(Also known as Tricep Strain, Strained Tricep, Triceps Injury, Torn Tricep, Tricep Tear, Strained Tricep Muscle, Pulled Tricep)
What is a tricep strain?
A tricep strain is a relatively uncommon condition that typically causes pain in the back of the upper arm and is characterised by partial or complete tearing of the triceps brachii muscle (figure 1).
The triceps muscle is located at the back of the upper arm (figure 1) and is comprised of three (‘tri’) muscle bellies (‘ceps’). These muscle bellies are known as the long, medial and lateral head of triceps. The triceps muscle originates from the shoulder blade (scapula) and upper aspect of the back of the humerus (upper arm bone). It attaches to the back of the elbow (i.e. the olecranon process of the ulnar) (figure 2) via the triceps tendon (figure 1).
The triceps muscle is primarily responsible for straightening the elbow joint (i.e. elbow extension). At the shoulder the long head of triceps also assists adduction and extension movements of the upper arm (i.e. moving the upper arm toward the body and backwards respectively). In everyday life, the triceps muscle commonly assists pushing movements (such as performing a push up) and also may act to stabilise the elbow during activities requiring fine motor control (such as writing). During stretch or contraction of the triceps, tension is placed through the triceps muscle and it’s respective tendons. When this tension is excessive (due to too much repetitive, prolonged or high force) and greater than the muscle can withstand, one or more of the triceps muscle bellies may tear. This condition is known as a tricep strain.
Tricep strains can range from a minor partial tear provoking minimal pain and loss of function, to a complete rupture. The severity of injury can range from a grade 1 to a grade 3 tear and are classified as follows:
- Grade 1: a small percentage of fibres are torn resulting in some pain, but allowing full function.
- Grade 2: a significant percentage of fibres are torn with moderate loss of function.
- Grade 3: all muscle fibres are ruptured resulting in major loss of function.
Most tricep strains are classified as grade 2 tears.
Causes of a tricep strain
A tricep strain typically occurs due to a sudden, forceful contraction (or less commonly, a stretch) of the triceps muscle. This typically occurs during heavy pushing or straightening of the elbow against resistance (such as performing explosive dips, push ups, bench presses, cable triceps exercises etc). At the gym, the use of heavy weights, quick movements and negatives (i.e. eccentric training) may increase the likelihood of the condition occurring. A tricep strain may also occur in sports involving throwing (such as cricket or baseball) or sport involving heavy falls or blocking (such as football or lacrosse).
Occasionally a tricep strain may develop gradually over time due to repetitive or prolonged activities placing stress on the triceps muscle. This may result in microscopic tearing, degeneration and weakening of the triceps predisposing the muscle to further injury. Tricep strains may occur more commonly in the older deconditioned athlete, especially following an inadequate warm-up.
Signs and symptoms of a tricep strain
Patients with a strained tricep typically experience a sudden pain or pulling / tearing sensation in the back of the upper arm at the time of injury. In less severe cases, symptoms may be minimal and patients may be able to continue the provocative activity only to experience an increase in pain, ache and stiffness after activity with rest (typically at night or upon waking the following morning). In patients with more severe injuries, the pain may be disabling, preventing further activity.
The pain associated with this condition is often experienced as an ache that increases to a sharper pain with activities involving prolonged, repetitive or forceful contraction (or stretch) of the tricep muscle. These activities may include pushing activities or activities involving straightening of the elbow against resistance (e.g. pushing yourself up from a chair, or performing exercises such as a push up, bench press or dip).
Symptoms are usually located in the back of the upper arm (triceps region). Occasionally, pain may radiate into the shoulder, elbow or forearm. Tricep muscle tightness, spasm and tenderness on firmly touching the injured region is often present. Bruising, swelling and weakness (of variable severity) may also be experienced.
In some cases, patients with a minor triceps tear may experience little or no symptoms. In these instances, minor discomfort or tightness may be the only complaint. In severe or chronic cases, muscle wasting and a noticeable deformity (or palpable hole) in the muscle may be detected corresponding to the location of the tear.
Diagnosis of a tricep strain
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a tricep strain. Further investigations such as an X-Ray, Ultrasound, CT scan or MRI scan may be required to confirm diagnosis, rule out other conditions and assess the severity of the tear.
Treatment for a tricep strain
Prognosis of a tricep strain
With appropriate physiotherapy treatment, most patients with a minor to moderate tricep strain that has not been present for long can usually recover within a number of weeks. In more severe or chronic cases recovery may take many weeks to months to achieve an optimal outcome. Those patients with a complete triceps rupture that need surgical intervention, usually require a rehabilitation period of 6 – 9 months or longer before returning to full activity or sport.
Contributing factors to the development of a tricep strain
There are several factors that can predispose patients to developing a tricep strain. These should be assessed and where possible, corrected, with direction from a physiotherapist. Some of these factors include:
- poor weight lifting, push up or dip technique
- tricep muscle weakness
- joint stiffness involving the elbow, shoulder, neck or upper back
- inadequate conditioning of the tricep muscle
- poor tricep flexibility
- neural tightness
- sub-optimal rehabilitation following a previous tricep or elbow injury
- poor biomechanics, posture, or core stability
- inappropriate or excessive training or activity
- participation in sports involving throwing, heavy blocking or falls
- inadequate recovery periods from sport or activity
- sudden increase in activity using the triceps (such as weight training)
- inadequate warm up
- increasing age
Physiotherapy for a tricep strain
Other intervention for a tricep strain
Despite appropriate physiotherapy management, some patients with a tricep strain do not improve sufficiently. When this occurs the treating physiotherapist (or doctor) can advise on the best course of management. This may include further investigations such as X-rays, Ultrasound, MRI or CT scan, pharmaceutical prescription, injection therapy (such as autologous blood injection or cortisone injection) or referral to appropriate medical authorities (such as an orthopaedic specialist or sports doctor) who can advise on any intervention that may be appropriate to improve the condition. In rare cases involving a complete rupture of the triceps muscle, surgical intervention may be indicated.
Exercises for a tricep strain
The following exercises are commonly prescribed to patients with a tricep strain. You should discuss the suitability of these exercises with your physiotherapist prior to commencing them. Generally, they should be performed 2 – 3 times daily and only provided they do not cause or increase symptoms.
Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place gradually and provided there is no increase in symptoms.
Static Triceps Contraction
Begin this triceps exercise with your elbow at your side and bent to 90 degrees and your palm in a fist as demonstrated (figure 3). Slowly push down against your other hand tightening your triceps. Hold for 5 – 10 seconds and repeat 10 times as hard as possible provided the exercise does not cause or increase symptoms.
Elbow Bend to Straighten
Begin this exercises standing in good posture with your palm facing your body as demonstrated. Slowly bend and then straighten your elbow as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 4). Repeat 10 – 20 times provided the exercise is pain free.
Rehabilitation Protocol for a tricep strain
Some of the most commonly recommended physiotherapy products to hasten recovery from a tricep strain include:
To purchase physiotherapy products for a tricep strain, click on one of the links or visit the PhysioAdvisor Shop.
Find a Physio for a tricep strain
Find a physiotherapist in your local area who can treat a tricep strain.
- Tricep Strengthening Exercises.
- Tricep Stretches.
- Cardiovascular Exercise.
- Upper Body Foam Roller Exercises.
- Massage Ball Exercises (Upper Body).
- Upper Body Resistance Band Exercises.
- Gym Exercises (Upper Body).
- Cable Exercises (Chest, Shoulders & Triceps).
- Cable Exercises (Back & Biceps).
- Arm Stretches.
- Arm Strengthening Exercises.
- Ice or Heat.
- R.I.C.E. Regime.
- Warming Up & Cooling Down.
- Returning to Sport.
- Inflammatory Pain.
- Mechanical Pain.
- Understanding Pain.
- Why is my injury not improving?
- Shoulder Diagnosis Guide.
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