free one-page chart ↓
It Hurts When You Push, Not When You Pull. That’s Your First Clue.
Triceps tendinopathy (often called triceps tendonitis) is pain at the BACK of the elbow, right on the bony point, that hurts when you push rather than when you pull. Bench press lockout, dips, push-ups, hammering, shoving a heavy door.
Most cases settle with graded loading, not rest. Expect 6 to 12 weeks to feel clearly better, and 3 to 6 months before full heavy pressing for a stubborn one.
It’s one of the least common elbow tendinopathies and one of the most often mislabeled… cos the bursa that sits on the same bony point produces a swelling everyone notices first.
Here’s what you’re probably living with. Every lockout stings. Push-ups have quietly left your program. Getting up out of a low chair with your arms now gets a wince.
Get this one wrong in either direction and it costs you. Rest it for three months and you end up with a weak tendon that still hurts. Push through a tendon that has actually TORN, and you can miss a repair window measured in weeks.
This article sorts out which one you’ve got, and what to do about it.
What is triceps tendinopathy?
The triceps is the big muscle on the back of your upper arm. It straightens the elbow. Its tendon attaches onto the olecranon, the point of your elbow you lean on at a desk.
Tendinopathy means the tendon has been loaded faster than it could adapt. It isn’t really inflamed, which is why “tendonitis” is the old name. The tendon gets thicker, more sensitive and less tolerant of load, especially near where it grips the bone.
Where does triceps tendonitis hurt?
Right on or just above the bony point at the back of the elbow.
It hurts in the last 20 or 30 degrees of straightening, under load. Not through the whole range.
The giveaway is the direction. Tennis elbow hurts gripping, on the outer side. Golfer’s elbow hurts on the inner side. Triceps tendinopathy hurts pushing. (Still not sure which spot is yours? Elbow pain by location sorts it.)
- Gym: bench press lockout, the last few inches of an overhead press, dips, push-ups, burpees, skull crushers.
- Daily life: pushing yourself up out of a chair with your arms, pushing a heavy door or a loaded cart.
- Sport and work: racquet serves and overheads, throwing, javelin, hammering, overhead painting.
How is it diagnosed?
Usually in the room, with your arm doing the talking.
- Resisted straightening. (I ask people to push against my hand with a straight arm. If that’s the movement that reproduces it, the diagnosis is usually done.)
- Tenderness right on the tendon where it meets the bone, or just above it.
- Strength check. Can you straighten the elbow fully against gravity, arm overhead? Pain with full strength points to tendinopathy. Real weakness points somewhere more urgent.
- Ultrasound shows a thickened tendon and can pick up a partial tear. Quick and cheap.
- X-ray sometimes shows a small bony spur at the tendon attachment. Common, and often not the cause of the pain.
- MRI when a tear is suspected and the surgeon needs to see how much of the tendon is still attached.
Is it triceps tendonitis, bursitis or a tear?
Olecranon bursitis. A soft, squashy swelling on the point of the elbow, often painless, often after leaning on it. That’s fluid in a sac sitting ON TOP of the tendon, not the tendon itself. Different problem, different treatment. See olecranon bursitis.
A stress reaction in the olecranon. Throwers and gymnasts can get bone pain here, not tendon pain. Pain at rest and pain at night point away from tendinopathy.
Arthritis or bony pinching at the back of the joint. Pain at the end of straightening can also come from the joint itself, with clicking, catching or loss of the last few degrees. See elbow osteoarthritis.
An actual triceps rupture. Rare, but it matters. A sudden pop while pushing or catching a fall, then a genuine inability to straighten the elbow against gravity, needs imaging urgently. Like the distal biceps at the front, this one has a repair window measured in weeks.
Tendinopathy is pain with strength. Rupture is weakness with a pop. Never treat the second as the first.
The window your elbow is on
In Closing Window terms, plain triceps tendinopathy runs on an OPEN window. Time is on your side, as long as you spend that time loading the tendon rather than hiding it. Starting the right program at week 2 or at month 4 still works. It just costs you more months the later you start.
A full rupture runs on a CLOSING window. Surgeons generally prefer to repair a torn triceps within the first few weeks, before the tendon pulls back and scars down. That’s the one version of this problem where waiting to see is the wrong plan.
The risk factors people don’t volunteer
Two things sit behind a lot of the triceps tendinopathies I see.
The first is a sudden jump in pushing volume. A new program, a new class, a house move, two weeks of ceiling painting.
The second is anabolic steroid use, which changes tendon quality and is strongly associated with triceps rupture specifically. Nobody mentions it unprompted and I don’t push. But if it applies to you, tell whoever is treating you. It changes how aggressively the tendon should be loaded.
Repeated steroid injections around the elbow belong on the same list. So do some antibiotics in the fluoroquinolone family, which are known to weaken tendons. If you’ve had a course recently, mention it.
How long does triceps tendinopathy take to heal?
Tendons don’t respond to rest. They respond to graded load. Rest just makes a weak tendon that still hurts.
- Weeks 0 to 2 (calm it down): cut the provoking load, don’t stop training. Drop dips, close-grip bench and lockouts. Isometric holds usually reduce pain within the session.
- Weeks 2 to 6 (build it up): slow, heavy, controlled triceps work through a partial range, avoiding the painful last few degrees at first. Slow down the lowering phase especially.
- Weeks 6 to 12 (get the range back under load): full range, building back toward the load that broke it, plus shoulder blade and overhead strength if your pushing pattern is poor.
- Months 3 to 6 (back to full volume): full pressing volume and sport. Stubborn cases genuinely take this long.
Your pain guide through all of it: up to about 3 out of 10 during the exercise is fine, as long as it has settled by the next morning. Worse the next morning means the dose was too high. Drop it back one step, don’t stop.
Triceps tendinopathy exercises
Do these in order. Move to the next stage when the current one is easy and the next-morning check is clean.
- Isometric push (stage 1). Stand side-on to a wall or a door frame, elbow bent to about 90 degrees, and push the back of your forearm, or your fist, into it as if you were straightening the arm. About 70 percent effort. Hold 30 to 45 seconds, rest a minute, 4 to 5 holds, 2 to 3 times a day.
- Band pushdowns (stage 2). Light resistance band anchored high, elbows tucked at your sides, push down and stop just short of the painful last few degrees. 3 sets of 15, every second day.
- Slow heavy triceps extensions (stage 2 to 3). Cable pushdowns or a dumbbell overhead extension heavy enough that 8 to 12 reps is hard. 3 seconds up, 3 to 4 seconds down. 3 to 4 sets, every second day.
- Full-range lockouts (stage 3). Once partial range is comfortable, take the same exercises all the way to straight. Then add push-ups on an incline (hands on a bench), and lower the incline over the weeks.
- Back to pressing (stage 4). Bench and overhead press at about half your old working weight, building by roughly 10 percent a week if the next-morning check stays clean. Dips come back last.
The lowering phase is where the tendon adapts best. Rush the way down and you’ve skipped the bit that works… kinda like doing half a rep and logging it twice.
Can I keep going to the gym?
Usually yes, just not the way you were.
- Keep: pulling work, legs, core, and pushing exercises that stay under that 3 out of 10.
- Swap: neutral-grip dumbbell press for barbell bench, incline push-ups for floor push-ups, landmine press for strict overhead press.
- Park for now: dips, close-grip bench, skull crushers and anything locked out under heavy load.
More on staying in the gym with a sore arm in powerlifting wrist, elbow and grip injuries.
Work, driving and sport
- Desk work: usually no time off. Watch how often you push up out of your chair on your arms.
- Manual work: pushing, hammering and overhead work modified for the first 2 to 6 weeks. Two hands on heavy doors and carts. Short sets of overhead work with breaks.
- Driving: rarely affected. Steering is mostly pulling, not pushing.
- Throwing and racquet sports: a graded return once full-range lockouts are comfortable, often somewhere between 6 weeks and 3 months, longer for serves and overheads.
Do injections help?
Steroid injection into a triceps tendon is generally avoided. This tendon ruptures, and steroid doesn’t help that tendency. If someone offers one, it’s fair to ask why, and how close to the tendon it’s going.
Other injections and shockwave therapy get offered for stubborn cases. They’re add-ons to a loading program, never a replacement for one.
Surgery for plain tendinopathy is uncommon and saved for the few that fail months of proper loading. Surgery for a true rupture is a different conversation, and a time-sensitive one.
What a hand therapist does differently
- Confirms it’s the tendon and not the bursa, the joint or a partial tear, and checks strength properly rather than assuming.
- Sets a loading dose you can actually progress, with the next-morning rule, so you stop guessing between “push through it” and “rest it”.
- Looks at HOW you push. A shoulder that rolls forward at lockout dumps load onto the elbow.
No brace fixes this one. A strap made for tennis elbow sits on the wrong side of the arm.
Get it checked today if
- There was a pop, and straightening against gravity is now weak or impossible.
- The point of the elbow is suddenly hot, red and swollen, especially with a fever. That’s a possible infected bursa, not tendinopathy.
Get it checked if
- Pain wakes you at night or is present completely at rest.
- You have tingling or numbness in the ring and little fingers. The ulnar nerve runs just beside this area. See cubital tunnel syndrome.
- The elbow is locking, catching or losing the last few degrees of straightening.
- Three months of sensible loading has changed nothing.
The elbow tendons all take months. The ones that take years are the ones that were rested for the first three.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. If pushing hurts and you’ve been told to rest it, that advice has an expiry date. Get someone to build you a loading program instead.
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.