What it is
Posterior elbow impingement occurs when bony or soft tissues at the back of the elbow pinch in terminal extension. It is common in throwers, gymnasts, and lifters who repeatedly lock out.
Improvement comes from managing extension load, correcting mechanics, and building capacity in supporting muscles.
What happens when it occurs
At end-range extension, the olecranon engages the fossa, and soft tissues can be trapped. Repeated high‑speed extension irritates the posterior compartment. Strength, mobility, and technique reduce pinch forces.
Common causes and risk factors
- High volumes of throwing or tumbling
- Heavy lockout work in pressing or handstands
- Limited shoulder mobility or trunk contribution
Who is most affected
Throwers, gymnasts, CrossFit participants, and lifters.
Typical symptoms
- Back of the elbow pain on hard lockout
- Clicking or catching in extension
- Loss of terminal extension
When to seek care
If pain persists, if locking occurs, or if swelling follows sessions.
How we diagnose
History, end‑range extension testing, palpation, and assessment of shoulder and thoracic mobility. X-ray identifies bony change; MRI assesses soft tissues when needed.
Management
- Modify lockout volume and depth
- Strength for triceps, forearms, and scapular stabilisers
- Mobility for shoulder and thoracic extension
- Throwing or pressing mechanics to reduce terminal stress
- Injection or arthroscopy for persistent mechanical symptoms
Rehabilitation milestones
Phase 1 weeks 0 to 2: pain control, range in mid arcs, technique drills.
Phase 2 weeks 2 to 8: progressive strength, reduce lockout loads, and mobility.
Phase 3 weeks 8 to 16: gradual re‑exposure to lockout, sport‑specific drills.
Phase 4 months 4 to 6: full return with criteria.
Readiness to progress
- Pain-free end‑range extension in testing
- Strength within 90 per cent
- Sessions completed without next‑day swelling
Prevention
- Limit repeated hard lockouts in early prep
- Maintain shoulder mobility and trunk power
- Use deloads during heavy phases
Australia snapshot
- Common in gymnastics, cricket fast bowling, and strength communities
- Access to imaging and arthroscopy is broad in metropolitan areas
- Most improve with technique and capacity work
Latest insights
Pull a little stress away from terminal extension while you build strength and mobility.
Technique fixes are often the quickest wins.
