Do you have pain at the front of your shoulder or elbow with lifting things? Is it a nagging pain that is getting worse over time and just won’t go away?
By lifting things, I don’t mean just dumbbells. All day long you’re likely lifting things. Think about it. Maybe one or two of these are tasks you can relate to.
Your toddler is on the ground screaming so you walk by and lift them up to calm them down.
You went grocery shopping and you’re carrying ten bags of groceries at a time inside because any less would prove you’re weak.
Finally, your washer and dryer aren’t right next to your closet (because that wouldn’t make any practical sense) so you have to carry your hamper all the way to the laundry room.
Your biceps are in constant use throughout the day, so if yours is injured and bothering you, it’s your safest bet to address it as soon as possible.As a physical therapist, I can attest to the fact that most bicep tendon issues do resolve themselves within 1-3 months with conservative treatment, but you’ve got to be sure you’re decreasing or modifying the activity that’s caused the biceps to get irritated in the first place (See Related: About Me)
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What is bicep tendonitis?
Bicep tendonitis is also called bicipital tendonitis. There are two possible locations for bicep tendonitis: proximal and distal. Why are there two locations? That’s because the bicep muscles become tendinous when they attach to the bone up at the shoulder and also down at the elbow. So both areas are susceptible to tendonitis overuse injuries.
Let me just clear up their names first.
Proximal biceps tendonitis = at the front of the shoulder
Distal biceps tendonitis = at the front of the elbow
Some common symptoms include feeling a vague, snapping pain at the front of the shoulder, a popping or catching when the arm rotates, swelling, and pain.
Common Causes of Bicep Tendonitis
The three most common causes of bicep tendonitis are repetitive overhead movements, having other nearby shoulder injuries, and your shoulder anatomy.
The most common cause of bicep tendonitis is repetitive movements especially overhead. Picture a baseball player bringing the ball up and out to throw is - their shoulder is abducted and externally rotated overhead. That repetitive movement often leads to bicep tendonitis. So people who are pitchers, racquet players, or swimmers are more prone to this injury.
In addition, other injuries can also greatly impact the biceps. For example, a rotator cuff tear & shoulder impingement often leads to a bicep tendinopathy or tear because they’re in close proximity at the shoulder. Another injury is a shoulder laxity, dislocation, or subluxation where the humerus moves too much and even dislocates causing a bicep injury or tear.
Lastly, the anatomy of the shoulder makes many of us more prone to shoulder impingement and tendon injury. Why? Well the head of the humerus (the large upper arm bone) likes to migrate upward, especially if we have a weak rotator cuff. This leads to impingement (pinching) of the structures that sit just above it like the long head of the biceps. So what am I saying? A weak shoulder can lead to bicep pinching and with more and more repetition over time, that can cause fraying and inflammation of that tendon, hence the tendonitis (which means tendon inflammation).
Location & Muscles Affected by Elbow Tendonitis
We first need to clear up the biceps brachii because it’s composed of two muscle heads: long head and short head.
Long head is more lateral and it originates at the supraglenoid tubercle and inserts at the radial tuberosity
Short head is more medial and it originates at the coracoid process and inserts at the radial tuberosity
Stand with your palm facing forward on your dominant arm. Now bend your arm and tense it as if you’re lifting something to fire your biceps. With your non-dominant hand, palpate (feel) the biceps - your guns! You can feel the muscle bellies and then move your way down to where they feel more like ropes - that’s where they turn into tendons before attaching to the bone in your forearm (near your elbow).
Testing for Bicep Tendonitis
Testing for bicep tendonitis typically begins in Physical therapy with some range of motion (ROM) tests, manual muscle selective tissue tensioning tests (testing tendon strength), muscle length tests (testing flexibility), manual muscle testing, palpation tests, and special tests (like Yergason’s).
Typical test results: tenderness to palpation near the origin or insertion, decreased and painful flexibility, strong but painful tendon strength testing, decreased strength (for the four main muscle actions), and swelling.
The biceps do these four actions: elbow flexion, wrist supination, shoulder flexion, and shoulder internal rotation (IR).
Bicep tendonitis is often easily diagnosable with the tests above. So from there, it’s typically suggested you perform 6-8 weeks of Physical therapy. Then if there is no improvement, your Physician may suggest further testing like getting an Xray, MRI, or ultrasound.
Conservative Treatment for Bicep Tendonitis
Disclaimer: The information provided is not intended to be a substitute for professional medical advice, diagnosis or treatment. Never disregard professional medical advice, or delay in seeking it, because of something you have read on this website. Never rely on information on this website in place of seeking professional medical advice.
Now that you better understand what bicep tendonitis is, what causes it, and which muscles are involved let’s now cover what you’re likely most interested learning about: treatment for bicep tendonitis.
Physical therapy treatment should always be 100% customized to you: the stage of your injury (recent/acute or chronic), your history, your activity level, your job, your impairments, your abilities, and your goals.
With that said, the below treatments are general treatments often prescribed by Physical therapists for bicep tendonitis, including many exercises for bicep tendonitis. Always consult your Physician before beginning any new exercise program.
Treatments for elbow tendonitis (from basic to advanced):
- Rest (less or modified repetitive aggravating activity)
- Joint mobilization (level depends on stage of injury; plus mobilization with movement (MWM))
- Range of motion exercise (without a pain-free range) like Pendulums (see Video)
- Stretching (plus contract-relax technique)
- Strengthening exercise (including isometrics)
- Functional exercise
- Manual/Massage: soft tissue massage, deep tissue massage, cross friction massage (if not an acute injury), dry needling
- Modalities: Ice, Ultrasound
- Postural education (less rounding, forward shoulder posture)
- Sling (if prescribed and more severe)
If those conservative treatments don’t help then PRP injections, corticosteroid injections, or even surgery may be needed (especially if there are other tears or injuries included).
Below are some products from Amazon that are often useful for addressing elbow tendonitis pain:
Physical Therapy Exercises for Bicep Tendonitis
In the following videos, I share how to test for bicep tendonitis, how to feel for tenderness, how to improve range of motion for the elbow and shoulder, how to stretch the biceps, how to improve shoulder mobility, and finally some strengthening exercises for bicep tendonitis.
How to Test Bicep Tendonitis
Yergason’s test: Manual resistance is applied against shoulder external rotation (ER) and supination. The test is positive if there’s pain in the bicipital groove.
How to Palpate for Bicep Tendonitis
Proximal: Place your index finger on one tubercle and the ring finger on the other tubercle. The middle finger is now between the other two fingers to palpate the area of the bicipital groove. This is where the tendon of the long head of the biceps brachii lies.
Distal: Place one hand on the front elbow crease. With the other arm, bring your palm up with the elbow bent and you’ll feel the distal tendon pop out into your fingers.
Mobility Exercises for Bicep Tendonitis
Range of Motion and Stretching for Bicep Tendonitis
Stretching for Bicep Tendonitis
Strengthening Exercises for Bicep Tendonitis
Mission: Mobilize, Modify, Move
It’s my goal to ensure you learn three things with every blog post: how to mobilize your body, how to modify exercise, and how to optimize your movement.
Above I shared a video for dynamic bicep mobility and stretching. I also shared some great bicep strengthening and shoulder stability exercises. Strengthening the biceps helps stimulate blood flow to the muscle to help speed up the healing process.
Now, let’s cover some ideas for how to modify exercise if you have bicep tendonitis:
- Consider adjusting your workout split to focus more on lower body and core more often temporarily until your shoulder and elbow feel better.
- Modify upper body exercises by working within a comfortable range of motion, using lighter loads, slowing things down, and adjusting your grip.
- Throughout the day, modify any of the overhead repetitive movements you make as that’s possibly the true cause of the inflammation.
Finally, if you plan to continue to strength train, I suggest you try these things out to move more optimally:
- Warm-up appropriately prior to lifting. Try using a band to do some light, high rep bicep curls, wrist supination work, and shoulder rotational work.
- During strengthening exercises, an eccentric-accentuated focus is shown to be effective for tendonitis.
- Definitely modify or skip these exercises temporarily: overhead press, bench press, and holding a barbell on your upper back. An easy substitution for overhead presses would be to switch to an incline press instead. So instead of working at 170-180 degrees of overhead shoulder flexion, you can work at around 120-130 degrees of flexion which may be more comfortable for you.
If any of what I said is confusing or you want additional help with addressing your impairments, be sure to watch the webinar “Outsmart your Injury” to learn more about exercise modification and how you can take control of your injury instead of letting it control you. Then reach out and let’s chat!
Thanks for reading!
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