Table of ContentsView AllTable of ContentsWhat Is Bicep Tendonitis?Physical TherapyOther TreatmentsTreatment Timeline
Table of ContentsView All
View All
Table of Contents
What Is Bicep Tendonitis?
Physical Therapy
Other Treatments
Treatment Timeline
If you havepain in your upper arm or shoulder, you may have irritated your biceps tendon, a condition known as bicepstendonitis. The pain may limit your shoulder motion and make performing normal work and recreational tasks difficult or impossible. You should see a healthcare provider who can diagnose biceps tendonitis and refer you to a physical therapist for treatment.
Your biceps are in your upper arm, and the biceps tendon connects your biceps muscles to your shoulder joint. If the tendon becomes injured through normal wear and tear, overuse, or a traumatic injury such as a fall, biceps tendonitis can occur.
Physical therapy(PT) for biceps tendonitis can help decrease pain, improve shoulder strength and range of motion, and improve functional mobility and arm use. You can do PT in an outpatient setting, at home, or both.
The biceps muscle helps to decelerate the elbow when it is extending, but overusing it repeatedly, such as a pitcher throwing a baseball repeatedly, places excessive stress on the tendon, leading to inflammation.
Age-related changes are another cause of biceps tendonitis. The ligament that courses over the long head of the biceps tendon can thicken as you age due to repeated micro-trauma to the area. This thickening of the ligament may cause abnormal rubbing on the tendon, leading to inflammation and irritation.
Shoulder androtator cuff injuriescan also contribute to biceps tendonitis. Since the biceps tendon works to stabilize the front of your shoulder, it may become overworked if you have shoulder instability or a rotator cuff tear. When a rotator cuff muscle is torn, your biceps tendon overworks to help stabilize the area, leading to biceps tendonitis.
The initial injury and inflammation of the biceps tendon is called tendonitis. Long-term biceps tendon problems are called biceps tendinopathy.
Anatomy of the Biceps
Yourbiceps musclesare located in the front of your upper arms. They course from two heads (hence the name, “bi” meaning two) near your shoulder joint. The short head of the biceps arises from the coracoid process of your shoulder blade. The long head of the biceps originates from the supraglenoid tubercle of yourshoulder jointand is encased in a synovial sheath.
This sheath provides lubrication to the tendon and allows it to glide and slide normally in the front of your upper arm. The biceps muscle travels down your upper arm and inserts on the radial tuberosity of your forearm.
The primary function of your biceps is elbow flexion. It also plays a role in turn your palm up (supination), and it also helps flex your shoulder joint and assists therotator cuff muscle groupin stabilizing the front of your shoulder. This is why overloading of the biceps tendon at your shoulder or elbow may cause biceps tendonitis.
Symptoms of Biceps Tendonitis
There are many symptoms of biceps tendonitis. These may include:
If you suspect you have biceps tendonitis, you should visit your healthcare provider for a diagnosis. Biceps tendonitis may be difficult to diagnose, as other conditions may present as anterior shoulder pain. A rotator cuff tear,AC joint arthritis,shoulder labrum injury, or cervical (neck) radiculopathy can all have overlapping symptoms.
Your healthcare provider can order diagnostic tests to accurately diagnose if your condition is biceps tendonitis and refer you to a physical therapist for treatment. Your physical therapist will work with you on a specific exercise regimen to treat your biceps tendonitis.
Physical Therapy Treatment for Biceps Tendonitis
There are many different treatments and modalities for biceps tendonitis. These are designed to decrease pain and inflammation,improve ROMand strength, and improve pain-free use of the arm and shoulder. Physical therapy is the main treatment for biceps tendonitis. Here are several exercises your physical therapist may work on with you.
Biceps Curls
If you experience pain or you are struggling to maintain proper form, stop and contact your physical therapist for advice.
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Biceps Stretch
There are several ways to stretch your biceps. Stretching your biceps can help improve your range of motion. A common bicep stretch is the standing bicep stretch. It can also help stretch your chest and shoulders.
Hold this stretch for up to a minute before releasing, and repeat up to three times.
Be careful not to overstretch your bicep, especially if it is injured. There are several variations of biceps stretches, and your physical therapist may suggest that you begin with a gentler stretch or modify this stretch for you.
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Shoulder Flexion
Shoulder flexion helps with your vertical range of motion. Do this exercise for 10 repetitions several times throughout the day. If you feel pain, stop and ask your physical therapist for modifications. They may modify the exercise or switch you to a different shoulder flexion exercise.
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Elbow Flexion
Elbow flexioncan help improve the range of motion on your injured side.
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Shoulder Internal Rotation
Shoulder rotation involves effort from both the biceps and rotation of the shoulder joint. It helps you to maintain the full motion of your shoulder joint.
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Shoulder External Rotation
Shoulder external rotation exercises can help to improve or maintain shoulder mobility and decrease pain. The following is one example of a shoulder external rotation stretch.
To do this exercise correctly, keep your arms as still as possible and make sure to avoid twisting your back.
Forearm Twist
Forearm twists help with the flexibility of the arm.
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Shoulder Circle Crossover
This exercise helps with shoulder mobility in biceps tendonitis.
Repeat this exercise three to six times and do one or two sets, or follow your physical therapist’s instructions.
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Other Ways to Treat Biceps Tendonitis
Physical therapy is the main treatment for biceps tendonitis. However, other treatments may help aid healing and can often be used in conjunction with targeted exercises.
Limiting movements involving reaching and lifting is essential until your symptoms improve. If you do need to reach or lift items for work or day-to-day tasks, talk with your physical therapist for recommendations on modifications while you heal.
Massage
Your physical therapist may performvarious massage techniquesfor your biceps tendonitis. Cross-friction massage may be done to stimulate collagen formation around your injured tendon. This can help decrease pain and improve localized circulation. Massage can also improve tissue mobility, allowing your shoulder and arm to move more freely.
Kinesiology Tape
Some physical therapists use a treatment technique called kinesiology taping, also known asK-tape. Your PT will apply strips of flexible fabric tape to your upper arm or shoulder. The tape decreases pain and spasms and facilitates proper muscle function.
A word of caution: K-tape is a newer treatment in PT and has not been proven to be effective in treating tendon disorders. Anecdotally, some people report improved symptoms and function with the tape, but more research is needed.
What Does Kinesiology Tape Do?
Heat
If you have biceps tendonitis, your physical therapist may apply heat to your upper arm and shoulder. The heat increases blood flow to the area, bringing in oxygen and nutrients and flushing out waste material that may have gathered due to inflammation.
Heat can also decrease pain and improve tissue mobility. To ensure the heat does not burn your skin, place a few layers of toweling between the hot pack and your skin. Notify your PT if you get too warm during a heat treatment.
Ice
Ice may be used in the treatment of biceps tendonitis. Ice decreases blood flow and can be used to control localized pain, swelling, and inflammation.
Your PT mayapply iceat the end of your therapy session to keep inflammation to a minimum. Care should be used, since ice placed directly on your skin may cause a frost burn. Notify your therapist if you feel discomfort during ice use in the PT clinic.
Ultrasound
Ultrasound has been used in PT clinics for many years. The treatment involves passing an ultrasound wand with a coupling gel over your injured tissue for five to 10 minutes. The wand sends ultrasonic waves into your biceps tendon, heating the tissue. This heat increases blood flow and cellular activity in the area.
Duringultrasound treatment, you should feel nothing except for mild warming around the ultrasound head. A burning sensation may be felt if ultrasound is not applied properly. Notify your PT if you feel any pain so adjustments can be made.
Although ultrasound has been used for many years in PT, exercise tends to be more effective. While your therapist may utilize ultrasound, they will likely use it in combination with various exercises.
Therapeutic Ultrasound in Physical Therapy
Electrical Stimulation
Electrical stimulationcan help treat biceps tendonitis or tendinopathy. The stimulation, or e-stim, can be used to decrease pain, improve muscle function, or increase circulation.
If your PT chooses to use e-stim for your biceps tendonitis, two to four small electrodes will be placed around your shoulder and upper arm, and electricity will be applied to the electrodes. This electrical impulse may tickle a bit, but it should not cause pain.
Most e-stim treatments, such as transcutaneous electrical neuromuscular stimulation (TENS) or neuromuscular electrical stimulation (NMES), last about 10 to 20 minutes.
Dry Needling
Dry needlingis a new treatment in physical therapy that involves injecting small needles into a tendon, much like acupuncture.The needle helps to decrease pain and muscle spasms and improve localized blood flow. Since it is a newer treatment, more research on its effectiveness is needed.
Iontophoresis
Iontophoresisis a special form of electrical stimulation that uses electricity to administer medication through your skin and into your injured biceps tendon. The medication is typically an anti-inflammatory liquid that is negatively charged. When a direct current that is also negatively charged is applied to the medicine, it repels it, driving the drug into your tendon.
Iontophoresis is usually applied for 10 to 20 minutes and should be painless. You may feel a bit of tingling underneath the medicated electrode, and some redness of your skin may occur after the iontophoresis is removed.
Some research has shown that iontophoresis can be effective for tendon problems, while other studies do not support its use as ananti-inflammatory treatment. Be sure you understand what to expect from iontophoresis, and speak with your physical therapist if you have any questions about it.
Uisng Iontophoresis in Physical Therapy
How Long Should Treatment Take?
Most cases of biceps tendonitis take about four to six weeks to heal. Your condition may take a bit longer if it is severe. Talk with your PT about how long your specific condition is expected to last.
If your pain continues after a month or two of therapy, your PT may refer you back to your healthcare provider for further treatment. Other more invasive treatments for persistent biceps tendonitis may includecortisone injections,platelet rich plasma injections, or surgery.
Summary
If you have pain in the front of your shoulder, you may have biceps tendonitis. This condition can make using your arm for normal work and recreational activities difficult. Working with a physical therapist to complete various exercises can help you gain motion and strength, relieve pain, and return to your previous level of function and activity.
3 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Orthopaedic Surgeons.Biceps tendinitis.UpToDate.Patient education: biceps tendinitis or tendinopathy (Beyond the Basics).Mcdevitt AW, Snodgrass SJ, Cleland JA, Leibold MBR, Krause LA, Mintken PE.Treatment of individuals with chronic bicipital tendinopathy using dry needling, eccentric-concentric exercise and stretching; a case series. Physiother Theory Pract. 2018;:1-11. doi:10.1080/09593985.2018.1488023Additional ReadingZeinali A, Rahimdel A, Shahidzadeh A, Shahidzadeh A, Mellat A.Comparison of the Effects of Kinesio Taping to Local Injection of Methyl Prednisolone in Treating Brachial Biceps Tendonitis.International Journal of Clinical Medicine.2017;8, 395-401. doi:10.4236/ijcm.2017.86037
3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Orthopaedic Surgeons.Biceps tendinitis.UpToDate.Patient education: biceps tendinitis or tendinopathy (Beyond the Basics).Mcdevitt AW, Snodgrass SJ, Cleland JA, Leibold MBR, Krause LA, Mintken PE.Treatment of individuals with chronic bicipital tendinopathy using dry needling, eccentric-concentric exercise and stretching; a case series. Physiother Theory Pract. 2018;:1-11. doi:10.1080/09593985.2018.1488023Additional ReadingZeinali A, Rahimdel A, Shahidzadeh A, Shahidzadeh A, Mellat A.Comparison of the Effects of Kinesio Taping to Local Injection of Methyl Prednisolone in Treating Brachial Biceps Tendonitis.International Journal of Clinical Medicine.2017;8, 395-401. doi:10.4236/ijcm.2017.86037
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Academy of Orthopaedic Surgeons.Biceps tendinitis.UpToDate.Patient education: biceps tendinitis or tendinopathy (Beyond the Basics).Mcdevitt AW, Snodgrass SJ, Cleland JA, Leibold MBR, Krause LA, Mintken PE.Treatment of individuals with chronic bicipital tendinopathy using dry needling, eccentric-concentric exercise and stretching; a case series. Physiother Theory Pract. 2018;:1-11. doi:10.1080/09593985.2018.1488023
American Academy of Orthopaedic Surgeons.Biceps tendinitis.
UpToDate.Patient education: biceps tendinitis or tendinopathy (Beyond the Basics).
Mcdevitt AW, Snodgrass SJ, Cleland JA, Leibold MBR, Krause LA, Mintken PE.Treatment of individuals with chronic bicipital tendinopathy using dry needling, eccentric-concentric exercise and stretching; a case series. Physiother Theory Pract. 2018;:1-11. doi:10.1080/09593985.2018.1488023
Zeinali A, Rahimdel A, Shahidzadeh A, Shahidzadeh A, Mellat A.Comparison of the Effects of Kinesio Taping to Local Injection of Methyl Prednisolone in Treating Brachial Biceps Tendonitis.International Journal of Clinical Medicine.2017;8, 395-401. doi:10.4236/ijcm.2017.86037
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