Biceps Tendinopathy: Causes, Symptoms, Treatment and Exercises

Have you ever felt a sharp pain on the front of your shoulder?  Did it happen after doing dips, pull-ups, rows, or on your bench press in the gym? Or did you feel it after a swim in the pool? Perhaps, on impact serving a tennis, squash, or volleyball?  What about reaching for your favourite coffee mug up on the highest cupboard shelf?  Or maybe you feel it while using your mouse at work?

If this sounds familiar, it is possible you might have a tendinopathy of your Long Head Biceps (LHB) tendon with or without impingement.

What is a Long Head of the Biceps (LHB) Tendinopathy?

A tendinopathy is a general term indicating that there is damage to a tendon (where the muscle connects to the bone). Micro tears, collagen fiber degeneration and/or inflammation can be present.  A LHB tendinopathy typically presents as pain over the front part of the shoulder.  There are several conditions that can occur with a LHB tendinopathy which include:

• Long Head Biceps Tendinitis (inflammation of the tendon itself).
• Long Head Biceps Tendosynovitis (inflammation of the tendon sheath, surrounding the tendon).
• Long Head Biceps Tendinosis (a degenerated tendon).
• Long Head Biceps strain or rupture (a tear in the tendon fibers or tendon separation in whole or in part from its tissue or boney attachment).

Commonly, injuries to the LHB tendon rarely present with just one of the above conditions, and often involve a combination of two or more. This is why most are classified under the blanket term, “tendinopathy”.

Causes of a Long Head Biceps Tendinopathy

Commonly, repetitive movements with the shoulder are typically the culprit in causing LHB tendinopathies.  The deconditioning and normal aging of the tissue can further compound the injury.  Athletes who preform overhead movements (i.e. racket sport athletes, volleyball players, swimmers), or high velocity motions where the arm and shoulder cranks back and releases (i.e. throwing sports like baseball and cricket), are typically susceptible to LBH tendinopathies.  Posture can further complicate things in an athlete.  For instance, if the athlete is hyperkyphotic (round/hunchback), and/or has excessively rounded shoulders, this can contribute to narrowing the space the LHB tendon needs to move. When joint and tissue space narrows, the LHB tendon can become impinged leading it to become irritated and damaged over time.

Physiotherapy, Chiropractic and Massage Therapy Treatment for Long Head Biceps Tendinopathy

Treatment with a health care professional will help diagnose the injury and start you on the path to recovery. Physiotherapist and Chiropractors will address correcting joint mechanics and posture by using manual therapy and strengthening. They also can use Acupuncture or other modalities such as ultrasound to help to control pain and inflammation.

Massage treatment addresses many of the surrounding structures around the Long Head Biceps Tendon.  General techniques are applied to the neck, upper to mid-back, chest and shoulder to address the long head bicep tendon specifically.  It is important to warm up and massage the surrounding structures since there are quite a number of muscles that attach to the shoulder complex and are involved with shoulder movement. Deep, specific techniques combined with shoulder movement (sometimes referred to as Pin & Stretch techniques, or Active Release Techniques), directly over the Long Head Biceps Tendon can encourage tissue mobility, decrease pain, and promote localized circulation important for the healing process.  Gentle cupping over the long head biceps tendon can help further bring circulation to the localized area to encourage healing and further tissue mobility in the area.

What are some safe home exercises I can do for Long Head Biceps Tendinopathy?

With any of these exercises, a little discomfort can happen and is okay to work through, but if you notice your symptoms worsen or experience unfamiliar pain, modify the weight and/or intensity of sets/reps as need be. In these examples, a dumbbell was used for demonstration purposes, but your injury might not allow you to start there. Resistance modifications such as therabands or cables can easily be used instead of a dumbbell to decrease discomfort if experienced during exercise.

Scapular “Scoops”

• • Arms outstretched at 90º
  • Rotate your thumbs down, and then back up, focusing on feeling how your scapula slides up and down the rib cage.  Then disassociate your shoulders by rotating your right thumb down and your left thumb up, then reverse and repeat.
  • If you feel your low back compensating (arching your back in order to get the shoulder movement you want), you can do this seated to help eliminate compensatory motions.  The idea is to feel your shoulder blade slide upward when your thumbs turn down, and then downwards when your thumb turns back. What you want to also avoid is shrugging your shoulders up as opposed to focusing on isolating scapular movement.
    

Isometric Hammer Grip Bicep Curl

• Start with your arm straight and shoulder blade set in a good position. Then bend the elbow to 90º with your palm facing inward and hold.
• Perform 2 – 3 sets of 5 – 10 second holds.

Isometric Supinated Grip Bicep Curl

• Same as the Hammer Grip Curl, but with your palm facing upwards, and hold.
• Perform 2 – 3 sets of 5 – 10 second holds.
  

Isometric Supinated/Hammer Grip Bent Elbow Shoulder Flexion

• Start with a lighter weight than above (<5 lbs) by your hip, and raise it to 90º of shoulder flexion in front of you and hold. Switch between a supinated and hammer grip to challenge the tendon in different positions/angles.
• Perform 2 – 3 sets of 5 – 10 second holds.

  

Single Arm Preacher Curls

• The incline is used to ease the pressure off the LHB tendon, and focus on the eccentric control or extension of the elbow movement, using a count of 3 – 5 seconds to help guide the pace of the controlled extension.
• Perform 2 – 3 sets, 12 – 15 reps.
  

These are just general exercises that work for some. However, we always recommend seeing a qualified health professional so they can assess you and provide you with individualized corrective exercises that are unique to your specific needs and goals.

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