Biceps Tendonitis Treatment with Physical Therapy
Biceps tendonitis involves inflammation of and injury to the biceps tendon, often due to repetitive overloading and overuse from sports activities that cause microtears in the fibers of the tendon. The biceps muscle and tendons help to bend the elbow, flex the shoulder and lift the arm upwards, rotate the forearm outwards, and assist the rotator cuff muscles in stabilizing the front of the shoulder. Biceps tendonitis is more common among athletes who play sports that place repetitive stress on the biceps tendon through repetitive overhead motions. Physical therapy can effectively address biceps tendonitis, decreasing pain and inflammation, improving shoulder range of motion and strength, and improving functional mobility of the arm and shoulder through a targeted exercise program.
Biceps Tendon Anatomy
The biceps muscle, located at the front of the upper arm, is attached to the shoulder blade (scapula) through two tendons, the short head of the biceps tendon and the long head of the biceps tendon. The distal biceps tendon attaches the biceps muscle to the elbow. The short head of the biceps tendon connects to the coracoid process of the shoulder blade, whereas the long head of the biceps tendon originates from the supraglenoid tubercle of the shoulder joint and is encased in a lubricating synovial sheath that allows it to glide and slide in the front of the upper arm.
The long head of the biceps tendon passes through the subacromial space and is held in places as it exits the shoulder by the bicipital groove and several ligaments and tendons. The bicipital space also contains the rotator cuff tendons and subacromial bursa. This pathway of the long head of the biceps tendon contributes to the higher rate of injury and pain in the long head of the biceps tendon compared to the short head of the tendon.
The biceps muscle and tendons have three main functions: 1) bending the elbow, such as when you have the palm of the hand facing forward and up, 2) helping to flex the shoulder and lift the arm upwards over the head, and 3) turning the forearm out (rotating it outwards). The biceps muscle and tendons also help move the shoulder joint and assist the rotator cuff muscles in stabilizing the front of the shoulder.
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How Biceps Tendonitis Develops
Biceps tendonitis involves inflammation of and injury to the biceps tendon, often due to repetitive overloading and overuse from sports activities that cause micro-tears in the fibers of the tendon. Tendinitis is more common in the long head of the biceps tendon. Inflammation of the tendon can cause swelling and thickening of the tendon, causing an increase in the size of the tendon in the limited bicipital space and leading to pain and limited shoulder mobility. Biceps tendonitis can occur concurrently with other shoulder injuries, such as rotator cuff injury, shoulder impingement, scapular dyskinesia, shoulder labrum injury, or glenohumeral arthritis.
Biceps tendonitis can develop due to the tendon becoming overloaded by being worked too hard beyond its capacity without sufficient rest and recovery time, overstretching or excessive compression of the tendon, or poor biomechanics in the shoulder that place significant compression and friction on the biceps tendon.
Common causes of biceps tendonitis include:
Sports that place repetitive stress on the biceps tendon through repetitive overhead motions, such as baseball, tennis, swimming, softball, volleyball, or gymnastics
Increasing the intensity or duration of overhead movements too quickly can place too much stress on the biceps tendon, leading to inflammation and pain
Muscular imbalances or weaknesses in the rotator cuff and scapular muscles that place additional stress on the biceps tendon
Shoulder joint looseness or hypermobility
Poor posture and shoulder biomechanics
Trauma to the shoulder due to a fall
Current or past shoulder injuries
Aging process, as tendons become stiff and less elastic with age along with reductions in blood supply to the tendon and slower tendon healing
Use of corticosteroids or anabolic steroids, which can heighten the risk of a tendon rupture
Smoking, which impairs blood supply to the body, can heighten the risk of a biceps tendon rupture significantly
Symptoms of biceps tendonitis are:
Pain in the upper arm and shoulder, particularly at the front of the shoulder and arm that worsens with overhead movement or lifting
Pain in shoulder or elbow when moving the upper part of the arm
Difficulty lifting the arm overhead
Feeling of weakness in the arm
Tenderness to touch at the front of the upper arm and shoulder
Snapping sound or feeling in the shoulder
Physical Therapy Treatment for Biceps Tendonitis
Physical therapy can effectively address biceps tendonitis, decreasing pain and inflammation, improving shoulder range of motion and strength, and improving functional mobility of the arm and shoulder through a targeted exercise program. Most cases of biceps tendonitis resolve with physical therapy treatment. The focus of the exercise program is to restore the integrity and strength of the dynamic and static stabilizers of the shoulder joint and restore the affected shoulder’s range of motion through gradual loading and strengthening of the biceps tendon and surrounding shoulder and scapular musculature.
Physical therapy for biceps tendonitis can include:
Passive modalities to manage pain and inflammation, such as ice to control pain and swelling through decreased blood flow; heat to increase blood flow and bring oxygen and nutrients to the area, which decreases pain and improves tissue mobility; ultrasound to create deep heat in the tissues for healing of the tendon; and electrical stimulation to decrease pain and stimulate muscle function.
Shoulder range of motion exercises are used to improve shoulder mobility and function, often starting with passive movements, and progressing to active exercises.
Manual therapy using soft tissue and shoulder joint mobilizations as well as cross-friction massage to decrease pain, improve localized circulation, and improve tissue and joint mobility.
Targeted strengthening of shoulder musculature including the rotator cuff muscles and scapular muscles. An improperly positioned scapula or weak rotator cuff muscles can contribute to the development of biceps tendinitis by forcing the biceps tendon to work harder in ways it was not designed to work. By strengthening scapular muscles for proper scapular positioning and neuromuscular control and improving rotator cuff muscle strength, stress is taken off the biceps tendon.
Muscular endurance training of the upper extremity helps to increase blood flow to the shoulder and biceps tendon and improve the way the shoulder functions.
Gradual tendon loading of the biceps tendon: The physical therapist gradually loads the tendon, starting with isometric exercises before moving on to concentric and eccentric strengthening exercises. Research has shown that eccentric loading of tendons is helpful for healing and recovery; eccentric exercises involve contracting the biceps muscle and tendon while it is lengthening.
Dry needling uses small needles inserted into the biceps tendon to decrease pain, reduce muscle spasms, and improve localized blood flow.
Return to sport and return to throwing program: the return to throwing and sport program is essential to help the athlete re-learn proper throwing mechanics and gradually rebuild throwing strength and stamina without symptom exacerbation. The therapist conducts sport-specific functional tests before giving the athlete the go-ahead to safely return to sport in order to minimize risk of re-injury.
Biceps tendonitis can cause debilitating shoulder pain and severely limit your ability to do daily tasks or engage in work and sports activities. Work with a physical therapist to relieve pain, restore shoulder mobility and range of motion, and return to sport and work safely.
