Bicep Tendonitis: How to Address the Root Cause | Precision Movement

Bicep Tendonitis: How to Address the Root Cause

Biceps Tendonitis is a Symptom, not the Root Cause

By Coach E

bicep tendonisis

Is pain from bicep tendonitis getting in your way? It’s time to stop treating the symptom and get to the real issue so you can find lasting relief.

Symptom Management

Let’s say you’ve had a shoulder pain that keeps showing up. It is centered at the front of your shoulder and is starting to drive you nuts.

At first the pain would come and go, but now it’s becoming more constant.

The pain has alternated between dull and achy to sharp and focused. The sharp pain tends to really show up when you are reaching above you – say to grab some glasses out of your cabinet or shoot a basketball at the hoop.

You first try to ice the tender area, holding an ice pack to the front of your shoulder as you relax at the end of each day, but nothing really changes.

So you switch to heat, hoping a heating pad will help ease the pain. Unfortunately, you don’t have much luck.

You try stretching the area – doing your basic shoulder and upper arm stretches to no effect. You start popping some over the counter pain meds, but whatever brief relief these give you never last.

bicep tendonitis pills

You’ve tried everything to treat this site of pain, but sustained relief never comes.

Why? Because the pain you’re trying to treat is biceps tendonitis and is actually a symptom of a more complex issue. And trying to treat that symptom without addressing the root cause isn’t going to get you very far.

Bicep Tendonitis Basics

Bicep tendonitis (or biceps tendinitis as it is sometimes spelled) is inflammation and aggravation of a tendon connecting your biceps muscle to your shoulder.

This inflammation can cause pain at the front of the shoulder, plus other symptoms like tenderness and weakness.

The pain may be sharp or dull, and it might radiate down the arm or the neck [1]. The pain and weakness may get worse after or during activities, especially those that involve overhead motions like throwing or lifting.

There are two upper tendons of your biceps – the long head and the short head. The short head originates from the coracoid process of the scapula and the long head originates from the supraglenoid tubercle. The long head of the biceps tendon is usually the culprit in biceps tendonitis.

bicep tendonitis anatomy

Image by

Excessive or improper forces on the tendon (which may be caused by a variety of reasons that we’ll get to later) can lead to this initial aggravation.

At first, your tendon starts to swell and the area becomes sensitive and inflamed. Over time, the tendon covering might start to thicken and enlarge, further aggravating the area [2].

It’s important to understand that the inflammation itself, or the tendonitis, is more of a symptom than anything. It is NOT in and of itself the real root cause of the pain.

In some cases, all of this irritation and swelling can eventually lead to a tear of the tendon. However, that is a pretty extreme case, and not what we are going to focus on here.

Instead, let’s focus on getting this inflammation under control before it gets to that point. To better understand the situation and what can go wrong to cause bicep tendonitis, let’s take a deeper look at the anatomy of the area.

Biceps Biomechanics

There are three bones that come together to make up your shoulder joint – your scapula (or shoulder blade), your collarbone (or clavicle), and your humerus (or upper arm bone).

The round head of your humerus sits into a shallow cavity in your scapula, called the glenoid cavity. These two parts make up the “ball” and “socket” of this ball-and-socket joint.

Along the front of your humerus sits the biceps muscle. The muscle works mainly to flex the elbow and supinate (or rotate outward) the forearm. However, the muscle also helps to provide some flexion at the shoulder joint [3].

As we’ve touched on, the biceps originates at two different parts of the scapula. As the muscle runs upwards, becoming the biceps tendon, the tendon separates into the two distinct branches. The short head attaches to the coracoid process on the front of the clavicle.

The long head runs up the bicipital groove of the humerus. It then crosses over the head of the humerus before attaching the very top of the shoulder joint, at the glenoid cavity.

bicep tendonitis anatomy

Image by

At the distal, or far end, it crosses the elbow and inserts onto your radius, in the forearm. However, it is the origin of the long head of the biceps tendon, at such a crucial spot, that sets the tendon up for vulnerabilities to inflammation.

Getting to the Root of Bicep Tendonitis

Because both heads of the biceps are connected to your shoulder blade, the position and functioning of these two structures are very closely tied.

If your biceps is tense and tight, it can produce a pulling force on the scapula, interfering with its position and functioning

bicep tendonitis fitness

And conversely, if scapular positioning is out of whack, the biceps tendon might start to get impinged, pinched, or otherwise aggravated by the surrounding structures.

This brings us to the real, root causes of bicep tendonitis – the causes you will have to address if you want to see results, and not end up like the frustrated symptom-treater at the beginning of this article.

There are 3 main causes we are going to focus on: scapulohumeral rhythm, poor posture, and scapular winging.

1. Scapulohumeral Rhythm

One common cause of bicep tendonitis is trouble with scapulohumeral rhythm – how the shoulder blade and upper arm move and function together.

This is important in both overhead and horizontal movements like pushing and pulling.

To lift your hand up to throw a ball or grab something off a high shelf, these two bones have to move together harmonically.

The scapula has to rotate the whole glenoid cavity upwards, at which point your upper arm can move freely overhead.

bicep tendonitis scapulohumeral rhythm

Image by

The two work in something close to a 2:1 ratio – for every 2 degrees of elevation coming from the humerus in the glenoid cavity, there is 1 degree of rotation coming from the scapula [4].

If your scapulohumeral rhythm is not functioning properly, impingements and pressure can result, causing excess tension and stress on structures like the long head of the biceps tendon.

2. Poor Posture

Poor posture is also intrinsically related to biceps tendonitis, although this connection may not seem very obvious at first. It all comes back to how posture affects the position of the scapulae, which as we’ve seen, affect the functioning of the biceps tendon.

scapular stabilization exercises kyphotic thoracic spine spine deformities, hunchback bicep tendonitis

Having an upper back that is hunched forwards (also called thoracic kyphosis – a condition all too common in the modern age) means that your shoulders are constantly rounded forward too. The posture creates improperly positioned scaps and all sorts of trouble [5].

This rounded back creates a less than ideal surface for scapular movement – in turn increasing the likelihood of issues with scapulohumeral rhythm and other dysfunctions at the shoulder joint.

3. Scapular Winging

Yet again we see the importance of scapular positioning in the final major root cause of bicep tendonitis – scapular winging.

scapular dyskinesis - winged scapula

Scapular winging occurs when the medial edges of the scapulae appear to “wing” out from the body. Why is this so important?

Well, this winging indicates muscular weaknesses or poor muscular control in the muscles that support and stabilize the scapulae. And I’m sure by now you can guess it – unstable scaps spells trouble for that poor biceps tendon.

Exercises for Biceps Tendinitis Rehab

With these real root causes in mind, it is easier to see why you won’t have any luck easing your discomfort if you are just treating symptoms like our pained friend at the beginning of this article…

Even when treating the symptoms of bicep tendonitis provides some temporary relief, it is not going to prevent the pain from returning.

To effectively rehab, you’ve got to address the root causes.

That means promoting proper muscular balance and strength as you focus on improving scapulohumeral rhythm, correcting your posture, and addressing any issues with scapular winging.

I’ve got plenty of articles on my site to help you address all three in more depth. To get you started, let’s take a look at 3 exercises that will help you tackle these key areas.

1. Shoulder Rotation Robot

This move is a simple and effective way to train proper scapulohumeral rhythm. It will help you focus on reciprocal movement while also improving scapular control.

● Stand with your back against a wall, fingers pointing down toward the ground and elbows slightly bent
● Keeping your upper arm and elbow pressing into the wall, start to lift your right fingers and forearm away from the wall as you rotate them up
● Let the back of your hand reach the wall, fingers pointed up, and pause, pressing both hands into the wall
● As you rotate your right arm back down to the starting position, lift your left arm up, swapping positions
● Continue to move, taking one hand up as the other moves down and pausing in between

2. Hovering Pushup

The hovering pushup is a great move for anyone dealing with bicep tendonitis, but is pretty much a must if you are dealing with poor posture and thoracic kyphosis.

This drill will help you learn to properly extend the shoulders while you retract the scaps – improving both posture and scapular control.
Hovering Pushup - bicep tendonitis

● Lie in a prone position
● Place your palms on the ground with thumbs under your armpits or a bit lower
● Raise both your chest and palms off the ground and hold for 10 to 30 seconds keeping your scapulae retracted and hands and fingers extended

3. Supine Serratus Activator

This move is great at helping you combat scapular winging and correct muscular imbalances in and around the shoulder blades. You’ll fire up muscles that are often inhibited, helping to build proper muscular balance in the shoulders and upper back.

● Lay on your back with legs bent, feet flat and arms by your side
● Bend your elbows so your fingers are pointing up towards the sky with palms facing together
● Drive your elbows into the ground to activate the lats and posterior deltoids without trying to pinch your scapulae together
● Picture your chest opening and the medial border of the scapulae moving up into your body and hold for 5 seconds
● Relax briefly and repeat

Give these moves a shot. If that biceps tendonitis pain shows up, causing an achy upper arm and shoulder, resist the urge to just treat the symptom. Instead consider the root issue and the complex structures involved, and try these exercises out instead.

This approach will help build strength, activate key muscles, promote muscular balance, and maybe most importantly – give you a better shot at effective, lasting pain relief.

About the Author

Eric Wong (aka Coach E) is the founder of Precision Movement and has a degree in Kinesiology from the University of Waterloo. He's been a coach since 2005 and spent his early career training combat athletes including multiple UFC fighters and professional boxers. He now dedicates himself to helping active people eliminate pain and improve mobility. He lives in Toronto (Go Leafs Go!) with his wife and two kids and drinks black coffee at work and IPAs at play. Click here to learn more about Eric.