Biceps tendinitis is a common cause of shoulder pain, often developing in people who perform repetitive, overhead movements. Biceps tendinitis develops over time, with pain located at the front of the shoulder, and usually worsens with continued activity. When treating biceps tendinitis, our physical therapists at Progressive Physical Therapy work to determine the exact source of the pain by assessing the entire shoulder, and typically prescribe a program of activity modification, stretching, and strengthening to resolve pain and return individuals to their desired activities.

The biceps muscle is made up of 2 parts: the long head and the short head. The long head of the biceps is most commonly implicated with tendinitis, as the tendon from the muscle runs up the length of the arm and attaches into the shoulder joint. It becomes a part of the shoulder joint capsule, which is surrounded by numerous other structures, including the rotator cuff.

Biceps tendinitis result when excessive, abnormal forces are applied across the tendon, including tension (a pulling of the muscle and tendon), compression (pushing or pinching), or shearing (rubbing). When the tendon is subjected to repetitive stresses, it can become irritated, swollen, and painful.

There are many factors that may lead to biceps tendinitis, including:

• Activities requiring repetitive overhead movement of the arms
• Weakness in the rotator cuff and muscles of the upper back
• Shoulder joint and/or muscle tightness
• Poor body mechanics (how a person controls his or her body when moving)
• An abrupt increase in an exercise routine
• Age-related body changes

Once biceps tendinitis has been diagnosed, your physical therapist at Progressive Physical Therapy will work with you to develop an individualized plan tailored to your specific shoulder condition and your goals. There are many physical therapy treatments that have been shown to be very effective in treating this condition:

Range of Motion. Often, abnormal motion of the shoulder joint can lead to biceps tendinitis. Your physical therapist will assess your shoulder motion compared to the expected normal motion and to the motion of your other shoulder.

Strength. The muscles of the shoulder and upper back work together to allow for normal, coordinated upper-body motion. Based on the way the shoulder joint is designed (a ball-and-socket joint, like a golf ball on a golf tee), there are many directions in which the shoulder may move. Therefore, balanced strength of all the upper-body muscles is crucial to make sure the shoulder joint is protected and is moving efficiently. There are many exercises that can be done to strengthen the muscles around the shoulder so that each muscle is able to properly perform its job, and stresses are appropriately dispersed.

Manual therapy. Physical therapists are trained in manual (hands-on) therapy. Your physical therapist will gently move and mobilize your shoulder joint and surrounding muscles as needed to improve their motion, flexibility, and strength. These techniques can target areas that are difficult to treat on your own.

Pain Management. Your physical therapist may recommend therapeutic modalities, such as ice and heat, to aid in pain management.

Functional training. Whether you work in a factory, are a mother of a young child, or play baseball, the ways in which you perform your normal daily activities can affect the health of your muscles, tendons, and joints. Improper movements can, over time, cause pain in the body. Physical therapists are trained to be experts in assessing movement quality, and in training people to function at their best. Your physical therapist will be able to point out and correct faulty movements, so you are able to attain and maintain a pain-free shoulder. Often, the strategies learned through specific education from your physical therapist will allow you to avoid reversing the positive effects of your physical therapy treatment during your normal daily activities, and help make sure your improvements last.