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Biceps Tendonosis: Causes, Symptoms, Treatment and Exercises

biceps-tendinopathy-massage-therapy-torontoBiceps tendonosis is a condition where the collagen fibers of the biceps tendon degenerate due to overuse.

Some of the most common symptoms include:

  • Pain in the anterior aspect of the shoulder (especially with overhead movements)
  • Tenderness to touch
  • Muscle weakness
  • Decreased shoulder mobility

What Causes Biceps Tendonosis?

Some of the most common causes are:

  • Repeated heavy loading
  • Poor ergonomics and biomechanics
  • Activities that involve repetitive overhead movements
  • Muscular imbalances of the upper back and/or shoulders

How Can Physiotherapy, Chiropractic and Massage Therapy Help with Biceps Tendonosis?

An experienced healthcare professional will guide you in your rehabilitation process from beginning to end. Your physiotherapist or chiropractor will start with a full assessment to identify the cause of the tendonosis and provide you with a customized treatment plan based on your lifestyle and treatment goals. Your Massage Therapist will focus on reducing pain, increasing mobility and strength, as well as correcting any kind of postural imbalance.

Participating in individualized strengthening exercises (isometrics, postural and corrective exercises) will be a major part of your recovery. In addition, your practitioner may include some other treatment methods based on your specific needs. These include joint mobilizations, soft tissue manipulation, cupping, acupuncture and dry needling.

What Should be Avoided with Biceps Tendonosis?

Every case is unique but generally speaking we recommend trying to avoid movements that aggravate your pain, especially if the pain doesn’t settle quickly. As your condition progresses, you may be required to perform exercises that may stimulate low levels of pain, but the pain is meant to settle by the next day and you should be able to see overall progress as time goes on. Also, as with any injury, avoid trusting Dr. Google and be sure to visit a trusted and knowledgeable health care practitioner that can give you honest, evidence based advice.

How Long Does it Take to Recover from Biceps Tendonosis?

Recovery from biceps tendonosis can vary from person to person. Depending on the stage, duration and physical demands of each person, healing can take from 10 – 12 weeks if addressed in the early stages and up to 3-6 months if addressed in the later, more chronic stages of the injury. However, if continued aggravation to the tendon occurs, the recovery process can take longer and sometimes irreversible tendon damage can persist.

What Can You Do At Home For Biceps Tendonosis?

*Remember, it is always recommended to check with a health professional before starting any type of rehabilitation program*

Mobility Exercises

  1. You can start with active shoulder movements by moving your arm forward and backwards in a pain free range 8 – 10 times, 3 times a day. Do this slowly and controlled.
  2. Light stretching to the biceps muscle for 30 seconds 3 repetitions 3 times a day.
  3. Shoulder blade mobility
    a. Pinching and pulling apart your shoulder blade, 10 repetitions, 3 times a day
    b. Shoulder blade circles both directions, 10 repetitions, 3 times a day
  4. Thoracic spine mobility
    a. Cat camel stretches in 4 point position, 10 repetitions, 3 times a day
    b. Spine twists, 10 repetitions, 3 times a day


One of the most important concepts of biceps tendonosis recovery is to slowly increase the tendon’s capacity to sustain load. This will allow you to rebuild your strength, while decreasing pain.

You can start by doing isometric bicep contractions by gently bending your elbow at 90 degrees with your palm down. While holding this position, place your hand under a table and lightly push up without bending your elbow. Hold this position for 30 seconds and repeat 3 times, 2-3 times a day. These exercises will be slowly progressed based on your tolerance with the guidance of your physiotherapist or chiropractor.

Additionally, strengthening your rotator cuff muscles, postural muscles and scapular muscles and correcting faulty movements in the region with the guidance of your physiotherapist or chiropractor is always recommended to avoid any risk of re-injury. These will be individualized based on your specific needs.

Improve the Way You Move!

The best way to prevent further injury and to speed up your current rehabilitation is to identify what activities or movements are aggravating the tendon. Take a moment to analyze the way you move during these aggravating tasks and try adjusting your work set up or correcting your form while you move. If you can make positive position changes, you can often speed up your recovery. Share this information with your trusted physiotherapist or chiropractor so they can help explain to you why this helps!

If you are experiencing shoulder pain, we encourage you to book an appointment with one of our experienced health care professionals. We would be happy to assist you in your road to recovery. Contact us today


  1. Bass, L. E. (2012). Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice,5(1). doi:10.3822/ijtmb.v5i1.153
  2. CHURGAY, C. A. (2009). Diagnosis and Treatment of Biceps Tendinitis and Tendinosis. American Academy of Family Physicians, 80(5). Retrieved October 20, 2018, from https://www.aafp.org/afp/2009/0901/p470.html.
  3. Kham, K. M., Cook, J. L., Taunton, J. E., & Bonar, F. (2000). Part 1: A new Paradigm for a difficult Clinical Problem. The Physician and Sports Medicine , 28 (5).
  4. Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS). Vancouver 2012. British journal of Sports Medicine , 47, 774.

Desiree Caceres Ramirez, RMT

Desiree Caceres Ramirez is a registered massage therapist practicing at Rebalance Sports Medicine in downtown Toronto.

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Yonge & AdelaideRebalance Clinic Yonge Adelaide
110 Yonge Street Suite 905
Toronto, ON M5C 1T4
T: (416) 777-9999
E: [email protected]
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155 University Avenue Suite 303
Toronto, ON M5H 3B7
T: (416) 306-1111
E: [email protected]

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