Partial tearing of the distal triceps tendon

[Robert_Paz]

Hi,

New to the forum, long time lifter. I’ve been dealing with elbow pain for the last three months which started with an inflamed bursa sac on my right elbow. I tried several rehab protocols (Starr, ripptoe chin-up protocol), reduced lifting, limited conditioning workouts with no success. I finally went to the Dr (sports medicine) who ordered an MRI, results being a partial thickness intrasubstance tearing of the distal tricep tendon.

I have full range of motion and can perform normal activities with little pain. The Dr says it will not heal but that I should see how I can work around the injury and reduce my workouts before considering surgery. Reducing workouts doesn’t exactly support strength training goals.

Following this advise I consulted with Dr. Baraki who feels like my elbow can improve substantially without surgery. He mentioned load management to desensitize the tendon. I did catch Dr. Michael Ray on a live Instagram feed and asked about load management strategies for a partially torn triceps tendon and he explained to pick movements that I would like to improve on (that’s easy: Bench press and strict press) and to use loads where pain is manageable and volume I can recover from adequately.

I took a few weeks off following my diagnosis and returned to the gym this week. I am planning to follow a LP type progression doing a pressing movement three days a week, alternating between bench and press. Chin-ups and pull-ups feel great by the way.

Monday: Bench 4x8-10, worked up to 115 with moderate pain
Wednesday: Press 4x8-10, worked up to 115 for a single and the pain made me nervous so I backed off for 4 sets of 10 @ 65 lbs
Friday: Bench 4x15

Each week I’ll alternate pressing twice a week and benching twice a week.

I’ve been lifting for 6 years having run SSLP, several TM cycles and did run the Bridge 2.0 over the summer. I’ve done power lifting meets in 2014 and 2015 but subsequently have gotten distracted with Crossfit and training for GORUCK events so my strength gains have been stagnant for the last couple of years. The injury is most likely overuse as I am 45 years old. At this point I am only interested in healing my elbow and getting stronger in order to compete again.

Am I on the right track as far as a load management strategy goes? I did listen to your live feed on the knee rehab template and am interested in applying the phase 1 strategy to my elbow where over 12 weeks I would start off with high volume and low intensity and gradually move over to lower volume and higher intensity. Do you think this approach would be beneficial in this situation?

Best Competition lifts
Squat: 418.5 lbs
Bench: 285 (competition bench), 300 TNG lbs
DL: 501.5 lbs
Best strict press: 205 lbs

I appreciate this forum and thank you for your time!

[Michael_Ray]

@Robert_Paz

Hi,

New to the forum, long time lifter. I’ve been dealing with elbow pain for the last three months which started with an inflamed bursa sac on my right elbow. I tried several rehab protocols (Starr, ripptoe chin-up protocol), reduced lifting, limited conditioning workouts with no success. I finally went to the Dr (sports medicine) who ordered an MRI, results being a partial thickness intrasubstance tearing of the distal tricep tendon.

I have full range of motion and can perform normal activities with little pain. The Dr says it will not heal but that I should see how I can work around the injury and reduce my workouts before considering surgery. Reducing workouts doesn’t exactly support strength training goals.

Following this advise I consulted with Dr. Baraki who feels like my elbow can improve substantially without surgery. He mentioned load management to desensitize the tendon. I did catch Dr. Michael Ray on a live Instagram feed and asked about load management strategies for a partially torn triceps tendon and he explained to pick movements that I would like to improve on (that’s easy: Bench press and strict press) and to use loads where pain is manageable and volume I can recover from adequately.

I took a few weeks off following my diagnosis and returned to the gym this week. I am planning to follow a LP type progression doing a pressing movement three days a week, alternating between bench and press. Chin-ups and pull-ups feel great by the way.

Monday: Bench 4x8-10, worked up to 115 with moderate pain
Wednesday: Press 4x8-10, worked up to 115 for a single and the pain made me nervous so I backed off for 4 sets of 10 @ 65 lbs
Friday: Bench 4x15

Each week I’ll alternate pressing twice a week and benching twice a week.

I’ve been lifting for 6 years having run SSLP, several TM cycles and did run the Bridge 2.0 over the summer. I’ve done power lifting meets in 2014 and 2015 but subsequently have gotten distracted with Crossfit and training for GORUCK events so my strength gains have been stagnant for the last couple of years. The injury is most likely overuse as I am 45 years old. At this point I am only interested in healing my elbow and getting stronger in order to compete again.

Am I on the right track as far as a load management strategy goes? I did listen to your live feed on the knee rehab template and am interested in applying the phase 1 strategy to my elbow where over 12 weeks I would start off with high volume and low intensity and gradually move over to lower volume and higher intensity. Do you think this approach would be beneficial in this situation?

Best Competition lifts
Squat: 418.5 lbs
Bench: 285 (competition bench), 300 TNG lbs
DL: 501.5 lbs
Best strict press: 205 lbs

I appreciate this forum and thank you for your time!

Hey Robert,

Thanks for the question. Sorry to hear about the tricep strain. Regarding load management, I think it’s crucial that we set the appropriate goal here. We aren’t training to make strength gains, but instead to try and return you to baseline prior to dealing with this issue. This premise will make it much easier to adjusting loading and embrace the process. I’m in agreement with Austin, this doesn’t sound like a surgical case (although I’d need a consult to fully weigh-in on this). With that said, starting with higher volume and low intensity with tempo work would be my recommendation for this issue. The higher volume and tempo will regulate the external load you are able to lift and we can likely keep RPE (internal intensity) slightly higher because of this, which will allow you to feel like you are still getting training completed.

Here’s an example approach:

Week 1: 4 x 10 at RPE: 5-6
Week 2: 4 x 10 at RPE: 5-6
Week 3: 4 x 8 at RPE: 5-6
Week 4: 4 x 8 at RPE: 6-7
Week 5: 4 x 6: at RPE: 6-7
Week 6: 4 x 6 at RPE: 7-8 etc.

If you need further guidance, we’d be happy to consult with you: Contact Us | Barbell Medicine. Keep us posted.

[Robert_Paz]

Michael,

Thank you for the response. I’ve been following the protocol with good results.

11/26 Bench 3x15 (45, 65, 65) elbow felt painful
Squat 5x5, 295, RPE 8
Rows 4x8 (135, 155, 175, 185) RPE 5, 6, 8, 9 respectively

11/27 off

11/28 Press 3x15 (45, 65, 85) elbow felt painful
Squat 2x5, 235 RPE 7
chin-ups 5xME (5,6,6,5,5)

11/29 off

11/30 Bench 3x15 (65, 95, 95) painful, had to stop each set at 10 reps due to pain, waited about 30 seconds then finished the set
Squat 1x5, 320 RPE 9 (felt very heavy)
DL 1x5, 350, RPE 8, elbow didn’t hurt but I could feel the tendon being “pulled”. Felt a little apprehensive before the set. Thought about going heavier after the set of 5 but decided against it.

12/3 Squat 3x5, 300 RPE 8
Press 3x12 (65, 95, 95) painful
Rows 4x8 (135, 155, 175, 190) RPE 5, 6, 8, 9 respectively

12/4 3 mile run(adding back in conditioning work), core work: 100 hollow rocks, 100 tucks, 100 flutter kicks

12/5 Squat 2x5, 240 tempo squats RPE 7, then 2x5, 300 belted squats, RPE 9, I was sore which made these challenging
Bench 3x12 (65, 95, 95) again painful, had to stop each set at 10 reps due to pain, waited about 30 seconds then finished the set
Pull-ups 5xME (These felt strange on my elbow, not painful but did not feel good. (3, 5, 5, 5, 5)

12/6 3 mile run in the AM, took the rest of the day off

12/7 Squat 1x5, 325 RPE 9, felt good, concentrated on elbow position. I tend to drive my elbow up too high.
Press 3x12 (65, 65, 65) elbow felt very painful today, did not feel comfortable moving up in weight. felt frustrated.
DL 1x5, again felt apprehensive before the lift, especially since my Press right before did not go well. Pulled 355 for 5 and never felt anything in my elbow. Felt encouraged! Loaded up 365 for 3 and my elbow felt great!

12/10 Busy day in the office, quick sesh…Squat 3x5, 305, RPE 8

12/11 Track workout in the morning, total miles 3.6
Warm up with push-ups but only doing the eccentric half of the movement, 3x10
Bench 3x10 (95, 95, 95) elbow felling better but still painful. Did 2 sets of 5 with 135, weight feels light but elbow hurts.
Row 3x8 (135, 155, 175) RPE 5, 6, 8
Chin-ups 5xME (4,5,5,5,5)
core work: 100 hollow rocks, 100 tucks, 100 flutter kicks, 100 mountain climbers (was curious to see how the elbow felt doing these)

12/12 Got talked into a WOD today before squats. First WOD in a month
6 rounds
10 single arm DB snatch, 55, Rt arm only
20 pistols

Cash out: 500m row
16:30…felt great to move
waited 5 min then,
Tempo squats 2x5, 245 RPE 9 after that wod, then belted squats for a single set of 5 at 305, RPE 9. Legs are smoked.

I’ve been icing my elbow 2-3 times a day and wearing a compression sleeve. Not taking any NSIADS, read this is counterproductive for tendinopathy. I’ve accepted that this may take a considerable amount of time to recover from. Will keep you posted on workouts. I read Jordan’s write up on pin bench. Thinking of incorporating this for the eccentric adaption. What are your thoughts?

Robert

[Robert_Paz]

12/13 PIN Press 3x10 (95, 95, 95) RPE 8

The elbow feels great doing these! very little pain, only slight discomfort on the last couple reps. This is very encouraging. Excited to try pin bench tomorrow. Elbow did look slightly inflamed after.

What’s your experience using voodoo wraps on the elbow area for warming up?

[Michael_Ray]

@Robert_Paz

Michael,

Thank you for the response. I’ve been following the protocol with good results.

11/26 Bench 3x15 (45, 65, 65) elbow felt painful
Squat 5x5, 295, RPE 8
Rows 4x8 (135, 155, 175, 185) RPE 5, 6, 8, 9 respectively

11/27 off

11/28 Press 3x15 (45, 65, 85) elbow felt painful
Squat 2x5, 235 RPE 7
chin-ups 5xME (5,6,6,5,5)

11/29 off

11/30 Bench 3x15 (65, 95, 95) painful, had to stop each set at 10 reps due to pain, waited about 30 seconds then finished the set
Squat 1x5, 320 RPE 9 (felt very heavy)
DL 1x5, 350, RPE 8, elbow didn’t hurt but I could feel the tendon being “pulled”. Felt a little apprehensive before the set. Thought about going heavier after the set of 5 but decided against it.

12/3 Squat 3x5, 300 RPE 8
Press 3x12 (65, 95, 95) painful
Rows 4x8 (135, 155, 175, 190) RPE 5, 6, 8, 9 respectively

12/4 3 mile run(adding back in conditioning work), core work: 100 hollow rocks, 100 tucks, 100 flutter kicks

12/5 Squat 2x5, 240 tempo squats RPE 7, then 2x5, 300 belted squats, RPE 9, I was sore which made these challenging
Bench 3x12 (65, 95, 95) again painful, had to stop each set at 10 reps due to pain, waited about 30 seconds then finished the set
Pull-ups 5xME (These felt strange on my elbow, not painful but did not feel good. (3, 5, 5, 5, 5)

12/6 3 mile run in the AM, took the rest of the day off

12/7 Squat 1x5, 325 RPE 9, felt good, concentrated on elbow position. I tend to drive my elbow up too high.
Press 3x12 (65, 65, 65) elbow felt very painful today, did not feel comfortable moving up in weight. felt frustrated.
DL 1x5, again felt apprehensive before the lift, especially since my Press right before did not go well. Pulled 355 for 5 and never felt anything in my elbow. Felt encouraged! Loaded up 365 for 3 and my elbow felt great!

12/10 Busy day in the office, quick sesh…Squat 3x5, 305, RPE 8

12/11 Track workout in the morning, total miles 3.6
Warm up with push-ups but only doing the eccentric half of the movement, 3x10
Bench 3x10 (95, 95, 95) elbow felling better but still painful. Did 2 sets of 5 with 135, weight feels light but elbow hurts.
Row 3x8 (135, 155, 175) RPE 5, 6, 8
Chin-ups 5xME (4,5,5,5,5)
core work: 100 hollow rocks, 100 tucks, 100 flutter kicks, 100 mountain climbers (was curious to see how the elbow felt doing these)

12/12 Got talked into a WOD today before squats. First WOD in a month
6 rounds
10 single arm DB snatch, 55, Rt arm only
20 pistols

Cash out: 500m row
16:30…felt great to move
waited 5 min then,
Tempo squats 2x5, 245 RPE 9 after that wod, then belted squats for a single set of 5 at 305, RPE 9. Legs are smoked.

I’ve been icing my elbow 2-3 times a day and wearing a compression sleeve. Not taking any NSIADS, read this is counterproductive for tendinopathy. I’ve accepted that this may take a considerable amount of time to recover from. Will keep you posted on workouts. I read Jordan’s write up on pin bench. Thinking of incorporating this for the eccentric adaption. What are your thoughts?

Robert

Glad to hear things are going well overall.
Regarding icing - I consider this a net neutral. The last I looked into efficacy of icing, it doesn’t decrease or expedite healing or recovery of the area (perhaps the research has changed since I last checked a few years back). I don’t typically recommend icing in clinic to patients unless they are wanting the numbing effect that comes with it. Same response for compression sleeves - net neutral and no supportive evidence it will be beneficial or harmful in this instance (although I typically argue here the negative is conditioning unnecessarily to an implement that isn’t needed).

“What’s your experience using voodoo wraps on the elbow area for warming up?” - Warming-up should involve performing the movement you are training at lower intensity. Voodoo floss is bullshit. The research on it is equally shit. I did a podcast a while back about voodoo floss - http://www.clinicalathlete.com/clinical-athlete-podcast/2017/7/4/voodoo-mind-tricks-will-this-dorsiflexion-help-my-shrunken-head. Keep us posted.

[Robert_Paz]

12/14
Squat 1x5, 330 RPE 9, back off set 1x5, 305 RPE 8
Pin bench press 3x10 135 (Elbow feels a little painful on the last couple of reps)
DL 1x5, 365 easy set. The elbow feels great doing pulls
Chin-up 5xME (6,6,6,4,5)

Gotcha on the voodoo floss. I’ll check out the podcast.

[Robert_Paz]

12/17
Squat 5x5, 310
Pin press 4x10 (95, 95, 95, 95) No change, weight feels light, elbow feels painful.
Rows 4x6, (135, 155x6, 175x6, 195x6)
Pullups 5xME (6,6,6,5,5)

12/18
Conditioning and core work

12/19
Squat 2x5, 245
Pin Bench 4x10 (120, 125, 135, 140) Elbow feels painful

12/20
Conditioning work

12/21
Squat 1x5, 335
Pin press 4x10 (100, 100, 100, 100) Elbow really hurts today
DL 1x5, 370

11/24
Squat 5x5, 315
Pin bench 4x8 (115, 115, 135, 140) no change, lots of pain. Pain increases with heavier weight.
Rows 3x3, 225
Chins ME in 7min (47 chin-ups)

I do not feel like my elbow is healing. It is in constant pain even when not training. After each workout of pressing or bench, the bursa sac begins to turn red and swell up. Ice and compression seems to get the swelling down. I still have full range of motion in my elbow and can perform normal activities except anything that requires throwing or intense pressing. Do I continue with this protocol with the understanding that the tendon will take a lot linger to heal than expected?

[Michael_Ray]

@Robert_Paz

12/17
Squat 5x5, 310
Pin press 4x10 (95, 95, 95, 95) No change, weight feels light, elbow feels painful.
Rows 4x6, (135, 155x6, 175x6, 195x6)
Pullups 5xME (6,6,6,5,5)

12/18
Conditioning and core work

12/19
Squat 2x5, 245
Pin Bench 4x10 (120, 125, 135, 140) Elbow feels painful

12/20
Conditioning work

12/21
Squat 1x5, 335
Pin press 4x10 (100, 100, 100, 100) Elbow really hurts today
DL 1x5, 370

11/24
Squat 5x5, 315
Pin bench 4x8 (115, 115, 135, 140) no change, lots of pain. Pain increases with heavier weight.
Rows 3x3, 225
Chins ME in 7min (47 chin-ups)

I do not feel like my elbow is healing. It is in constant pain even when not training. After each workout of pressing or bench, the bursa sac begins to turn red and swell up. Ice and compression seems to get the swelling down. I still have full range of motion in my elbow and can perform normal activities except anything that requires throwing or intense pressing. Do I continue with this protocol with the understanding that the tendon will take a lot linger to heal than expected?

I recommend getting a consult with us so we can provide some individual advice. Sorry to hear this has persisted but I think we can likely help guide the path to your goals.

[Robert_Paz]

11/25
Ruck and core-work

11/26
Pin press 4x8 (95, 105, 110, 95) very pain full, backed off a little on weight for the last set
Tempo squat 2x5, 250
Conditioning work

12/27
Conditioning/core

12/28
Squat 1x5, 340 Squats feeling good but I’m pulling my elbow up on the last rep which is causes slight pain.
Pin bench 4x8 (95, 115, 135, 140) pain is 4/10
Paused DL 1x5, 370, elbow popped on the first rep and felt no pain the entire set. DL feeling strong

I found your podcast on tendinopathy and a paper referenced in Stronger by Science on tendinopathy, which is a very good read! After doing some research I’m very encouraged.

I’m about to leave for a week on a family vacation and I am not sure what gym facilities I’ll have access to. Next week I’ll continue the protocol with slow tempo push-ups. I do plan on contacting you for a consult when we are back in town. Thank you for the feedback so far and have a Happy New Year!

[Michael_Ray]

@Robert_Paz

11/25
Ruck and core-work

11/26
Pin press 4x8 (95, 105, 110, 95) very pain full, backed off a little on weight for the last set
Tempo squat 2x5, 250
Conditioning work

12/27
Conditioning/core

12/28
Squat 1x5, 340 Squats feeling good but I’m pulling my elbow up on the last rep which is causes slight pain.
Pin bench 4x8 (95, 115, 135, 140) pain is 4/10
Paused DL 1x5, 370, elbow popped on the first rep and felt no pain the entire set. DL feeling strong

I found your podcast on tendinopathy and a paper referenced in Stronger by Science on tendinopathy, which is a very good read! After doing some research I’m very encouraged.

I’m about to leave for a week on a family vacation and I am not sure what gym facilities I’ll have access to. Next week I’ll continue the protocol with slow tempo push-ups. I do plan on contacting you for a consult when we are back in town. Thank you for the feedback so far and have a Happy New Year!

No problem! Happy New Year to you as well.