Bicep Tendonitis
I see a lot of people in the clinic with a condition called biceps tendinitis.
Most people will feel this pain in one of two places. Either at the front of the shoulder or down near the front of the elbow. Both of these fall under the umbrella of biceps tendinitis, but they occur at different parts of the same muscle and tendon.
When the pain is at the front of the shoulder, it is typically referred to as long head of the biceps tendinitis. The long head of the biceps tendon runs up through the front of the shoulder and attaches near the top of the socket at the labrum. Because of its position, it is heavily involved in shoulder stability and is often irritated with overhead activity or repetitive throwing.
When the pain is near the crease of the elbow, this is usually referred to as distal biceps tendinitis. This portion of the tendon attaches near the radius in the forearm and is more involved with bending the elbow and rotating the forearm.
While these are both forms of biceps tendinitis, they behave a little differently and require slightly different treatment approaches.
For long head of the biceps tendinitis, the focus is often on improving strength and control around the shoulder. This includes strengthening the rotator cuff and surrounding shoulder muscles to help take pressure off the irritated biceps tendon. If the shoulder is doing a better job of controlling movement, the bicep does not have to work as hard.
For distal biceps tendinitis, we shift more of the focus toward the forearm. Strengthening the wrist flexors, extensors, and grip muscles can help reduce the load placed directly on the distal bicep tendon during lifting and daily activities.
That said, there are also some important similarities in how we treat both conditions.
In most cases, I like to start with isometric exercises for the biceps. These involve activating the muscle without a lot of movement and are usually better tolerated early on. Isometrics help begin loading the tendon in a controlled way and can reduce pain while improving the tendon’s ability to handle stress.
From there, we gradually progress to more dynamic strengthening. The goal is to build the tendon’s capacity so it can tolerate real-world demands again.
These demands might include throwing a baseball, lifting weights, carrying groceries, or even picking up a bag of mulch.
The key is progression. We want to gradually increase the load on the tendon without overwhelming it.
Even though we work to strengthen the surrounding muscles to offload the tendon, we still need to directly load the biceps in a controlled way so they can fully recover.
I’ll include a video with some ideas for biceps tendon exercises here.
Both of these conditions are very common in throwers, weightlifters, tennis and pickleball athletes, and manual laborers. Anyone who is repeatedly using their arms for lifting, gripping, or overhead activity is at risk.
If you are dealing with pain in the front of your shoulder or near your elbow and are not sure what is going on, feel free to reach out. We would be happy to help you figure out the root cause and get you back to doing what you enjoy.
If you’d like to learn more about Bicep Tendonitis, I’d love to speak with you over a free phone consultation.
- Dr. Kutsche
