Bicep Tendonitis (Long Head)

Injuries > Shoulder > Bicep Tendonitis (Long Head)

(Also known as Bicep Tendinitis, Bicep Tendinopathy)

N.B. Although research suggests that 'bicep tendinopathy' is the more appropriate term to describe overuse injuries to the bicep tendon, we will use the term 'bicep tendonitis' in this document as it is more widely known.

What is bicep tendonitis?

Bicep tendonitis is a condition characterized by tissue damage, and inflammation to the bicep tendon causing pain in the front of the shoulder.

The muscle at the front of the upper arm is known as the biceps. The biceps attaches to the front of the shoulder blade via the short and long head of biceps tendons and then inserts into the forearm via the distal biceps tendon (figure 1).

The biceps muscle is responsible for bending the elbow against resistance and assisting with arm elevation activities. During contraction of the biceps, tension is placed through the long head of biceps tendon. When this tension is excessive due to too much repetition or high force, damage to the biceps tendon may occur. Bicep tendonitis (long head) is a condition whereby there is damage to the long head of biceps tendon with subsequent degeneration and inflammation. This may occur traumatically due to a high force going through the biceps tendon beyond what it can withstand or due to gradual wear and tear associated with overuse.

Causes of bicep tendonitis

Bicep tendonitis most commonly occurs due to repetitive or prolonged activities placing strain on the biceps tendon. This typically occurs due to excessive lifting (especially overhead), arm elevation activities (e.g. putting the washing on the line), heavy pushing or pulling, stretching the arm behind your back, throwing sports or sleeping on the affected side.

Occasionally, bicep tendonitis may occur suddenly due to a high force going through the biceps tendon beyond what it can withstand. This most commonly occurs during heavy lifting (e.g. during bench presses or dips at a gym) or with sudden elevation movements of the shoulder.

Signs and symptoms of bicep tendonitis

Patients with this condition typically experience pain in the front of the shoulder. In less severe cases, patients may only experience an ache or stiffness in the shoulder that increases with rest following activities requiring strong or repetitive contraction of the biceps muscle. In more severe cases, patients may experience an ache that increases to a sharper pain with activity. Activities that typically increase symptoms include:

• lifting
• overhead or arm elevation activities
• heavy pushing or pulling
• lying on the affected side
• taking the affected arm behind the back
• throwing
• moving the affected arm across the body

Occasionally, patients may experience a feeling of arm weakness, particularly when elevating the arm or attempting to lift heavy objects.

Diagnosis of bicep tendonitis

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose bicep tendonitis. Occasionally, further investigations such as an ultrasound, X-ray or MRI scan may be required to assist with diagnosis and assess the severity of the condition.

Prognosis of bicep tendonitis

Most patients with bicep tendonitis heal well with appropriate physiotherapy and return to normal function in a number of weeks. Occasionally, rehabilitation can take significantly longer and may take many months in those who have had their condition for a long period of time. Early physiotherapy treatment is therefore vital to hasten recovery and ensure an optimal outcome in all patients with this condition.

Treatment for bicep tendonitis

Patients with this condition generally respond well to appropriate physiotherapy. The success rate of treatment is largely dictated by patient compliance. One of the key components of treatment is that the patient rests from any activity that increases their pain until they are symptom free. This allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.

Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the problem becoming chronic. Immediate, appropriate treatment in patients with bicep tendonitis is essential to ensure a speedy recovery. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence.

Patients with bicep tendonitis usually benefit from regular icing and the use of anti-inflammatories in the initial phase of injury. This is usually appropriate in the first 72 hours following injury or when inflammatory signs are present (i.e. morning pain or pain with rest). Ice and anti-inflammatories may significantly hasten the healing process by reducing the pain and swelling associated with inflammation.

Patients should also undergo a graduated flexibility and strengthening program of the biceps to ensure an optimal outcome. Exercises to improve shoulder blade stability, rotator cuff strength, posture and upper back flexibility are also important. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they should be commenced. In the final stages of rehabilitation, a gradual return to activity or sport is indicated as guided by a physiotherapist.

Contributing factors to the development of bicep tendonitis

There are several factors which can predispose patients to developing bicep tendonitis. These need to be assessed and corrected with direction from a physiotherapist. Some of these factors include:

• joint stiffness (particularly the shoulder or thoracic spine)
• muscle tightness (particularly the biceps or pectorals)
• inappropriate or excessive training
• inadequate warm up
• muscle weakness (particularly the scapula stabilisers and rotator cuff)
• poor posture

Physiotherapy for bicep tendonitis

Physiotherapy treatment for patients with this condition is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:

• soft tissue massage
• electrotherapy (e.g. ultrasound)
• stretches
• joint mobilization
• ice or heat treatment
• postural re-education
• exercises to improve strength, flexibility, shoulder blade stability and posture
• anti-inflammatory advice
• activity modification advice
• a gradual return to activity program

Other intervention for bicep tendonitis

Despite appropriate physiotherapy management, some patients with this condition do not improve adequately. When this occurs the treating physiotherapist or doctor can advise on the best course of management. This may include further investigations such as X-rays, ultrasound, MRI or CT scan, pharmaceutical intervention, corticosteroid injection, autologous blood injection, or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition.

Exercises for bicep tendonitis

The following exercises are commonly prescribed to patients with bicep tendonitis. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 1 - 3 times daily and only provided they do not cause or increase symptoms.

Bicep Stretch

Begin this exercise with your back and neck straight and your arm supported behind you on a bench or table (figure 2). Gently lower your body, allowing your arm to move further behind you until you feel a mild to moderate stretch pain-free. Hold for 15 seconds and repeat 4 times provided there is no increase in symptoms.

Figure 2 – Bicep Stretch (left arm)

Static Biceps Contraction

Begin this exercise with your elbow at your side and bent to 90 degrees, palm up as demonstrated (figure 3). Push up against your other hand, tightening your biceps. Hold for 5 seconds and repeat 10 times as hard as possible without increasing symptoms.

Figure 3 – Static Biceps Contraction (right arm)

Shoulder Blade Squeezes

Begin this exercise standing or sitting with your back straight (figure 4). Your chin should be tucked in slightly and your shoulders should be back slightly. Slowly squeeze your shoulder blades together as hard and far as possible provided it does not cause or increase symptoms. Hold for 5 seconds and repeat 10 times.

Figure 4 – Shoulder Blade Squeezes

Physiotherapy products for bicep tendonitis

Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include::

1. Arm Slings
2. Ice Packs or Heat Packs
3. Postural Supports
4. Sports Tape (for postural taping)
5. Shoulder Supports
6. Resistance Band (for strengthening exercises)
7. TENS Machines (for pain relief)
8. Foam Rollers (for self massage)
9. Therapeutic Pillows

To purchase physiotherapy products for bicep tendonitis click on one of the above links or visit the PhysioAdvisor Shop.

Find a Physio for bicep tendonitis

Find a physiotherapist in your local area who can treat bicep tendonitis.

Other Exercises

• View more Biceps Flexibility Exercises.
• View more Biceps Strengthening Exercises.
• View Shoulder Flexibility Exercises.
• View Shoulder Strengthening Exercises.

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