Biceps tendinitis is a common cause for shoulder pain, especially for people who perform repetitive overhead motions such as throwing or lifting. While it’s fairly easy to diagnose, it’s annoying to have and will often require activity modifications as it heals.
What is Biceps Tendinitis?
The biceps muscle has two heads, simply named the long head and the short head. With biceps tendinitis, it’s usually the long head (which attaches to the top front of the shoulder) that gets injured. The long head tendon attaches to the shoulder joint capsule, and it is very near other important shoulder structures, such as your rotator cuff.
When the biceps tendon has any kind of abnormal or excessive stress, it may get inflamed. This includes excessive tension (pulling), compression (pinching), or shearing. If this happens repetitively, your body’s ability to heal itself may lag compared to these stresses, and this can lead to pain and injury via inflammation and swelling.
Typically, when a tendon first becomes inflamed, health practitioners refer to the injury as a tendinitis. If symptoms persist, usually longer than 2 weeks, longer-term changes may happen to the tendon (usually termed tendinopathy or tendinosus).
Risk Factors for Biceps Tendinitis:
| 1. | Repetitive overhead movements. |
| 2. | Poor movement mechanics and posture. |
| 3. | Weakness in the rotator cuff. |
| 4. | Age-related changes. |
| 5. | Abrupt increase in upper body exercise routine. |
How Do You Know If You Have Biceps Tendinitis?
People with biceps tendinitis often have a deep ache in the front of the shoulder. More specifically, pain is usually localized at the bicipital groove.
Sometimes pain can radiate distally down the arm. Symptoms will usually come on with overhead motions, pulling, lifting, or the follow-through of a throwing motion. Instability of the shoulder may also present as a palpable or audible snap when shoulder motion occurs.
Common Symptoms of Biceps Tendinitis:
| 1. | Sharp pain in the front of your shoulder when you reach overhead. |
| 2. | Tenderness to touch at the front of your shoulder. |
| 3. | Dull, achy pain at the front of the shoulder, especially following activity. |
| 4. | Weakness felt around the shoulder joint, usually experienced when lifting or carrying objects, or reaching overhead. |
| 5. | A sensation of “catching” or “clicking” in the front of the shoulder with movement. |
| 6. | Pain when throwing a ball. |
| 7. | Difficulty with daily activities, such as reaching behind your back to tuck in your shirt, or putting dishes away in an overhead cabinet. |
If your symptoms remain after 2 weeks of rest and activity modification, seek a health practitioner to confirm your diagnosis and screen for other possible conditions.
Physical Therapy for Biceps Tendinitis:
If your symptoms are persistent (have been ongoing for more than 2 weeks), then you’ve reached the point where you need to see a physical therapist. During your appointment, try your best to explain where your pain is, and what movements aggravate it. A comprehensive physical exam should include your posture and your entire upper extremity, including your neck and shoulder girdle. Additionally, some clinicians will have access to imaging techniques such as ultrasound or x-ray, but if their diagnostic exam indicates biceps tendinitis, these images may not be necessary.
Finding a health practitioner who is a skilled manual therapist may help speed up your recovery. Manual therapy is great to loosen tight muscles, mobilize stiff joints, and improve the blood flow in target areas.
Step 1: Reduce Inflammation
The first step that any health practitioner should take is to relieve any possible inflammation. Rest and anti-inflammatory medication will help to reduce inflammation and begin the healing process.
Step 2: Range of Motion
Once the pain has begun to subside, you should start to work on improving your pain-free range of motion. This will include not only the glenohumeral joint, which is what most people think of when they think of the shoulder, but also the neck, trunk, scapula (shoulder blade). If you have adequate flexibility in all of these other parts of your body, your glenohumeral joint won’t have to work as hard.
Two important ranges of motion for the shoulder include: flexion and internal rotation. You should be able to reach all the way overhead (full flexion) and have full internal rotation without pain. Having tight muscles in the back of your shoulder can lead to increased stress at the front of your shoulder, right where your biceps tendon is.
The primary goals in Step 2:
1. Keep your upper trunk flexible.
2. Allow your scapula to move freely.
3. Ensure adequate internal rotation.
Step 3: Build Strength
Early in your recovery, you can work on pain-free strengthening of the muscles in the shoulder as well as the back muscles that support the shoulder.
The rotator cuff muscles help to stabilize and protect the glenohumeral joint, so any basic shoulder-conditioning program should begin with these.
You also want to focus on stabilizing your scapula, which is the base that the humerus moves on. The shoulder girdle must be strong and stable enough to transfer all the forces between your arm and your body, and it must also be mobile enough to move with the humerus to allow for full range of motion.
Primary goals of Step 3:
1. Rotator cuff strengthening.
2. Middle and low trap strengthening.
Step 4: Functional Training
Once you’ve started the healing process, significantly decreased inflammation, gained full range of motion, and have started strengthening, you’re ready for functional training. This is the last and most rewarding part of rehab because you’re now training to regain full strength and function.
You move with your entire body in a coordinated fashion, whether you want to return to playing baseball or carry a basket of laundry. If you move improperly (PTs refer to this as aberrant motion), this places increased stress to your tissues, which can lead to damage over time. So, even if your diagnosis is biceps tendinitis, a good physical therapist will know to treat the entire body. Whatever your goal is after physical therapy, your treatment should teach you to move more efficiently and optimally prepare you to return to your normal life.
Primary goals of Step 4:
1. Ensure proper mobility of the shoulder, trunk, and scapula so you can perform movements correctly.
2. Begin with slow, coordinated movements before progressing to full-speed movements.
3. Work with a therapist, trainer, or coach to ensure that you are moving properly and efficiently!
Exercises To Prevent Biceps Tendonitis:
Flexibility Exercises
To prevent biceps tendinitis, it’s important to maintain adequate flexibility in your trunk and scapula. Flexibility is an important component of any well-rounded workout program. If you’re focused on a lot of heavy weight lifting, make sure to balance that out with stretching so you decrease your risk of injury.
1. Pec Stretch
Stand in a doorway and extend your arms out to the sides against the doorway. Push your chest forward while squeezing your shoulder blades back and down (keeping your shoulder blades packed). Ideally, you’ll feel this in your chest and not in the front of your shoulder. Hold for 30 seconds and repeat 3x.
2. Rhomboid Stretch and Massage
The rhomboids will prevent full movement of the shoulder blade when your arms are elevated. Do this stretch, or massage, to help loosen them up. Hold for 30 seconds and repeat 3x.
3. Sleeper Stretch
This stretch is meant to help improve internal rotation and prevent the humerus from sliding forward, straining the biceps tendon.
Lay on your side with your bottom arm in front of you and bend the elbow. Use your other hand and lightly push down on your bottom forearm until you feel a stretch in the back of the shoulder. Hold for 30 seconds and repeat 3x.
Strength & Stability Exercises
It’s also critical to build strength, stability, and functional movement in the musculature surrounding the shoulder joint.
4. Standing External Rotation at 90 Degree Abduction
In this exercise, we’re targeting the rotator cuff.
Raise your elbows up to 90 degrees from your shoulders with your forearms reaching forward. Holding the handle of a light resistance band in each hand, rotate your right forearm up to a cactus arm position, keeping your elbow at shoulder height. Perform 10 repetitions on your right side while keeping the left arm in the starting position. Then switch sides, performing 10 reps on the left arm. After performing 10 reps on each side, perform 10 more with both shoulders at the same time.
This will improve your rotator cuff strength and endurance. Keep your core engaged the entire time, making sure not to overarch your back when doing this exercise.
5. Inverted Row or High Rows
This exercise targets your scapular stabilizers. These muscles specifically work to keep your scapula in place. In fact, studies have shown that this exercise helps with throwing power more than the bench press or triceps strengthening.
Maximize every repetition by squeezing your shoulder blades together at the top of the exercise.
6. Crawling Patterns
Crawling patterns, like the bear crawl, are excellent exercises to build shoulder strength and closed-chain dynamic stability (including reflexive strength). Reflexive strength refers to your ability to anticipate movements before they happen, or react to movements as they happen. At the same time, crawling helps improve or maintain the flexibility of your wrists and forearms.
While this exercise might look easy, crawling is actually pretty challenging. You’ll feel your heart rate increase as you challenge your upper body, legs, and core to move your body around while keeping your shoulders and hips square.
It’s important to note – only perform this exercise if it’s completely pain-free. If there is any inflammation or restrictions in flexion, crawling can be too aggressive and re-aggravate the tissue.
7. Pushup-to-Side Plank
This exercise is meant to strengthen the stabilization of the joint in multiple directions. It will challenge your stability, as well as train you to keep your shoulder blades stable and packed when in the side plank. Don’t let your shoulders dip forward when performing the pushup or the side plank!
Alternative: If done properly, the Turkish Get up is another excellent exercise that challenges both shoulders as well as the rest of your body.
Even if you’re experiencing injury in one part of your body, for example your biceps muscle, it’s critical to look at how you move overall. The focus of your training program should not just be to look better. The purpose of training is to strengthen your bones, muscles, and mind. But moving improperly in one joint could affect your movement overall. Be mindful of your form in every exercise, train smart, and you’ll build a more injury-resistant body.
Have lingering questions? Reach out in the comments below!
I love it..
How often do you suggest doing these? I have this exact issue after having a shoulder decompression and a cuff bursar removal, the operation was one year ago, I’ve since starter weight training again.
The pain is evident sometimes immediately after training and usually lags through to the next morning, in most cases it’s gone by the following afternoon unless I’ve been particularly aggressive in my lifting.
The exercises for the rotator cuff and scapula stability can be done daily. However, it sounds like you’re still having pain with your training. I wouldn’t progress anything until this pain continues to decrease or goes away, or you may be making things worse.
Thanks Ken, I’ll give some ibuprofen a go over the Christmas period and call it quite on the training until the new year. I’ll let you know how I get on, have a nice Christmas and new year!