If you have pain in your upper arm or shoulder, you may have irritated your biceps tendon, a condition referred to as biceps tendonitis. The pain may limit your shoulder motion and make performing normal work and recreational tasks difficult or impossible.
Physical therapy for biceps tendonitis can assist in decreasing pain, improve shoulder strength and range of motion (ROM), and enhance functional mobility and use of your arm.
Anatomy of the Biceps
Your muscles are located in the front of your upper arms. They course from two heads (thus the name”biceps”) 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 slide 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.
While the function of your biceps is to turn your forearm into a palm up position, it also works to help move your shoulder joint and assists the rotator cuff muscle group in stabilizing the front of your shoulder. Overloading of the biceps tendon at your shoulder or elbow may cause biceps tendonitis.
Injury to the Biceps Tendon
Biceps tendonitis is usually caused by overloading and overusing the biceps tendon. This often happens in repetitive overhead activity, such as racquet sports or when throwing a baseball. The biceps muscle helps to decelerate your elbow as it is stretching, and overusing it in rep may place excessive pressure on the tendon, leading to inflammation.
There is a ligament that courses over the long head of the biceps tendon, and this may thicken as you age due to repeated micro-trauma into the area. This thickening of the ligament may cause abnormal rubbing on the tendon, leading to inflammation and irritation.
Since the biceps tendon works to stabilize the front of your shoulder, it may become overworked if you have shoulder instability or rotator cuff tear. When a rotator cuff muscle is torn, your biceps tendon may overwork to help stabilize the area, leading to tendonitis.
It should be noted that the initial injury and inflammation of the biceps tendon is called tendonitis. Long-term biceps tendon problems are often referred to as biceps tendonopathy.
Symptoms of Biceps Tendonitis
There are many symptoms of potential biceps tendonitis. These may include:
- Pain on your upper arm and shoulder
- Difficulty lifting your arm up
- Feelings of weakness in your arm
- Tenderness to touching at the front of your upper arm and shoulder
If you suspect you have biceps tendonitis, you should visit your physician right away to get a diagnosis. That way, you can be sure to start on the ideal treatment for your condition.
Diagnosis of biceps tendonitis involves performing a clinical examination of your shoulder, elbow, and upper arm. Your physician may order diagnostic tests like magnetic resonance imaging (MRI) to see the soft tissue structures around your shoulder. This can confirm (or rule out) biceps tendonitis.
Biceps tendonitis may be difficult to diagnose, as other conditions may pose as anterior shoulder pain. These may include rotator cuff tear, AC joint arthritis, shoulder labrum injury, or cervical (neck) radiculopathy.
Physical Therapy Evaluation for Biceps Tendonitis
Your first appointment with a physical therapist for biceps tendonitis is called an initial evaluation. During this session, your local Physical Therapist will interview you about your injury.
They will ask how your injury occurred, how it is affecting your work and recreational activities, and if you have had and treatment so far for your problem. Your local Palmdale Physical Therapist will also ask about your medical history and may review any medication that you are taking.
During the Physical Therapy evaluation for biceps tendonitis, your physical therapist will perform various tests and measures. These are done to determine your functional baseline and to guide treatment for your shoulder. Tests commonly performed through an evaluation for biceps tendonitis include:
- Range of motion (ROM)
- Special shoulder tests
- Functional mobility
After your local Palmdale Physical Therapist has assessed your condition and completed the evaluation, they will discuss your plan of care with you. Goals will be set, and treatment for your tendonitis can begin.
Physical Therapy Treatment for Biceps Tendonitis
There are many different treatments and modalities that may be used to treat biceps tendonitis. These are designed to help decrease pain and inflammation, improve ROM and strength, and enhance pain-free use of your arm and shoulder.
Exercise should be your main tool in the treatment of biceps tendonitis. Exercise has been proven to help improve ROM, strength, and functional mobility to your arm and shoulder. It can also help improve circulation to the tendon and help facilitate healing.
Various exercises may be contained in your biceps tendonitis rehab program, including:
Shoulder ROM Exercises
Shoulder ROM exercises may be passive, where your local Palmdale Physical Therapist moves your arm and shoulder, active assistive (you move your shoulder with the assistance of an external device), or active. Range of motion exercises can improve shoulder mobility and function and may offer much-needed movement to your biceps tendon.
Rotator cuff strengthening. If your local Palmdale Physical Therapist supposes that rotator cuff weakness is causing your biceps tendonitis, he or she may prescribe exercises to strengthen those muscles.
Exercises may include internal and external rotation with a resistance band, the empty can exercise, or active range of motion with a free weight. Your Palmdale Physical Therapist can show you which exercises are best for your problem.
Scapular stabilization. The biceps tendons, both long and short, attach to your shoulder blade (scapula), and an improperly positioned scapula may be implicated as a cause of your biceps tendonitis. Working to gain neuromuscular control of your scapula may be prescribed for your biceps tendonopathy.
While in the Physical Therapy clinic, your therapist may have you work on improving upper extremity endurance. This can bring increased blood flow to your shoulder and biceps tendon, and can enhance the way your shoulder moves and functions.
Utilizing an upper body ergometer (UBE) may be helpful, and a rowing machine may be done to improve shoulder stamina.
Some evidence indicates that performing eccentric exercise can help with tendonopathy and biceps tendon problems. Eccentric exercises are ones that contract the biceps muscle and tendon when it is lengthening. It is theorized that this form of contraction will help to remodel the collagen that makes up the tendon, helping it to heal correctly.
Your physical therapist may also have you perform a home exercise program that you do independently. These exercises can help you maintain gains that you achieve in the practice.
Exercise for biceps tendonitis should be challenging, but not painful. If any exercise causes pain to increase, you should stop it an check in with your Palmdale Physical Therapist.
Your local Palmdale physical therapist may perform various massage techniques for your biceps tendonitis. Cross friction massage may be done to stimulate collagen formation around your tendon.
This can help decrease pain and improve localized circulation. Massage may also boost tissue mobility, allowing your shoulder and arm to move more freely.
Some physical therapists utilize a treatment technique called kinesiology taping, also referred to as K-tape. Your Palmdale Physical Therapist will apply strips of flexible fabric tape into your arm or shoulder. The tape is used to decrease pain and spasm or to facilitate proper muscle function.
A word of caution: K-tape is a newer treatment in PT and has not been demonstrated to be effective in the treatment of tendon disorders. Anecdotally, some people report improved symptoms and function with the tape, but it has not (yet) passed observational scientific scrutiny.
Your Palmdale physical therapist may apply heat to your upper arm and shoulder if you have biceps tendonitis. The heat increases blood flow to the area, bringing in oxygen and nutrients and flushing out waste material that may have gathered as a result of inflammation.
Heat can also be used to decrease pain and enhance tissue mobility. Be sure the heat does not burn your skin; a few layers of toweling should be placed between the hot pack and your skin. Notify your Palmdale Physical Therapist if you get too warm during a heat treatment.
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 Palmdale Physical Therapist may apply ice at the end of your therapy session to keep inflammation to a minimum.
Care should be used as ice placed directly on your skin may cause a frost burn. Notify your therapist if you feel discomfort during ice use in the Palmdale Physical Therapy clinic.
Ultrasound has been a physical modality that has been used in Physical Therapy clinics for many years. The treatment involves passing an ultrasound wand with a coupling gel over your injured tissue for five to ten minutes.
The wand sends ultrasonic waves in your tendon, heating the tissue. This heat increases blood flow and cellular activity in the area.
During ultrasound treatment, you should feel nothing except for gentle warming around the ultrasound head. A burning sensation may be felt if ultrasound is not applied correctly, so notify your Palmdale Physical Therapist if you feel any pain so adjustments can be made.
Although ultrasound has been used for many years in Physical Therapy, many research studies have found that it fails to offer significant benefits when compared to other treatments, such as active exercise.
Many Palmdale physical therapists do not use ultrasound due to this lack of benefit. Still, some therapists use it, and you may encounter it when being treated for your biceps tendonitis.
This is How Your Physical Therapist Uses Ultrasound
Electircal stimulation may be used to help treat your tendonitis or tendonopathy. The stimulation, or e-stim, can be used to decrease pain, improve muscle function, or increase circulation.
If your Palmdale Physical Therapist 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 little, but it should not cause pain. Most e-stim treatments, like transcutaneus electic neuromuscular stimilation (TENS) or neuromuscular electrical stimulation (NMES), last for about 10 to 15 minutes.
Dry needling is a new treatment in physical therapy that involves injecting small needles into a tendon, much like acupuncture. The needle will help to decrease pain and muscle spasm and enhance localized blood flow. As it is a new treatment, little research has been done regarding dry needling.
Using Iontophoresis in Physical Therapy
Iontophoresis is a special form of electrical stimulation that uses electricity to administer medication through your skin and to your injured biceps tendon.
The medication is typically an anti-infammtory liquid that is negatively charged. When a direct current that is also negatively charged is applied to the medication, it repels it, driving the medication in 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 eliminated.
Some research has shown that iontophoresis can be effective for tendon problems, while other studies do not encourage its use as an anti-inflammatory treatment. Be sure you understand what to expect from iontophoresis and speak to your physical therapist if you have any questions about it.
How Long Should Physical Therapy Take?
Biceps tendonitis can be a nagging problem, and it may take a few months to fully clear. Most cases can be treated successfully in about four to six weeks. Your condition may take a little longer if it is severe, or it may be a distant memory in only a few weeks of treatment. Talk to your Palmdale Physical Therapist about how long your specific condition is expected to last.
If your pain continues after a month or two of therapy, your Palmdale Physical Therapist may refer you back to your doctor for further treatment. Other more invasive treatments for persistent biceps tendonitis may include cortisone injections, platelet rich plasma screen, or surgery.
A Word From Quite Well
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. Overall, working with a local Palmdale physical therapist can help you gain motion and strength, relieve pain, and return to your previous level of function and activity.