Biceps Tendinopathy as a Cause of Shoulder Pain

Biceps tendinopathy involves irritation or damage to the biceps tendon, typically caused by overuse or repetitive strain to the shoulder. Biceps tendinopathy is a condition I treat regularly and is a common problem for new Mums who are doing much more lifting and carrying while looking after the little bubs than they may be used to. 

The pain associated with biceps tendinopathy is usually around the front of the shoulder and may radiate to the upper arm. It is also common to feel generally tense and sore in the surrounding shoulder muscles and sometimes the neck. Picking up and lifting with the affected arm is usually the most pain provocative activity; a feeling of weakness is also common. 

Diagnosis of biceps tendinopathy requires a thorough physiotherapy assessment to exclude other possible causes of pain. Sometimes, an ultrasound scan may be requested to confirm the diagnosis. 

Physiotherapy treatment of shoulder pain caused by a biceps tendinopathy usually involves a combination of the following:

Rest and Avoid Overuse: Give your affected arm a break from activities that exacerbate the pain. Avoid repetitive motions that strain the biceps tendon, such as lifting heavy weights or performing excessive overhead activities.

Ice: Applying ice to the affected area for about 15-20 minutes several times daily can help reduce inflammation and alleviate pain.

Pain Management: Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen may help manage pain and reduce inflammation. However, I recommend you consult your doctor before using these medications, which might have potential side effects or interactions.

Manual therapy: Hands-on treatment techniques may help ease pain and decrease muscle tension associated with biceps tendinopathy. 

Dry Needling: I find that tender myofascial trigger points are commonly associated with biceps tendinopathy and may be found within the muscles of the shoulder girdle and the biceps muscle. These trigger points may contribute to pain, sensitivity and muscle weakness and respond well to dry needling treatment. 

Laser Therapy: I have found that ultrasound or laser therapy promotes healing and reduces pain in tendinopathies. 

Bracing or Taping: In some cases, I may use a brace or tape to help support the affected area, reducing strain on the biceps tendon.

Modify Activities: Adjust your daily activities to avoid movements that trigger or worsen your symptoms. This might mean altering how you do certain activities, including your workout routine and using proper lifting techniques.

Therapeutic exercises:  I will design a tailored exercise program to improve flexibility, strength, and stability around the shoulder joint. Gradual strengthening exercises that target the biceps and surrounding muscles can help support the tendon and, promote healing and restore the tendon's ability to withstand the load stresses involved with childcare, activities of daily living, sports and gym, etc. Gentle stretching exercises can help improve the flexibility of the biceps and surrounding muscles. However, it's important to avoid aggressive or painful stretching that could worsen the condition. Isometric exercises can be helpful for pain management in the early stages and may progress to eccentric exercises, which involve focusing on the controlled lengthening of the muscle under tension. These exercises can help stimulate tendon healing and strengthen the tendon-muscle complex. An example of an eccentric exercise for the biceps is the "hammer curl", where you lower the weight slowly.

Gradual Return to Activity: Once your symptoms improve, I'll guide you to gradually reintroduce activities and exercises while noticing any signs of discomfort. Avoid rushing back into strenuous activities that could aggravate the condition.

Medical Intervention: In severe cases that do not respond to physiotherapy treatment, your doctor might consider corticosteroid injections or other medical interventions; however, injections have not been found to be very helpful in the long term, and there are some associated risks. Surgery is generally considered a last resort and is rarely necessary.

Remember, the approach to treating biceps tendinopathy can vary depending on the severity of the condition and your circumstances. I would always recommend a thorough assessment with an experienced physiotherapist as a starting point if you are struggling with shoulder pain. 

By Lorraine Carroll

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