According to the Australian Institute of Health and Welfare, 2,430 people went to the hospital with bicep muscle and tendon related injuries.[1] This is likely to be underestimated as people diagnosed with these conditions are not usually seen in hospitals. Researchers also showed that 12% of elite athletes playing overhead sports (e.g. swimming, volleyball) had a biceps tendon injury.[2]
Biceps tendonitis is particularly common in high-level overhead sports, as the repetitive stress on the shoulder can aggravate the biceps tendon. However, biceps tendonitis is rarely diagnosed on its own and is a sign that there could be other underlying shoulder injuries (e.g. rotator cuff tendinopathy, impingement syndrome).
Read on to understand what you should know about biceps tendonitis; the risk factors, treatment options and expected recovery time.
What is Biceps Tendonitis?
Biceps tendonitis (biceps tendinopathy) describes pain at the front of the shoulder and less commonly the elbow due to inflammation of the biceps tendon(s). Over time, tendons between the bicep muscle(s) and bones can also experience structural changes, such as swelling and loosening.
What are the symptoms of biceps tendonitis?
Symptoms of biceps tendonitis include pain at the front of the shoulder that extends down the front of the arm. People may also experience clicking or grating as well as pain that increases with movement, particularly with overhead activities.
Common symptoms of biceps tendonitis
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Deep aching pain and tenderness in the front part of the shoulder
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Pain that worsens with repetitive activities, lifting or pulling motions
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Pain that is aggravated by overhead movements
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Clicking or popping sensation during shoulder movements
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Muscle weakness of the biceps muscle
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Pain that radiates toward the neck or down the arm
What causes biceps tendonitis?
Biceps tendonitis is caused by overuse and repetitive movement. The activities that most commonly cause biceps tendonitis are sports such as swimming, tennis and cricket, as well as work that requires repetitive heavy lifting.
Common causes of biceps tendonitis
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Overuse of the bicep tendon
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Poor posture
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Excessive heavy lifting
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Poor throwing techniques in sports
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Repetitive injury of the biceps tendon
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Shoulder impingement
Sports that increase the risk of biceps tendonitis
Sports that involve repeated overhead arm movements or contact sports that put the biceps tendon under a lot of tension increases your risk of having biceps tendonitis.
Here is a list of the most common sports that can result in biceps tendonitis:
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Swimming
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Gymnastics
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Football
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Rock climbing
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Cricket
How is biceps tendonitis diagnosed?
Biceps tendonitis can be frustrating and cause a lot of pain during activities. In addition, this condition may progress and lead to tendon tears that will limit the mobility of your shoulder if left untreated.
There are several options available when it comes to diagnosing your injury as biceps tendonitis. One of the most common and most recommended by Australian GPs is an assessment from a physiotherapist.
Physiotherapists are rehabilitation experts that can effectively diagnose and treat tendon injuries such as biceps tendonitis.
A physiotherapy assessment is similar to your visit with a GP. Your physiotherapist will start with a consultation and ask you about your medical history and lifestyle. Use this time to discuss relevant information about your injury and pain.
After establishing a background of your condition, your physiotherapist will perform a physical test to identify the specific cause of your injury and rule out other conditions.
After your initial assessment, your physiotherapist will guide you through your treatment program.
This will include:
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Timeline of recovery
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Exercises to support your recovery even at home
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Expert advice and education
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Tailored treatment program based on your lifestyle.
How is biceps tendonitis treated?
Biceps tendonitis is an overuse injury and can happen over time. Symptoms of pain and discomfort during activities may come and go, but your activities will only lead to more complications unless you address the root cause of your problem.
There are several options when it comes to treating biceps tendonitis. One of the more common and the treatment option referred to by Australian GPs the most frequently is physiotherapy.
Physiotherapists routinely see sporting injuries such as biceps tendonitis and they are in the best position to give quality care and rehabilitate you back to your pre-injured state.
Your treatment will focus on decreasing your pain, improving your mobility, and increasing the strength of shoulder musculature to provide better stability in the shoulder region.
Depending on the severity of your biceps tendonitis, a physiotherapist may provide you with a combination of the following types of treatments:
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Therapeutic Exercises - Exercises to correct impairments, especially restoring the rhythm and natural movement of the shoulder joint.
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Manual Therapy - Hands-on techniques used by your physiotherapist to improve your joint mobility and decrease your pain.
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Strengthening Exercises - Strengthening of your shoulder muscles to improve stability and control of the surrounding muscles.
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Soft Tissue Mobilisation - Hands-on massage-like treatment to stimulate muscle relaxation and improve blood circulation in the area of your neck and biceps tendon.
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Stabilisation Exercises - Exercises that will help stabilise the shoulder joint.
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Taping Techniques - Specialised tape to promote control and help stabilise the shoulder.
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Expert Guidance and Advice - Advice on how you can gradually return to your activities and prevent re-injury.
A typical physiotherapy session with your local physiotherapist will last anywhere between 30-60 minutes. It is not uncommon for patients to feel the benefits in just one session.
Next step - Creating a treatment plan made for you
After your initial evaluation, your physiotherapist will create a specific plan of care to get the most out of your recovery and help you get back to a pre-injured state.
Self-care for biceps tendonitis
If you think you have biceps tendonitis, here are the best things you can do and avoid.
Things to do:
- Rest
Take a temporary break from your work or activities that may aggravate your condition.
- Apply cold compress
Apply ice or cold packs regularly for 15 minutes to reduce swelling and pain.
- Stretch
Do self-stretching exercises regularly on your shoulder and neck muscles to relieve stiffness and reduce tension in the area.
- Observe proper posture:
Slouching can increase the tension and irritate the nerves in your neck and shoulder, which may further increase your pain. Observe a proper posture, roll your shoulders back and down, and keep your head aligned with your shoulders.
Things to avoid:
- Avoid overhead activities
Limit your overhead movements as much as possible to avoid stress on the shoulder joint while the tendons are healing.
Do I need a specialist or surgery?
It is very rare that this injury requires specialist or surgical intervention.
In more severe cases, diagnostic imaging can be done to identify any underlying tissue damage or other problems.
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X-ray scans can check for bone and arthritic lesions within the shoulder joint and rule out other conditions that may cause your symptoms.
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MRI scans can check for tears of the biceps and rotator cuff tendons. This would also provide detail about the severity of your biceps tendonitis.
Your GP may prescribe you over-the-counter medications to combat inflammation and alleviate pain.
In some cases, steroid injections may be beneficial for severe biceps tendonitis. However, it must be used carefully because it can cause further weakness of the biceps tendon if over-prescribed.
Severe cases of biceps tendonitis with a complete tear of the tendons require surgical intervention to repair the damages.
Your GP may refer you to a physiotherapist to rehabilitate your shoulder and help you recover fast.
What is the recovery time / prognosis for biceps tendonitis?
Ultimately, recovery time is dependent on being proactive and seeking professional treatment along with the severity of your biceps tendonitis.
It is possible to recover from biceps tendonitis within six weeks to a few months.
It is vital to rest and limit overhead movements while you are recovering. Guided and gradual return to your function is the key to treating biceps tendonitis.
Physiotherapy helps improve the outcome of patients with biceps tendonitis and helps them maximise their recovery.
Important factors in recovery include:
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Sticking to your specific rehabilitation program and exercising regularly
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Resuming your sports activity gradually
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Paying attention to pain, and resting as necessary.
Can biceps tendonitis be prevented?
Guaranteeing prevention can be impossible, however, you can decrease the risk of biceps tendonitis through some of these techniques:
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Avoid excessive overhead activities - If you are performing these activities for sports or work, make sure that you properly pace your activities and provide sufficient rest for your body.
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Strengthen your shoulders – Strengthening exercises for the rotator cuff muscles will help you prevent shoulder injuries such as biceps tendonitis. Your physiotherapist will also teach you key exercises to strengthen other weak muscle groups.
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Observe proper posture – Poor posture can increase your risk of having an injury. Muscles and tendons have to work extra hard to maintain inefficient posture.
Outlook and the main takeaways
Biceps tendonitis starts with mild pain and discomfort on the front side of your shoulder during or after performing an activity. It is vital to be mindful of these signs and listen to your body. Rest is an essential aspect of your day or training.
Book a visit to your physiotherapist today and have your biceps tendonitis be assessed, and start your road to recovery.
Anatomy of the biceps
Biceps are muscles located in the front part of the upper arm and contract to bend the elbow and shoulders.
It includes a “short head” and “long head” that work as a single unit. The short head tendon attaches to the coracoid process of the shoulder blades. The long head of the biceps tendon attaches to the shoulder socket (glenoid).
Inflammation of the long head of the biceps tendon due to excessive stress can lead to biceps tendonitis resulting in painful arm elevation.
