Bicep's tendinopathies are common with athletes. A tendinopathy basically means “problem to a tendon” and englobe different condition like tendinitis, tendinosis and more. There are different types of bicep tendinopathies but in the article, we will focus on the long head bicep tendinopathy which is the most common. Physiotherapy can help treat this condition
Anatomy:
The bicep muscle has 2 muscle bellies:
Short head and long head
These 2 muscles will have a common attachment at the elbow, more specifically on the radial tuberosity of the radius. However, they will have two different attachments at the shoulder. The long head will attach to the supraglenoid notch of the scapula, and the short head to the coracoid process of the scapula. The long head tendon will pass true the subacromial space with put it at risk of impingement. Note that the long head of the biceps tendon is also partially attached the shoulder labrum and is therefore somewhat linked with labrum tears.
The main function of the bicep is elbow supination.
It is also an elbow flexor, a shoulder flexor, and a shoulder abductor if the shoulder is externally rotated.
Signs and symptoms
- Shoulder pain (in the front of the shoulder)
- Pain when touching the bicep tendon.
- Pain with activities requiring lifting,
- Pain with your arms up
- Sudden increase in training.
Diagnosis:
Just like with many tendinopathies, the goal of the assessment will be to confirm the diagnosis, but also to find the cause. That is why your physiotherapist should perform a complete body scan to try to find out what is wrong when your climb and what is causing the tendon to get inflamed.
Your physio will ask you questions to try to find signs of bicep tendinopathy. The physio will ask about your pain patterns, the location and intensity of the pain and the timeline.
Range of motion and strength testing of your shoulder and elbow will for sure be performed. Pain when bicep resisted testing is common.
A few tests can be performed to help with diagnosis including:
- Speed test
- Ferguson test
Your physio will also test functional motion to try to find out why your bicep is getting inflamed. Weakness around rotator cuff, scapular dyskinesia and upper back stiffness are common causes of bicep tendinopathy. Your neck is also potentially a cause.
Treatment
Protect
First you will have to protect the bicep tendon. Complete rest will most likely not be required. Your physio and yourself will have to follow the tendon recovery loading principal in order to insure proper adaptation to your tendons. You might have to slow down your activities, but only temporary.
In term of pain control, ice can be used on the pain full area. Acupuncture, dry needling and anti-inflammatory could also be used to decrease pain temporarily
Mobility
Lack of mobility to the neck, upper back, shoulder or elbow could be linked with biceps tendinopathy. Therefore, your physio might provide you with mobility exercises as well as manual therapy. The exercises will depend on your body and situation. Upper back stiffness is quite common and can be a problme. An upper back mobility exercise could therefore be prescribed
Bicep friction could also help with pain and bicep mobility.
Strength
Once you have full mobility, you will then have to strengthen your bicep. Remember that your bicep as multiple function at the elbow and shoulder joint. You will therefore have to work on all of them.
You might start with isometric exercises
Moving on with eccentric, which is a key component of tendon rehab.
Remember that you will also have to work on other potential muscle weakness around your shoulder and elbow to prevent the bicep inflammation to come back
Scapular muscles are often weak with many athlete. That lack of strength could decrease the subacromial space where the long head of the bicep goes true. That could lead to an impingement and a tendinopathy.
Proprioception
Your proprioception might be decrease after an injury and you will need ot perform specific exercises to recover it.
Return to sports:
The last stage is there for you to make sure you work on specific skills related to your sport. You will restart training, but your risk will be slightly elevated compared to a non-injured athlete.
You will work on more complexes exercise involving the whole body. You should have full mobility, full strength, and great proprioception at this stage.
Sport specific exercises
Prognostic:
Most people will fully recover from long head bicep. Pain can last quite a few weeks. Rehabilitation can be quiet long (up to a year). On average, patients will be back 100% somewhere between 8 to 12 weeks assuming they are getting treated
What to do next:
If you suspect you have long head biceps tendinopathy, the next step is to seek help from a physiotherapist. A trained professional can assess your condition, identify underlying causes, and create a personalized treatment plan to help you recover. Physiotherapy is key to managing pain, restoring function, and preventing future injuries. If you're in luck and live in Kanata, Ontario, you can visit us at Kinoveo Physiotherapy Clinic, where our experienced team is ready to help you get back to your activities pain-free.
Disclaimer
The health and medical information on this site is designed for educational purposes only. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatments. Consult your health care professional before making any decisions to your health. Call 911 in case of a medical emergency. If you have any concerns or questions about your health, you should always consult with a physician or another health-care professional.
The research
Krupp, R. J., Kevern, M. A., Gaines, M. D., Kotara, S., & Singleton, S. B. (2009). Long head of the biceps tendon pain: differential diagnosis and treatment. Journal of Orthopaedic and Sports Physical Therapy, 39(2), 55–70. https://doi.org/10.2519/jospt.2009.2802
