Physical Therapy for Biceps Tendonitis

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. Physical therapy for biceps tendonitis can be helpful to decrease pain, improve shoulder strength and range of motion (ROM), and improve functional mobility and use of your arm.

Anatomy of the Biceps

Your biceps muscles are located in the front of your upper arms. They course from two heads (hence 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 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.

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 extending, and overusing it in repetition may place excessive stress 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 to 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 biceps 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 possible biceps tendonitis. These may include:

  • Pain in your upper arm and shoulder
  • Difficulty lifting your arm up
  • Feelings of weakness in your arm
  • Tenderness to touching in 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 right 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 view 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 present 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 PT 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 condition. Your PT will also ask about your medical history and may review any medication that you are taking.

During the PT 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 during an evaluation for biceps tendonitis include:

Once your PT 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 biceps 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 improve pain-free use of your arm and shoulder.

Exercise

Exercise should be your main tool in the treatment of biceps tendonitis. Exercise has been shown 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 included in your biceps tendonitis rehab program, including:

  • Shoulder ROM exercises. Shoulder ROM exercises may be passive, where your PT 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 provide much-needed movement to your biceps tendon.
  • Rotator cuff strengthening. If your PT suspects 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 PT can show you which exercises are best for your condition.
  • 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.
  • Enduarance exercise. While in the PT 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 improve the way your shoulder moves and functions. Using 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 while it is lengthening. It is theorized that this type of contraction helps to remodel the collagen that makes up the tendon, helping it to heal properly.

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 clinic.

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 PT.

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 may 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 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 proven 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 vigorous scientific scrutiny.

Heat

Your 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 improve 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 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 as 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 a physical modality that has been in use 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, so notify your PT if you feel any pain so adjustments can be made.

Although ultrasound has been used for many years in PT, many research studies have found that it fails to offer significant benefits when compared to other treatments, such as active exercise. Many 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.

Electrical Stimulation

Electircal stimulation may be used to help treat your biceps tendonitis or tendonopathy. 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, like transcutaneus electic neuromuscular stimilation (TENS) or neuromuscular electrical stimulation (NMES), last for about 10 to 15 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 spasm and improve localized blood flow. Since it is a new treatment, little research has been done regarding dry needling.

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-infammtory 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 PT 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 bit longer if it is severe, or it may be a distant memory in only a few weeks of treatment. 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 doctor for further treatment. Other more invasive treatments for persistent biceps tendonitis may include cortisone injections, platelet rich plasma injections, or surgery.

A Word From Verywell

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 can help you gain motion and strength, relieve pain, and return to your previous level of function and activity.

Was this page helpful?

Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Mcdevitt AW, Snodgrass SJ, Cleland JA, Leibold MBR, Krause LA, Mintken PE. Treatment of individuals with chronic bicipital tendinopathy using dry needling, eccentric-concentric exercise and stretching; a case series. Physiother Theory Pract. 2018;:1-11. doi:10.1080/09593985.2018.1488023


Additional Reading