8 Bicep Tendonitis Exercises

If you have pain in your upper arm or shoulder, you may have irritated your biceps tendon, a condition known as biceps tendonitis. The pain may limit your shoulder motion and make performing normal work and recreational tasks difficult or impossible. You should see a healthcare provider who can diagnose biceps tendonitis and refer you to a physical therapist for treatment.

Your biceps are in your upper arm, and the biceps tendon connects your biceps muscles to your shoulder joint. If the tendon becomes injured through normal wear and tear, overuse, or a traumatic injury such as a fall, biceps tendonitis can occur.

Physical therapy (PT) for biceps tendonitis can help decrease pain, improve shoulder strength and range of motion, and improve functional mobility and arm use. You can do PT in an outpatient setting, at home, or both.

This article will explain biceps tendonitis and its symptoms and describe eight exercises that can help improve the range of motion of your arm and shoulder affected by biceps tendonitis.

What Is Bicep Tendonitis?

There are several possible causes of bicep tendonitis. It is usually caused by overloading and overusing the biceps tendon. This often happens in repetitive overhead activities, such as racquet sports or baseball throwing.

The biceps muscle helps to decelerate the elbow when it is extending, but overusing it repeatedly, such as a pitcher throwing a baseball repeatedly, places excessive stress on the tendon, leading to inflammation.

Age-related changes are another cause of biceps tendonitis. The ligament that courses over the long head of the biceps tendon can thicken as you age due to repeated micro-trauma to the area. This thickening of the ligament may cause abnormal rubbing on the tendon, leading to inflammation and irritation.

Shoulder and rotator cuff injuries can also contribute to biceps tendonitis. Since the biceps tendon works to stabilize the front of your shoulder, it may become overworked if you have shoulder instability or a rotator cuff tear. When a rotator cuff muscle is torn, your biceps tendon overworks to help stabilize the area, leading to biceps tendonitis.

The initial injury and inflammation of the biceps tendon is called tendonitis. Long-term biceps tendon problems are called biceps tendinopathy.

Anatomy of the Biceps

Your biceps muscles are located in the front of your upper arms. They course from two heads (hence the name, “bi” meaning two) near your shoulder joint. The short head of the biceps arises from the coracoid process of your shoulder blade. The long head of the biceps originates from the supraglenoid tubercle of your shoulder joint and is encased in a synovial sheath.

This sheath provides lubrication to the tendon and allows it to glide and slide normally in the front of your upper arm. The biceps muscle travels down your upper arm and inserts on the radial tuberosity of your forearm.

The primary function of your biceps is elbow flexion. It also plays a role in turn your palm up (supination), and it also helps flex your shoulder joint and assists the rotator cuff muscle group in stabilizing the front of your shoulder. This is why overloading of the biceps tendon at your shoulder or elbow may cause biceps tendonitis.

Symptoms of Biceps Tendonitis

There are many symptoms of biceps tendonitis. These may include:

• Pain in your upper arm and shoulder
• Difficulty and pain lifting your arm up
• Feelings of pain or aching in your upper arm
• Snapping sound or sensation in your shoulder

If you suspect you have biceps tendonitis, you should visit your healthcare provider for a diagnosis. Biceps tendonitis may be difficult to diagnose, as other conditions may present as anterior shoulder pain. A rotator cuff tear, AC joint arthritis, shoulder labrum injury, or cervical (neck) radiculopathy can all have overlapping symptoms.

Your healthcare provider can order diagnostic tests to accurately diagnose if your condition is biceps tendonitis and refer you to a physical therapist for treatment. Your physical therapist will work with you on a specific exercise regimen to treat your biceps tendonitis.

Physical Therapy Treatment for Biceps Tendonitis

There are many different treatments and modalities for biceps tendonitis. These are designed to decrease pain and inflammation, improve ROM and strength, and improve pain-free use of the arm and shoulder. Physical therapy is the main treatment for biceps tendonitis. Here are several exercises your physical therapist may work on with you.

Biceps Curls

Biceps curls help you strengthen the muscles in your upper arm so that you can safely pick things up. Generally, you will want to do around 10 repetitions of biceps curls. Pick weights that make it challenging by the time you get to 10 but that allows you to still maintain good form. Focus on form and don’t rely on momentum to get you through your repetitions.

If you experience pain or you are struggling to maintain proper form, stop and contact your physical therapist for advice.

• Stand with your legs hips width apart and engage your core.
• Hold one dumbbell in each hand with your palms facing forward.
• Keeping your elbows against the side of your body, bend your elbows, and bring the weights toward your shoulders, with your palms facing toward you.
• Then, lower the weights back to their starting position.

Biceps Stretch

There are several ways to stretch your biceps. Stretching your biceps can help improve your range of motion. A common bicep stretch is the standing bicep stretch. It can also help stretch your chest and shoulders.

• Stand tall and relax your shoulders down your back.
• Place your arms behind you with your palms facing down.
• Interlock your fingers.
• Keeping your arms straight, raise your arms up behind you as high as far as you comfortably can.

Hold this stretch for up to a minute before releasing, and repeat up to three times.

Be careful not to overstretch your bicep, especially if it is injured. There are several variations of biceps stretches, and your physical therapist may suggest that you begin with a gentler stretch or modify this stretch for you.

Shoulder Flexion

Shoulder flexion helps with your vertical range of motion. Do this exercise for 10 repetitions several times throughout the day. If you feel pain, stop and ask your physical therapist for modifications. They may modify the exercise or switch you to a different shoulder flexion exercise.

• Begin with both arms resting at your sides, palms facing your thighs.
• Raise your arm up, fingers pointing towards the ceiling and your palm facing away from you.
• Hold your arm up for five seconds, then gently lower it back to your side.

Elbow Flexion

Elbow flexion can help improve the range of motion on your injured side.

• Relax both arms at your sides.
• Flexing at the elbow, bring your palm up towards your shoulder.
• Your physical therapist may recommend you use your uninjured hand to help bring your palm closer to your shoulder, increasing the flexion.
• Then, lower your palm and relax the arm at your side.

Repeat this exercise 15 times or as instructed by your physical therapist.

Shoulder Internal Rotation

Shoulder rotation involves effort from both the biceps and rotation of the shoulder joint. It helps you to maintain the full motion of your shoulder joint.

• Lay on your back with your knees bent.
• Holding a weight in the hand on the injured side, make a right angle.
• The elbow should be against your side and touching the surface you are lying on, with the weight held up in your hand.
• Keeping your elbow touching the surface and against your side, move the weight away from your body, palm up.
• Do not lower your hand all the way.
• Bring the hand and weight back to the original right angle.

Do this exercise for up to 15 repetitions or as directed by your physical therapist.

Shoulder External Rotation

Shoulder external rotation exercises can help to improve or maintain shoulder mobility and decrease pain. The following is one example of a shoulder external rotation stretch.

• Choose a doorway in your home.
• Stand in front of the door frame, and hold the frame of the door with your hand on the injured side, forming a right angle between your forearm and upper arm.
• Use the hand on the uninjured side to hold your elbow on the injured side against your body.
• Rotate your body away from the doorframe.
• Stop when you feel a stretch in the shoulder and hold for five seconds or as instructed by your physical therapist.
• Try to do this in repetitions of three and up to three times a day, eventually holding the stretch for up to a minute.

To do this exercise correctly, keep your arms as still as possible and make sure to avoid twisting your back.

Forearm Twist

Forearm twists help with the flexibility of the arm.

• Begin with your arms at your side.
• Bend your elbow to a 90-degree angle.
• Turn your palms upwards and hold for five seconds.
• Turn your palms downwards and hold for five seconds.
• Lower your arms down back by your side.

Hold this exercise for five seconds and repeat it 10 times, or as instructed by your physical therapist.

Shoulder Circle Crossover

This exercise helps with shoulder mobility in biceps tendonitis.

• Begin standing straight with your arms at your sides.
• Move your arms out to the side with the palms facing forward.
• Pull your shoulder blades together, moving your arms behind you.
• Raise your arms up with your palms facing forward.
• Your hands should meet.
• At this point, cross your arms in front of your body until they are horizontally crossed.
• Then reverse the movement so that your palms are behind you and facing away from you.

Repeat this exercise three to six times and do one or two sets, or follow your physical therapist’s instructions.

Other Ways to Treat Biceps Tendonitis

Physical therapy is the main treatment for biceps tendonitis. However, other treatments may help aid healing and can often be used in conjunction with targeted exercises.

Massage

Your physical therapist may perform various massage techniques for your biceps tendonitis. Cross-friction massage may be done to stimulate collagen formation around your injured tendon. This can help decrease pain and improve localized circulation. Massage can also improve tissue mobility, allowing your shoulder and arm to move more freely.

Kinesiology Tape

Some physical therapists use a treatment technique called kinesiology taping, also known as K-tape. Your PT will apply strips of flexible fabric tape to your upper arm or shoulder. The tape decreases pain and spasms and facilitates proper muscle function.

A word of caution: K-tape is a newer treatment in PT and has not been proven to be effective in treating tendon disorders. Anecdotally, some people report improved symptoms and function with the tape, but more research is needed.

Heat

If you have biceps tendonitis, your physical therapist may apply heat to your upper arm and shoulder. The heat increases blood flow to the area, bringing in oxygen and nutrients and flushing out waste material that may have gathered due to inflammation.

Heat can also decrease pain and improve tissue mobility. To ensure the heat does not burn your skin, place a few layers of toweling between the hot pack and your skin. Notify your PT if you get too warm during a heat treatment.

Ice

Ice may be used in the treatment of biceps tendonitis. Ice decreases blood flow and can be used to control localized pain, swelling, and inflammation.

Your PT may apply ice at the end of your therapy session to keep inflammation to a minimum. Care should be used, since ice placed directly on your skin may cause a frost burn. Notify your therapist if you feel discomfort during ice use in the PT clinic.

Ultrasound

Ultrasound has been used in PT clinics for many years. The treatment involves passing an ultrasound wand with a coupling gel over your injured tissue for five to 10 minutes. The wand sends ultrasonic waves into your biceps tendon, heating the tissue. This heat increases blood flow and cellular activity in the area.

During ultrasound treatment, you should feel nothing except for mild warming around the ultrasound head. A burning sensation may be felt if ultrasound is not applied properly. Notify your PT if you feel any pain so adjustments can be made.

Although ultrasound has been used for many years in PT, exercise tends to be more effective. While your therapist may utilize ultrasound, they will likely use it in combination with various exercises.

Electrical Stimulation

Electrical stimulation can help treat biceps tendonitis or tendinopathy. The stimulation, or e-stim, can be used to decrease pain, improve muscle function, or increase circulation.

If your PT chooses to use e-stim for your biceps tendonitis, two to four small electrodes will be placed around your shoulder and upper arm, and electricity will be applied to the electrodes. This electrical impulse may tickle a bit, but it should not cause pain.

Most e-stim treatments, such as transcutaneous electrical neuromuscular stimulation (TENS) or neuromuscular electrical stimulation (NMES), last about 10 to 20 minutes.

Dry Needling

Dry needling is a new treatment in physical therapy that involves injecting small needles into a tendon, much like acupuncture. The needle helps to decrease pain and muscle spasms and improve localized blood flow. Since it is a newer treatment, more research on its effectiveness is needed.

Iontophoresis

Iontophoresis is a special form of electrical stimulation that uses electricity to administer medication through your skin and into your injured biceps tendon. The medication is typically an anti-inflammatory liquid that is negatively charged. When a direct current that is also negatively charged is applied to the medicine, it repels it, driving the drug into your tendon.

Iontophoresis is usually applied for 10 to 20 minutes and should be painless. You may feel a bit of tingling underneath the medicated electrode, and some redness of your skin may occur after the iontophoresis is removed.

Some research has shown that iontophoresis can be effective for tendon problems, while other studies do not support its use as an anti-inflammatory treatment. Be sure you understand what to expect from iontophoresis, and speak with your physical therapist if you have any questions about it.

How Long Should Treatment Take?

Most cases of biceps tendonitis take about four to six weeks to heal. Your condition may take a bit longer if it is severe. Talk with your PT about how long your specific condition is expected to last.

If your pain continues after a month or two of therapy, your PT may refer you back to your healthcare provider for further treatment. Other more invasive treatments for persistent biceps tendonitis may include cortisone injections, platelet rich plasma injections, or surgery.

Summary

If you have pain in the front of your shoulder, you may have biceps tendonitis. This condition can make using your arm for normal work and recreational activities difficult. Working with a physical therapist to complete various exercises can help you gain motion and strength, relieve pain, and return to your previous level of function and activity.