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Biceps Tendinopathy

Background & Etiology

Biceps Tendinopathy is pain in the biceps tendon, in the biceps musculotendinous junction of the upper arm. This condition often occurs in conjunction with other destabilizing injuries of the shoulder, including rotator cuff tears, shoulder instability, and impingement syndrome. When inflammation occurs, this condition is then referred to as biceps tendonitis.

A tendon is part of the muscle that attaches muscle to bone. It is a strong, fibrous tissue that is responsible for transferring the forces generated by the muscle to the bone, thus producing movement at the joint. When a tendon becomes irritated it becomes painful, especially with movement. Tendon pain is called tendinopathy.


Tendinopathy is common in older individuals, and individuals who suddenly increase weight training, thus causing strain on the biceps. Other common causes of biceps tendinopathy include:

  • Participating in athletic activities that can strain the biceps like weight training or wrestling
  • Repetitive strain injuries (RSI) that occur in people who consistently use the biceps muscle for sport or work
  • Patients with rheumatoid arthritis may be susceptible to tendinopathy
  • Strain caused by an underlying condition like impingement syndrome or shoulder instability.
  • Irritation due to repetitive overhead activities, or routine lifting and chores.
  • The tendon can weaken with age and rupture

Signs and Symptoms

  • Upper arm pain or tenderness directly over the tendon that can radiate to the forearm or shoulder
  • Pain or burning sensation during activities, particularly those that require heavy lifting
  • Weakness may occur as the inflammation gets worse
  • Feeling of tightness or loss of motion due to discomfort
  • Swelling of the tendon


If an individual suspects they have tendinopathy, the initial treatment should consist of avoiding the positions and activities that produce the pain. A course of conservative treatment is usually recommended that would include rest, ice, physical therapy and non-steroidal medications to reduce inflammation.

If symptoms persist, treatment by your physician may be necessary. This may include steroidal medication or injections, in conjunction with therapy. Treatment for any underlying conditions will also be required. Surgery is rarely recommended for biceps tendinopathy, but may be considered in extreme cases.

Physical Therapy Interventions

Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of Biceps Tendinopathy include:

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage and joint mobilization by a physical therapist to regain mobility and range of motion of the upper arm.
  • Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the arm and effected muscle.
  • Neuromuscular Reeducation (NMR) to restore stability, retrain the upper extremity, and improve movement technique and mechanics (for example, throwing, lifting, or overhead motion activities) in daily use of the involved upper extremity.
  • Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation in the upper arm.
  • Home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.

Medical Interventions

Procedures that your physician may recommend and perform in addition to physical therapy may include:

  • REST and ICE
  • The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
  • Steroidal injections to reduce inflammation
  • Pain medication to reduce discomfort and allow the patient to perform the recommended exercises
  • Surgery to correct underlying pathology or the cause of the condition


Most patients recover full function following a course of conservative care that includes physical therapy, medication and/or injections. It is important that once the pain and inflammation is reduced, and motion and strength are restored, the patient gradually returns to full activities. Instruction in daily activities or sport performance is helpful for reducing a reoccurrence of biceps tendinopathy.


It is easier to prevent tendinopathy than to treat it. Below are some tips to reduce the risk of tendinopathy.

  • Warm up lightly before activity to improve circulation and lubricate the muscle and tendon. Warm up should be performed concentrating on the area that will be used.
  • Stretch the tendons and muscles you will be using after your warm up prior to the activity, and after it. Do not bounce when stretching. Instead, hold the stretch for 15-20 seconds.
  • Strengthen the muscles and tendons that you need to use for your activity. A regular strengthening program three times a week will keep muscles prepared for the job you are asking them to perform.
  • Do not work through pain. Listen to your body. Avoid the “no pain, no gain” philosophy.