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Tendinitis a threeheaded muscle, hence the prefix tri that’s visible on the back of the arm. The medial and lateral heads originate on the humerus, while the long head actually attaches up at the shoulder blade. All three muscles insert on the electron of the ulna via a common tendon and act to extend or straighten the elbow. The long head also extends and stabilizes the shoulder due to its attachment up at the scapula. (Tendinitis)
Although the diagnosis is often referred to as triceps tendonitis, triceps tendinopathy is a better descriptor for this condition because inflammation likely isn’t the primary driving factor. Instead, you can just think about it as an overload of the tendon, meaning that you probably just did a little bit more than what it could handle over a certain period of time. This is not to be confused with golfer’s elbow on the inside of the elbow, tennis elbow on the outside of the elbow, or anything to do with instability, trauma, significant swelling or numbness and tingling. (Tendinitis)
I would expect fairly localized pain in the back of the elbow that worsens with increasing demands on the triceps. For example, I would expect a 40 pound dumbbell skull crusher to cause more issues than a 20 pound dumbbell skull crusher because it’s a greater load. Similarly, a very fast repetition would likely present more challenges than a very slow repetition because tendons are also affected by the rate or speed of loading, and triceps tendinopathy does not mean that you have to discontinue all training. (Tendinitis)
Instead, you have to find a level of training that allows you to have tolerable symptoms somewhere around a three out of ten pain or less while making objective progress in your lifts. Symptoms for tendinopathies can often take three or more months to resolve, so the focus should be on improving function over the long term. The most important concept to understand for any teninopathy is load management. (Tendinitis)
Essentially, you’re attempting to achieve a Goldilocks principal level of load, not too much where you’re exacerbating symptoms and prolonging recovery, but not too little where you’re deconditioning and not driving. Beneficial adaptations start with the big picture. (Tendinitis)
Has your training changed significantly in the past three months? That may have contributed to symptoms? Did you alter frequency, volume, and or intensity? Analyze your current program to see if there’s any reasonable modifications that you can make based on any significant fluctuations in these variables that might have occurred over the past few weeks or months. (Tendinitis)
The next things you’re going to look at are exercise selection, technique, and tempo as they relate to your compound multijoint exercises, assuming they’re part of your normal routine. The three main pushing movements that target the triceps include a vertical press where your arms end up overhead, a horizontal press where your arms end up straight out in front of you, and a dip where your arms end up down at your side. (Tendinitis)
The easiest thing to start with here is finding exercise variations that are most comfortable for you. For example, an overhead press can be done with a barbell. Dumbbells, kettlebells, or unilaterally. Horizontal pressing can include any type of pushup, bench press, dumbbell press, machine press, or even incline options. Now, if your symptoms are exactly the same regardless of the movement, you can try to modify your technique to reduce the demand on your triceps. (Tendinitis)
For example, a wider pushup or bench press will likely challenge the triceps less than a very narrow pushup or bench press. For an overhead press, you can shorten the range of motion. Bringing the bar all the way down where your elbows are maximally flexed will place more load on the triceps than if you limit the movement to about 90 degrees of elbow flexion. Finally, you can alter the tempo. A lot of tendinopathy protocols implement a three second eccentric, 1 second pause, and three second concentric. (Tendinitis)
These aren’t inherently special numbers, but decreasing the speed of the movements can be helpful, as mentioned earlier. Also, it’ll force you to use a lighter load, and the consistent tempo can help with maintaining technique and tracking. Objective progress next up, examining single joint isolation exercises. There are four main types for the triceps elbow extension with the shoulder in maximal flexion, elbow extension with the shoulder flexed to 90 degrees, elbow extension with the shoulder in neutral, and elbow extension with the shoulder extended. (Tendinitis)
While the multijoint exercises are optional, depending on your goals, picking one to two of the isolation exercises will be necessary to ensure appropriate loading of the triceps. Just like the compound exercises, though, you can try to find variations that work best for you. I’d try to implement a fairly strict, consistent technique with that same tempo initially for one to two exercises. For example, a dumbbell skull crusher can be done with shoulders maintained at 90 degrees of flexion, no shoulder, internal or external rotation, bringing the weight to 90 degrees of elbow flexion and then straightening the arms.
A similar technique could be used for a standing triceps press down with a rope bar or band. I’d highly recommend executing these one arm at a time. These would be done for three to five sets of six to twelve repetitions, two to three times per week at a three out of ten pain or less at an intensity that is close to failure. I’ll give a sample routine at the end of the video. Lastly, accessory exercises. There’s no research to support this for tricep tendinopathy, but other elbow issues benefit from strengthening of the shoulder. (Tendinitis)
Therefore, I would expect the same here, especially since the long head of the triceps also moves and stabilizes the shoulder. I’m going to pick three options. One, supine shoulder flexion with a dumbbell while trying to keep the elbow straight and low back flat against the ground or bench. This movement will strengthen the shoulder extensors, including the long head of the triceps in a lengthened position while also improving your shoulder flexion range of motion, which may transfer well to something like an overhead triceps extension. (Tendinitis)
Three sets of six to eight reps with a slow tempo to emphasize the eccentric portion of the movement is a good place to start. Number two, strengthening the shoulder extensors in a shortened position. This can be done with a straight arm banded pulldown or in a prone position with the hands behind the back. The banded movement may have some carryover to a standing triceps press down, while the prone variation may carry over to something like a dip by improving your shoulder extension range of motion. (Tendinitis)
Lastly, it never hurts to include direct rotational work. You can perform knee supported external rotation with a slow tempo for three sets of ten to 15 reps to improve your shoulder external rotation strength as well as your shoulder internal rotation range of motion. You don’t necessarily have to do all of them. You can pick one to three exercises to perform two to three times per week that support your goals. For example, you might notice a deficit in range of motion or strength on your affected side that you want to specifically target with regards to other treatments, massage, foam, rolling, stretching, et cetera. (Tendinitis)
If you like those things, they feel good and they aren’t taken away from the progress of your resistance training or causing flare ups. Go for it. Otherwise, I’m indifferent. Let’s summarize. Triceps tendinopathy comes down to a load management issue. The first thing you want to do is identify if you’ve had significant changes in volume, intensity and or frequency within your training over the past few weeks or months. (Tendinitis)
If so, try to modify those variables first. Next, address your compound exercises. Try to find options that are comfortable for you. If that’s not possible, modify the technique to decrease the demand on the triceps and use a slower tempo. Finally, you want to implement isolation exercises to ensure appropriate loading of the triceps while also incorporating some shoulder accessory work to potentially support the area. (Tendinitis)
I can’t provide a specific program that’s going to work for everybody watching because you’ll have different training histories, goals, chronicity and severity of symptoms, et cetera. But a very general layout using an upper lower split might look something like this. Monday and Thursday are leg days, Tuesday and Friday are upper body days. During those upper body days, you might start with two to four compound pushing and pulling exercises for three to four sets each. (Tendinitis)
Then you may move on to single joint exercises like bicep curls and standing tricep pushdowns for three to five sets of six to twelve reps. Finally, you might end with something like the supine shoulder flexion for three sets of six to eight reps. Wednesday and Saturday are rest days, and Sunday is an optional day to do another triceps exercise and accessory exercise. Some points before I finish the video, expect the process to take at least three months, if not longer. (Tendinitis)
Expect there to be some ups and downs, but understand that occasional flareups don’t necessarily mean you’re damaging anything. Just adapt the programming as needed. Be patient. Focus on improving function in the form of increased sets and reps. Rather than only gauging progress based on symptoms, you can continue doing. (Tendinitis)
The peronal muscles are located in the outer compartment of the lower leg. The peronius brevis originates on the lower portion of the fibula and inserts on the base of the fifth metatarsal. The peronius longus sits over the top of the peronius brevis originates higher up on the fibula and travels around the bottom of the foot to attach to the planar aspect of the medial cuneiform and base of the first metatarsal.
Both tendons wrap around the lateral malleolis, the bump on the outer portion of your ankle, and are held in place by the superior and inferior peronal retinacula. In a non weightbearing position. The peronials act as plantar flexors, pointing the foot downward and everters, turning the sole of the foot outward. During walking, the peronius longus provides stability to the transverse arch of the foot and keeps the first ray in contact with the ground. (Tendinitis)
There are three primary types of peronal tendon injuries that I’m going to categorize as traumatic or nontraumatic. An acute peronial tendon subluxation, in which the tendon has slipped out of its groove behind the lateral malleolis may occur when the superior peronal retinaculum is torn. The mechanism of injury often involves a contraction of the peronials when the ankle is in a dorsiflexed and non neutral position during stopping, landing, or a cutting maneuver. (Tendinitis)
In sports such as skiing, gymnastics, soccer, basketball, and football, complete rupture of a peroneal tendon may also occur during a high force mechanism of injury. Additionally, after any traumatic injury to the foot or ankle, the ottawa ankle rules will be used by a healthcare professional to rule out the possibility of a fracture. They’ll assess if you have the ability to walk four steps or have tenderness at the lateral malleolis, base of the fifth metatarsal, medial malleolis, or navicular. (Tendinitis)
If any of these traumatic injuries are suspected, consultation with a medical doctor is recommended immediately because surgery or immobilization may be warranted. Now let’s discuss the nontraumatic category, and when I say nontraumatic, I’m focusing on injuries that are not acute in nature and don’t require prompt medical attention. For example, it’s possible to have chronic peronal tendon subluxations or a partial tear while having little to no symptoms or loss of function. (Tendinitis)
Peronal tendinopathy refers to pain and loss of function associated with loading of the tendon. This may be an overuse injury related to activities like running or playing sports, or associated with recurring lateral ankle sprains. It’s not uncommon for chronic ankle instability and peronal tendon issues to go hand in hand. Symptoms may be reproduced with palpation of the tendons, stretching of the tendons into dorsiflexion, and inversion or contraction of the tendons into eversion. (Tendinitis)
If chronic subluxations are suspected because of a history of snapping or popping, this may be recreated with resisted dorsiflexion and eversion. The nontraumatic category is the focus of the exercises and recommendations in this video, particularly peronal tendinopathy. (Tendinitis)
The purpose of the exercise progressions that I’m going to present is to train the function of the peronials, improve their tolerance to various stressors and positions, and increase the strength and range of motion of the feet, ankle and legs in general. Key targets will be plantar flexion strength, eversion strength, dorsiflexion, range of motion and single leg stability during dynamic movements. Level one for the single leg strength progression is a body weight squat.
Gently tap your butt to a chair and stand back up. If it’s too challenging, shorten the range of motion or use your hands for assistance. Aim for three sets of 20 reps. Level two is a step up. Use a stair or objects stacked six to seven inches high. You don’t want to push off with the back leg, so focus on putting all of your weight through the working leg. If it’s too difficult, decrease the height or use your hands for assistance. (Tendinitis)
Aim for three sets of 20 reps per leg. Level three lateral step down same exact cues, except this movement will allow for a little more ankle dorsiflexion. Aim for three sets of 20 reps per leg. Level four forward step down or elevated lateral step down. You can either step forward off the step or continue to perform the lateral step down while gradually increasing the height of the step. Aim for three to four sets of eight to 15 slow and controlled reps per leg for the dynamic balance progression. (Tendinitis)
You want to ensure that the base of your big toe stays planted on the ground. If it helps, you can place an object under that area for feedback back, such as a coin. Level one single leg balance work your way up to standing on one leg for three sets of 60 seconds. Level two single leg RDL stand on one leg while keeping a slight bend in both knees. Hinge at your hips until your trunk is almost parallel with the ground, and then return to the starting position. (Tendinitis)
Repeat this movement without touching your foot to the ground. If this is too challenging, use your hands to help with balance, shorten the range of motion, or tap your foot to the ground. Aim for three sets of twelve to 15 reps. Level three three way RDL reach your arms in three directions to the left middle and then to the right. That counts as one rep. Aim for four to five reps total. Level four three way RDL with knee drive, you can progress the previous movement by adding a knee drive for the heel raise progression.
You want to keep even pressure on the ball of your foot so that you aren’t rolling off the big toe or little toe. Level one double leg heel raises on flat ground aim for three sets of 25 slow and controlled reps. Use your hands for balance as needed. Level two single leg heel raises on flat ground aim for three sets of 15 reps. Level three single leg heel raises on a step aim for three to four sets of eight to 15 reps. (Tendinitis)
Over time, you can add weight as needed. For ankle e version, you can use a band or a weight attached to your foot insideline. Let’s walk through the setup for ankle eversion on the left leg, wrap a resistance band around the end of your left foot, bring it across the bottom of your right foot, and hold it firmly with your right hand. Your left hand is going to ensure that you don’t compensate by performing external rotation of the hip as opposed to eversion of the ankle, which involves moving your foot outward. Work up to three sets of 25 reps using the most challenging resistance band you can find. (Tendinitis)
The other option is to lie on your side with your top leg hanging off the bed, bench, or table without rotating your hip. Bring the outer part of your foot up toward the ceiling, slowly lower down and repeat. Add an ankle weight if needed, and aim for three sets of 25 reps. More complex exercises, like a single leg heel raise with a band pulling outward on the midfoot, are often suggested to simultaneously train the plantar flexion and eversion actions of the peronials.
Rehab can always get as creative as you want, but I think it’s important to master and progress the basics first. Before laying out a structured program for you, I want to mention three things. One, the exercise progressions are meant to serve as a framework rather than an individualized prescription. For everyone watching this video, it’s important to tailor the exercises to your symptoms, function and goals.
Two, the exercises should always be tolerable and not cause a flare up of symptoms the following day. If they do cause a flare up, it probably means that you did a little too much and need to scale back at the next session. Three. If you intend to return to sport or higher level activities, you’ll need to include additional exercises to help get you there. Examples include hopping, jumping and running progressions, more challenging single leg exercises that place your ankle in compromising positions, and just a gradual exposure to your desired activity. (Tendinitis)
If you do perform the exercises outlined in this video, you’ll likely want to train at least two times per week, with at least two days of rest between sessions. For example, you might go through this routine on Mondays and Thursdays. As your tolerance and function improve, you might add a third training day with the same exercises or other exercises that serve a similar purpose. In this example, you might implement the movements on Mondays, Wednesdays and Fridays.
In either scenario, it would be helpful to incorporate general physical activity, such as walking or cycling for up to 30 minutes per day. As you manage symptoms associated with a peronal tendon injury, it’s important to modify aggravating activities as needed. For example, if you’re a runner, you may need to lower the mileage, pace or frequency of your runs. Additionally, it might be beneficial to focus on flat ground running initially rather than trail running or running on sloped surfaces. (Tendinitis)
If you have problems with walking and navigating your daily life, tracking your steps is crucial. It’ll help you determine your baseline level of function and tolerance so that you can slowly improve both over time. Although it seems simple, walking can be a critical component of rehab. What about shoes and orthotics? The main consideration is that you probably don’t want either forcing you into a supinated position, especially if you’ve had previous ankle sprains, and perform activities that put you at risk for future ankle sprains.
A podiatrist is someone you can consult with to discuss this topic further. In summary, peronial tendon injuries can be generally categorized as traumatic or nontraumatic. Traumatic incidents that involve an acute peronal tendon, dislocation or subluxation, complete rupture of the tendon or a fracture require immediate consultation with a medical doctor, as surgery or mobilization may be warranted.
For most nontraumatic issues that are more chronic in nature, such as peroneal tendinopathy, nonoperative management is recommended. Rehabilitation may include exercises that train the function of the perennials, improve their tolerance to various stressors and positions, and increase the strength and range of motion of the feet, ankle and legs. In general, exercise should be tolerable and performed two to three times per week. (Tendinitis)
Additionally, it’s important to modify aggravating activities, track your daily steps, and implement a gradual return to sport or your desired activity. This video is meant to serve as a framework rather than an individualized prescription. It’s important to tailor the exercises to your symptoms, function and goals or seek the assistance of a qualified healthcare provider. Thank you so much for watching. If you enjoyed the video, please hit that like button. Subscribe, turn on notifications and leave any questions or comments down below. Peace.
So tip number one is you will need relative rest for your wrists if they’ve got inflammation in them or tendonitis in them. Now, it’s quite difficult if you have a desk job and you have to type to give them rest, but you can do that through actually adjusting your workstation and using different types of things when you’re typing. So, for instance, what do I mean with that? If you think of when you use a regular mouse, then you tend to hold it in this position and these tendons work really hard with the muscles that extend your wrist. (Tendinitis)
As soon as you use an upright mouse that puts your hand in this position, you don’t use these muscles at all. You’re now using other muscles and other tendons. So that can be quite useful for some patients. Other things that can help is if you make your chair higher, because think about it. Let me just see if I can show you this. Say, for instance, I’m sitting at this level and my keyboard is there and I’m typing like that.
So if you can see the angle of my hands now, as soon as I lift myself up, that I’m slightly higher, can you see it changes the angle of the wrist. So even through just something simple like that, you can make a difference to which muscles and tendons work harder or give them a little bit of relative rest. Another feature that can be useful is that you make sure your keyboard is the right size for you.
Sometimes a larger keyboard is better, sometimes a smaller keyboard is better, because then depending on the size of it, it’s going to depend on how much you’ve actually got to use your wrists while you’re typing. So just go and think about things like that. How can you give those wrists relative rest while you’re still managing to do your work? What was it that just got into my head there while I was saying that? Something about the. (Tendinitis)
It’ll come back to me in a minute. Of course, the other thing that’s important is also to take breaks during the day, but we’ll get back to that one under point number three. So, yes, workstation adaptations is extremely important. If you’ve got tendonitis of your wrists, then tip number two is do strength training. I know stretching can make it feel, if it’s sore, it feels as if you want to be stretching it the whole time, and it can sometimes help, but you’ll find that the pain comes back quite quickly from that. (Tendinitis)
Whereas if you do strength training, one, it’s better at taking the pain away for longer than stretching alone, and two, it actually increases the blood supply and the oxygen through the muscles and attendance, which helps it to heal. And the stronger it is, the better the endurance. So the more it can tolerate the work that you’re putting through it. And it’s not rocket science, it’s anything that you use your hands with to grip hard and do exercise with will exercise the muscles of the wrist.
So to give you a few examples, a theraband is a really useful piece of kit and you can get them off Amazon. You can get packets of about five different colors, and the different colors are usually different strengths of them. So those can be useful because you start with the very easy ones, because if you go and do hard strength training on a tendon that’s painful, you can irritate it. So you’ve got to start quite gently.
Now, you can either do very isolated wrist movements. So actually, let me put this back a bit and bring this down so you can see me lower down. Okay. So if we think about it, yes, you can go and isolate the wrist muscles themselves by, I would always say support your forearm, not necessarily on your knee.
I would support it on a side of a table, that the wrist is free to come off the side of the table and move, tie this bit to something, or just hold it in your other hand like I’m going to do now, and you can just do that type of thing nice and slow and you can do it in all directions. (Tendinitis)
So if you turn your hand into this direction, you’ll be exercising different muscles. But I always feel it’s a bit of a waste if you’re just doing one muscle group at a time for things like this. And to be honest, if you isolate the tendons that much, it can sometimes irritate them further.
So I tend to use combination exercises. So, for instance, doing bicep curls with them. So if you think of a bicep curl doing that motion, yes, you’re exercising the bicep, but can you see that my wrist flexes have to work quite hard to not allow my wrist to be doing that.
So as long as you keep your wrist in a nice, good position, these muscles are now working isometrically and it’s something that’s much less likely to irritate the tendons when they saw. Same thing goes for if we think of the wrist extensors. If you do something like this movement, then yes, you’re exercising your shoulder muscles, your rotated calf, but you’re working your wrist extensions isometrically again. (Tendinitis)
So they’ve got to contract to not allow your wrist to jumble around while you’re doing it. So I prefer exercises like those. That doesn’t necessarily add extra load onto those tendons. In the same way, if you went and isolated that movement. So yes, and the nice thing about bicycles is you can do it with the hand in this position, then these tendons are getting a bit more exercise. You can do it like that and you can even do it like that.
So there’s plenty of scope there to work with. Now, tip number three is that you will have to change your habits. You cannot carry on working all day long without taking enough breaks and expect an overuse injury like that. To get better, you’re going to have to be breaking your day up. I know it’s annoying because when people get into their work they don’t like taking breaks. But doing your exercises first thing in the morning is great. (Tendinitis)
It’s not going to last for longer than an hour or 2 hours they affect. So try to get into the habit of every single hour taking a break and just doing one of those exercises. You don’t even have to do three sets of ten of them, just do ten, something like that, that you get the oxygen moving and the blood supplies moving. That way you can keep it healthy throughout the day. So honestly, just force yourself, set the alarm clock or something and listen to that alarm clock. (Tendinitis)
If it goes off, jump off, grab your band, do something ten times, go back to what you were doing and just make it non negotiable. If you want to get rid of a wrist injury like that from overuse, you’re going to have to start being good with doing things like that. So the three tips is one relative rest.
So make sure you adjust your workstation that you don’t have to use those muscles in that same way so much. Two strength training, three regular breaks with strength training in it. Excellent. Let me know if you’ve got any questions and if you need more help with your injury or you want a tailored treatment plan, you’re welcome to check out. Go to Home
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