If you have bicep tendonitis, we will cover four simple exercises to address the issue before it reaches the worst-case scenario of tendon rupture.
The good news is that this routine won’t just help prevent the worst-case scenario. You will also strengthen the supporting muscles to get back to pain-free shoulders for good.
This article will specifically cover the underlying causes of proximal bicep tendonitis. Dr. B also has some insight into what she’s commonly seen in her practice.
You can follow along with video instructions on YouTube: 4 Unique Exercises to Fix Bicep Tendonitis.
With proximal bicep tendonitis, most people have pain in the front of the shoulder. You can often feel the tendon. Look for the division in the deltoid in the front of your shoulder. Place your thumb in the division, then hold your elbow at a roughly 90-degree angle and rotate your forearm back and forth. You will feel the groove where the tendon sits.
If you touch it and it’s painful, that indicates that some work needs to be done to restore pain-free movement.
Dr. B says:
“Classically if you are in the impingement range [60 to 120 degrees of flexion] with your arm and you internally rotate, you may feel a lot of pain in your proximal bicep tendon. That’s going to irritate the area and you may feel a little click.”
One of the interesting surgery recovery trends Dr. B noticed in her practice involved fraying or a rupture on the long head of the biceps. Patients who did not have fraying or ruptures made more rapid recovery progress than people who did have those issues.
Focusing on preserving the long head of the biceps against wear and tear can help provide a speedier recovery after shoulder surgery and the ability to restore normal shoulder mechanics.
Let’s say you’ve had a shoulder pain that keeps showing up. It is centered at the front of your shoulder and is starting to drive you nuts.
At first the pain would come and go, but now it’s becoming more constant.
The pain has alternated between dull and achy to sharp and focused. The sharp pain tends to really show up when you are reaching above you – say to grab some glasses out of your cabinet or shoot a basketball at the hoop.
You first try to ice the tender area, holding an ice pack to the front of your shoulder as you relax at the end of each day, but nothing really changes.
So you switch to heat, hoping a heating pad will help ease the pain. Unfortunately, you don’t have much luck.
You try stretching the area – doing your basic shoulder and upper arm stretches to no effect. You start popping some over the counter pain meds, but whatever brief relief these give you never last.
You’ve tried everything to treat this site of pain, but sustained relief never comes.
Why? Because the pain you’re trying to treat is biceps tendonitis and is actually a symptom of a more complex issue. And trying to treat that symptom without addressing the root cause isn’t going to get you very far.
Bicep Tendonitis Basics
Bicep tendonitis (or biceps tendinitis as it is sometimes spelled) is inflammation and aggravation of a tendon connecting your biceps muscle to your shoulder.
This inflammation can cause pain at the front of the shoulder, plus other symptoms like tenderness and weakness.
The pain may be sharp or dull, and it might radiate down the arm or the neck . The pain and weakness may get worse after or during activities, especially those that involve overhead motions like throwing or lifting.
There are two upper tendons of your biceps – the long head and the short head. The short head originates from the coracoid process of the scapula and the long head originates from the supraglenoid tubercle. The long head of the biceps tendon is usually the culprit in biceps tendonitis.
Image by www.moveforwardpt.com
Excessive or improper forces on the tendon (which may be caused by a variety of reasons that we’ll get to later) can lead to this initial aggravation.
At first, your tendon starts to swell and the area becomes sensitive and inflamed. Over time, the tendon covering might start to thicken and enlarge, further aggravating the area .
It’s important to understand that the inflammation itself, or the tendonitis, is more of a symptom than anything. It is NOT in and of itself the real root cause of the pain.
In some cases, all of this irritation and swelling can eventually lead to a tear of the tendon. However, that is a pretty extreme case, and not what we are going to focus on here.
Instead, let’s focus on getting this inflammation under control before it gets to that point. To better understand the situation and what can go wrong to cause bicep tendonitis, let’s take a deeper look at the anatomy of the area.
There are three bones that come together to make up your shoulder joint – your scapula (or shoulder blade), your collarbone (or clavicle), and your humerus (or upper arm bone).
The round head of your humerus sits into a shallow cavity in your scapula, called the glenoid cavity. These two parts make up the “ball” and “socket” of this ball-and-socket joint.
Along the front of your humerus sits the biceps muscle. The muscle works mainly to flex the elbow and supinate (or rotate outward) the forearm. However, the muscle also helps to provide some flexion at the shoulder joint .
As we’ve touched on, the biceps originates at two different parts of the scapula. As the muscle runs upwards, becoming the biceps tendon, the tendon separates into the two distinct branches. The short head attaches to the coracoid process on the front of the clavicle.
The long head runs up the bicipital groove of the humerus. It then crosses over the head of the humerus before attaching the very top of the shoulder joint, at the glenoid cavity.
At the distal, or far end, it crosses the elbow and inserts onto your radius, in the forearm. However, it is the origin of the long head of the biceps tendon, at such a crucial spot, that sets the tendon up for vulnerabilities to inflammation.
Getting to the Root of Bicep Tendonitis
Because both heads of the biceps are connected to your shoulder blade, the position and functioning of these two structures are very closely tied.
If your biceps is tense and tight, it can produce a pulling force on the scapula, interfering with its position and functioning.
And conversely, if scapular positioning is out of whack, the biceps tendon might start to get impinged, pinched, or otherwise aggravated by the surrounding structures.
This brings us to the real, root causes of bicep tendonitis – the causes you will have to address if you want to see results, and not end up like the frustrated symptom-treater at the beginning of this article.
There are 3 main causes we are going to focus on: scapulohumeral rhythm, poor posture, and rotator cuff dysfunction.
1. Scapulohumeral Rhythm
One common cause of bicep tendonitis is trouble with scapulohumeral rhythm – how the shoulder blade and upper arm move and function together.
This is important in both overhead and horizontal movements like pushing and pulling.
To lift your hand up to throw a ball or grab something off a high shelf, these two bones have to move together harmonically.
The scapula has to rotate the whole glenoid cavity upwards, at which point your upper arm can move freely overhead.
Image by changethewayyoumove.ca
The two work in something close to a 2:1 ratio – for every 2 degrees of elevation coming from the humerus in the glenoid cavity, there is 1 degree of rotation coming from the scapula .
If your scapulohumeral rhythm is not functioning properly, impingements and pressure can result, causing excess tension and stress on structures like the long head of the biceps tendon.
2. Poor Posture
Poor posture is also intrinsically related to biceps tendonitis, although this connection may not seem very obvious at first. It all comes back to how posture affects the position of the scapulae, which as we’ve seen, affect the functioning of the biceps tendon.
Having an upper back that is hunched forwards (also called thoracic kyphosis – a condition all too common in the modern age) means that your shoulders are constantly rounded forward too. The posture creates improperly positioned scaps and all sorts of trouble .
This rounded back creates a less than ideal surface for scapular movement – in turn increasing the likelihood of issues with scapulohumeral rhythm and other dysfunctions at the shoulder joint.
3. Weak Rotator Cuff / Dysfunction
If the rotator cuff is weak or dysfunctional, then the biceps or other ill-suited muscle has to pick up the slack. Most commonly, your biceps will help attempt to maintain the dynamic alignment of the movement patterns or joint centration of the shoulder.
But the biceps can’t do as good of a job as your rotator cuff when it’s functioning well. So the biceps gets sore and overworked doing a job that it isn’t great at in the first place. That results in inflammation which turns into pain over time. It’s working more than it should and doesn’t get the recovery time required for the work it’s doing.
Exercises for Bicep Tendonitis Rehab
First, if you’re in acute pain, say 5 out of 10, the simplest thing to do is ice the area for 15 minutes, three times a day.
Next, Dr. B recommends pendulums because “the shoulder loves to be distracted.”
Acute Pain Pendulums
- Bend over at the waist
- Let your arm hang with gravity doing all of the work
- Gently sway your arm or swing it in a clockwise then counterclockwise motion
- Repeat for 5 minutes every hour
Performing pendulums and gentle isometric contracts (hold the wrist of your sore arm, then push and hold against your hand for 5 seconds) can really settle that acute inflammation. It won’t take your pain entirely away, but it should move the intensity from a 5/10 to around a 3/10.
Once you’re in that lower pain range, you’ll be ready to move on to the four exercises that will restore proper function and get your shoulder out of a wear and tear habit.
Quick Recommendations Before Diving In
If you know you have rotator cuff issues, skip over to our rotator cuff video and give those exercises a try first. They’ll put you on the road to recovery faster because you’re addressing the root cause.
Second, forward head posture can mess with your shoulder alignment. That stems from sleepy muscles around your spine, usually combined with sitting for hours at at time. Give these exercises a try for good spine health and getting your shoulders back in alignment.
Even if you don’t do them right now, you can use the save button on YouTube to bookmark the videos and try the exercises when it’s more convenient.
#1) ASMR: Biceps
This first exercise will release the short and long heads of the biceps. It’s crucial that the biceps tendon can glide properly. In Dr. B’s experience, the short head of the biceps (the one that comes off the coracoid) can become tight. Over time that tightness will bind the long head of the biceps and prevent it from gliding the way it should.
- Place your thumb at the junction between your pec and your biceps
- Start with your arm curled, then slowly straighten it
- While uncurling your arm, move your thumb down a little toward the elbow
Repeat for 1-2 minutes, moving your thumb down your arm as much as you wish.
You may feel tender because your thumb is putting pressure on the long head of your biceps. You will also notice that at full extension, your shoulder moves back as you extend your arm. That will put a slight extra stretch onto the long head of the biceps, which can further help release tension in the area.
#2) Active Overhead Stretch
The active overhead stretch releases some tension on the biceps. At the same time, it also activates the rotator cuff muscle (the serratus anterior) so that the biceps doesn’t have to do all of the work of the shoulder joint sensation and stability on its own.
- Face a wall and stand close
- Place your arm on the wall above your head, you may have to lean toward the wall to get a little bit of a stretch through the biceps and lats
- Keep your arm straight and locked out
- Tuck the bottom of your scapula in toward your body (posterior tilting)
- If you can lift your hand off the wall, do so.
a. If you cannot, gently move your shoulder toward the wall to stretch the area and improve your ROM
- Simultaneously, pull your humerus (upper arm bone) into the shoulder socket to activate the rotator cuff
- Hold for 5 – 10 seconds
Perform 1-2 sets at 3-6 reps each. Start slow and work up to 6.
#3) Extended Elbow Wrist Fl-Ex
The extended elbow wrist flexion-extension develops the strength of your biceps at the lengthened range of motion and terminal elbow extension. It also helps fire up your other rotator cuff muscles that contribute to the stability and centration of the joint.
- Begin with your arm extended in front of you, palm up, and elbow slightly flexed
- Ramp up activation of the biceps (focusing on the medial/inner aspect) and triceps
- Keep your muscles at full activation and slowly extend your elbow
- Continue extending your elbow to full terminal extension (not hyperextension)
- Flare your fingers and extend your wrist (hand moves backward) while maintaining elbow extensions
- Move to wrist flexion without changing elbow extension, and activate wrist muscles
- Hold for 10 seconds
- Release wrist flexion to neutral and slowly return your elbow to slight flexion, and release.
Repeat for 3 reps, and perform 1 or 2 sets.
Remember to breathe while doing this exercise. It’s normal at first to hold your breath while focusing on muscle activation.
Most people are weakest toward their terminal elbow extension. This exercise will strengthen those muscles and practice co-contraction of the rotator cuff muscles for the stability of your shoulder.
#4) Shoulder Circle Crossover
The shoulder circle crossover is one of Coach E’s favorite shoulder mobility exercises. So much so that he included it as one of the Fundamental Precision Movements.
For bicep tendonitis, the top half of the circle will net you the most benefit.
- Stand straight with your arms horizontally extended, palms facing forward
- Pull your shoulder blades together into extension
- Rotate your palms so they face backwards
- Bring your arms back behind you into further into shoulder extension
- Sweep your arms up as you rotate your palms forward until they meet at the top
- Focus on good spine posture and breathing
- When your hands meet at the top cross them in front of your body until they’re crossed horizontally in front of you
- Reverse the motion until your palms are behind you facing backward (step 4)
Repeat for 3 – 6 repetitions, and perform 1-2 sets.
This will get tiring fast because you’re maintaining constant muscle activation at full range of motion. Start slow and work up to the high end of sets and reps as your muscles strengthen.
Perform this routine 2-3 times a week for four weeks.
If you’re having some pain in the bicep tendon as you’re doing the exercise, that’s a great clue that you’re either missing activation, or you’re missing the alignment.
You can use two cues for yourself: try and pull the humeral head (maybe think of sucking the humeral head) toward the glenoid throughout the full range of motion. The second cue is to double-check that you’re getting the posterior tilt of your scapula.
These cues should alleviate any kind of impingement pain you might have going through this routine.
A helpful way to remember to do this is scheduling these routines in the free ROM Coach app.
It will send you a reminder, and there’s a helpful follow-along video. You’ll also get recommended progressions based on how many times you’ve performed the routine.
Thanks for reading. Performing the routine for a few weeks should help keep you doing whatever it is you love to do.
This article was reviewed and updated on March 4, 2022 by our Chief Medical Officer, Dr. Erin Boynton, MD, FRCS to include to include new research, exercises and information on latest surgical developments.
Step 1: Stand upright and hold a yardstick, broom, or other stick behind your back in both hands, knuckles facing down. Step 2: Slowly raise the stick up your back with both hands until you feel a stretch in your injured arm. Step 3: Hold this position for thirty seconds, then gently release your arms back down.What is the fastest way to heal bicep tendonitis? ›
- A break from the sport or activity that caused the problem.
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Physical therapy and exercises.
- Cortisone injections.
- Platelet rich plasma.
Pain from biceps tendinitis usually worsens at night, especially if the patient sleeps on the affected shoulder. Repetitive overhead arm motion, pulling, or lifting may also initiate or exacerbate the pain. The pain is most noticeable in the follow-through of a throwing motion.Does bicep tendonitis ever go away? ›
In most cases, tendonitis will resolve within six months to a year. But if overuse continues to be a problem, it is possible to develop a biceps tear. There are degrees of biceps tears and many people live with minor tearing without problem.Should you massage bicep tendonitis? ›
Bicep tendonitis massage is one of the most commonly used modalities for biceps tendinitis treatment. It helps stimulate collagen formation around the tendon, decrease pain, and improve circulation and tissue mobility.What pain killer for bicep tendonitis? ›
Although biceps tendonitis can be painful, if properly treated early it can usually be resolved completely. Cold packs or ice will reduce swelling and pain caused by tendonitis. Nonsteroidal anti-inflammatory medications such as aspirin or ibuprofen will help relieve swelling and pain.Why do I keep getting bicep tendonitis? ›
People may develop bicep tendonitis as a form of repetitive strain injury. If they have poor technique while playing a sport, or if they have poor posture while working, they may tear the tendons in their biceps.How do I relax my bicep tendonitis? ›
- Dumbbell Curls. Hold your dumbbells (5 to 8 pounds) like you are holding a hammer with your palms facing each other. ...
- Dumbbells Shoulder Flexion. Begin with your arms at your side. ...
- Flexion and Extension. ...
- Biceps Stretch. ...
- Single Shoulder Flexion.
Gently bend your wrist back so that your fingers point down toward the floor. You may also do this next to a wall and rest your fingers on the wall. For more of a stretch, bend your head to the opposite side of your affected arm. Hold for 15 to 30 seconds.
FAQs on biceps tendinitis
In general, compression is recommended to help ease the soreness and pain of tendinitis and other injuries. A compression sleeve, or other methods of compression therapy, is part of the standard recommendations for healing.
Heat may be more helpful for chronic tendon pain, often called tendinopathy or tendinosis. Heat can increase blood flow, which may help promote healing of the tendon. Heat also relaxes muscles, which can relieve pain.What is the best anti-inflammatory for bicep tendonitis? ›
Initial treatment — Initial treatment of biceps tendinitis includes: A nonsteroidal antiinflammatory drug (NSAID), such as ibuprofen (eg, Advil, Motrin) or naproxen (eg, Aleve) is often recommended for five to seven days.Does massaging bicep tendonitis help it recover? ›
For people suffering from tendonitis, it can help with pain relief and speed up the recovery process. Since tendonitis can take weeks to heal, using a massage therapy program to both relax and strengthen the inflamed tendon can give the sufferer a better chance of a full and speedy recovery.What are the 4 symptoms of tendonitis? ›
- pain and tenderness in the affected tendon, which is often worse when you move it.
- a grating sensation as the tendon moves.
- a lump on the tendon.
- weakness in the affected area.
- decreased range of motion.
Tendons require a long time to heal because of their poor blood supply. Continued and repetitive activity puts stress on the tendon and slows down the healing process.What foods are good for tendonitis? ›
Eating the right foods such as, adding more brightly, colored vegetables to your diet, provide your body with vitamins and minerals to also help reduce tendonitis. Salmon, flaxseeds and certain kinds of nuts have Omega-3 fatty acids, which carry strong anti-inflammatory ingredients.Is it rotator cuff or bicep tendonitis? ›
Rotator cuff tendinitis is also called impingement, bursitis or biceps tendinitis. These are all different names for the same problem. They mean that there is pain and swelling of the cuff tendons and the surrounding bursa.How should I sleep with bicep tendonitis? ›
Bicep Tendonitis causes pain and tenderness at the top of your arm, so your shoulder pain will worsen if you try to sleep on your front or side. To get to sleep with bicep tendonitis, it's best to sleep either on your back, or on the non-affected side – using the sleeping positions above.What is the fastest way to get rid of tendonitis? ›
Rest: try to avoid moving the tendon for 2 to 3 days. Ice: put an ice pack (or try a bag of frozen peas) wrapped in a tea towel on the tendon for up to 20 minutes every 2 to 3 hours. Support: wrap an elastic bandage around the area, use a tube bandage, or use a soft brace. You can buy these from pharmacies.What happens if you ignore bicep tendonitis? ›
A nagging pain and weakness may feel like something you can ignore and “push through,” but know that biceps tendonitis, if it progresses to frays and a more significant breakdown of tissue, can lead to a partial or full rupture of the biceps tendon.
Nonsteroidal anti-inflammatory drugs (NSAIDs): These oral medications are used to control pain by decreasing the inflammation around the biceps tendon. Strengthening and stretching exercises: Doctors often prescribe a physical therapy program, which may be done at home or under the supervision of a physical therapist.Will a cortisone shot help bicep tendonitis? ›
Non-operative treatments including corticosteroid injections are effective for the treatment of biceps tendon issues.Does Icy Hot help bicep tendonitis? ›
If you experience a sudden injury to a tendon, ice can reduce pain and swelling. Ice the area for 15 to 20 minutes every 4 to 6 hours — and put a towel or cloth between the ice pack and your skin. Heat may be more helpful for chronic tendon pain, often called tendinopathy or tendinosis.Can stress cause bicep tendonitis? ›
Causes. Overuse, aging, and stress can cause the biceps' tendons to deteriorate. Repetitive overhead activity can often be blamed for these injuries.Why does bicep tendonitis hurt more at night? ›
For those with tendonitis, a variety of factors can cause more pain at night, including decreased blood flow to the area, effects of gravity, and overuse during the day.How do you strengthen your bicep tendons? ›
- Biceps Tendon Strengthening Exercises.
- Active elbow flexion and extension: Gently bring the palm of the hand on your injured side up toward your. ...
- Biceps stretch: Stand facing a wall (about 6 inches, or 15 centimeters, away from the wall). ...
- Biceps curl: Stand and hold a 5- to 8-pound weight in your hand.
While recovering from biceps tendonitis, gentle exercises and stretches can help speed up your recovery and help with the healing process. It's best to perform bicep tendonitis exercises at the direction of an orthopedic surgeon or physical therapist, to avoid making the inflammation worse.How long does it take to rehab bicep tendonitis? ›
Proximal biceps tendonitis usually heals well in 6 weeks to a few months and doesn't cause any long-term problems. It's important to rest, stretch, and rehabilitate the arm and shoulder long enough to let it heal fully. A slow return to activities and sports can help prevent the tendonitis from coming back.What is dry needling for bicep tendonitis? ›
Dry needling is a new treatment in physical therapy that involves injecting small needles into a tendon, much like acupuncture. 1 The needle helps to decrease pain and muscle spasm and improve localized blood flow. Since it is a new treatment, little research has been done regarding dry needling.How do I know if I have bicep tendonitis? ›
According the American Academy of Orthopaedic Surgeons, the common symptoms of biceps tendonitis include: Pain or tenderness in the front of the shoulder, which worsens with overhead lifting or activity. Pain or achiness that moves down the upper arm bone. An occasional snapping sound or sensation in the shoulder.
This application method is perfect for TAPING BICEPS, and in particular, K Taping for BICEPS TENDONITIS. Kinesiology Tape may be used to help provide pain relief and support to injured areas. All you need is a sharp pair of scissors, 2 MINUTES of your time and a little practice and patience.How do you rehab a bicep tendonitis? ›
With palms down, raise the arm on your injured side, and touch the thumb side of your hand to the wall. Keep your arm straight and turn your body away from your raised arm until your experience a stretching sensation in your bicep. Hold the stretch for 15 seconds, rest, and then complete 2 more repetitions.Is heat or ice better for bicep tendonitis? ›
If you experience a sudden injury to a tendon, ice can reduce pain and swelling. Ice the area for 15 to 20 minutes every 4 to 6 hours — and put a towel or cloth between the ice pack and your skin. Heat may be more helpful for chronic tendon pain, often called tendinopathy or tendinosis.What is the best position to rest bicep tendonitis? ›
Bicep Tendonitis causes pain and tenderness at the top of your arm, so your shoulder pain will worsen if you try to sleep on your front or side. To get to sleep with bicep tendonitis, it's best to sleep either on your back, or on the non-affected side – using the sleeping positions above.What if my bicep tendonitis won't go away? ›
When to See a Doctor. The symptoms of biceps tendinitis may be similar to other, more severe conditions. See a doctor if you have: Pain that doesn't go away with rest or after using over the counter non-steroidal anti-inflammatory medicines (NSAIDs), such as aspirin, ibuprofen, or naproxen.