Biceps Tendinitis: Signs You Have It and How to Treat It, According to Physical Therapists

Upper arms feeling achy? Is it more uncomfortable to lift a heavy bag of groceries or curl a weight at the gym? You may be experiencing biceps tendinitis (tendonitis), which is defined as irritation and inflammation in the tendons that connect your biceps muscles to your shoulders and elbows. It can make even the most basic tasks, like brushing your hair, feel challenging. 

Though it’s rare to talk about or pinpoint your biceps outside of exercise, they’re integral to so many everyday movements. And they can usually handle a lot of the stress and strain they have to absorb as you lift, carry, and curl all sorts of things. Occasionally, though, our biceps tendons can get hurt.

The good news: Your biceps muscles are strong and resilient, and there's a lot you can do to help them recover and avoid further irritation, says Gwen Smith, PT, DPT, a physical therapist at Hinge Health.

Read on to learn more about biceps tendinitis: what it is, what causes it, and how to get relief with exercises from our Hinge Health physical therapists.

What Is Biceps Tendinitis?

Biceps tendinitis is an inflammation or irritation of your biceps tendon. To get a clearer picture, it helps to have a crash course in shoulder and arm anatomy. Your shoulder is a ball-and-socket joint made up of your upper arm bone (humerus), shoulder blade (scapula) and collarbone (clavicle). Your biceps tendon attaches your biceps muscle to your shoulder blade bone. 

“Tendinitis typically happens on the long head of your biceps tendon, which is the part that connects your biceps muscle to your shoulder joint,” explains Dr. Smith. Tendinitis can also happen in the short head of your tendon, which attaches to a bump on your shoulder blade known as the coracoid process.

Symptoms of Biceps Tendinitis 

Biceps tendinitis symptoms can vary, but they often include the following:

• Pain in the front of the shoulder that often gets worse at night

• Pain in the front of the shoulder that gets worse when you lift, pull, or reach overhead

• Pain that usually begins slowly and develops gradually over time

• Pain that may develop down the upper arm bone

• Occasional snapping sounds at the shoulder

Common Causes of Biceps Tendinitis

Many different factors can contribute to why you might develop biceps tendinitis. They include:

Doing too much, too often. Activities that have a lot of repetitive overhead motion — think swimming, tennis, or baseball — can contribute to biceps tendinitis if your body isn’t quite ready to tolerate them. “We also see it a lot in people who try to get back into weightlifting after a long hiatus — their biceps usually aren’t ready for the overhead lifts and shoulder presses until they’ve done the proper conditioning and strengthening,” says Dr. Smith.

Normal age-related changes. As we get older, shoulder mobility and function can change in ways that irritate the biceps tendon,” explains Dr. Smith. As a result, biceps tendinitis can become more common with age.

Rotator cuff changes. Many people who develop biceps tendinitis also have weakness in their rotator cuff, a group of muscles that stabilizes the shoulder joint, says Dr. Smith. “If that area isn’t strengthened, it may make it harder for you to steady yourself when you do certain overhead motions,” she explains.

Past shoulder injuries. If your shoulder has been injured in the past, your biceps tendons may be more prone to irritation.

Smoking. You’re more likely to develop biceps tendinitis — and even a biceps tendon rupture — if you’re a smoker. A 2020 study in the journal Therapeutic Advances in Chronic Disease found that people who light up are more likely to go on to develop the condition, thanks to poor blood flow in the area.

Treatment Options for Biceps Tendinitis 

Remember how you used to hear about RICE (rest, ice, compression, and elevation) when you were nursing a sports injury? The thinking about this recovery plan, however, has changed over the years. 

Now, Hinge Health physical therapists, among many other experts, recommend a different approach that focuses less on rest and more on movement and rehabilitation. This approach uses the acronyms PEACE and LOVE, which is based on a 2019 model published in the British Journal of Sports Medicine. In the PEACE and LOVE model, you want to start your recovery for biceps tendinitis with the PEACE framework:

• Protect the injured area by scaling back on activity, like lifting or curling heavy objects, that causes pain in the first few days after injury — but don’t avoid movement entirely. 

• Elevate the injured area above your heart to reduce swelling.

• Adjust anti-inflammatories, like ibuprofen. It’s best to limit their use, as high doses can impact tissue healing. But if you’re in a lot of pain or your symptoms are limiting your function and movement, talk to your doctor about whether it’s safe for you to use them. Another option is an over-the-counter topical NSAID gel like diclofenac (Voltaren), which may also help to reduce inflammation.

• Compression. If it hurts to move your biceps, a gentle compression wrap may help for the first few days or weeks after injury. Just make sure you exercise without the wrap as you strengthen the biceps muscles and tendons. 

• Education. Listen to your body. It will tell you when an activity is too much for your biceps. A physical therapist can help you tune in to these clues, too.

A few days after the injury or onset of pain, you can move on to show LOVE to the affected bicep:

• Load the injured area by gradually returning to normal activities, using pain as your guide. Know that some pain during or after activity is okay, but your pain should not exceed an acceptable level for you. Maybe you only load up your grocery bag halfway to ease back into carrying it, or if you have a baby or toddler, try carrying them for less time than normal. At the gym, this may look like starting back with less weight when you do certain moves, like biceps curls.

• Optimism. It’s natural to get discouraged when you’re injured, but maintaining the belief that you have the capacity to heal and can return to meaningful activities is a critical component of healing. Simply believing that you will get better really does matter.

• Vascularization means increasing blood flow to the injured area by engaging in exercise you can handle. This may even reduce the need for pain medication.  

• Exercise, or an active approach to recovery, restores mobility and strength. You can use pain as a guide to gradually progress your exercise and increase difficulty. The exercises below can help you specifically target the biceps tendon and the muscles that support it. 

Physical therapy can be very beneficial for biceps tendinitis, not just because you learn specific stretching and strengthening exercises for your tendons, but because it helps you find your movement sweet spot. A PT can help you safely experiment with different levels of intensity. Too intense? Back off a bit so you don’t ramp up inflammation that may create tendon tears and require even longer recovery. Too easy? Push yourself to work the muscles more. When you find your unique sweet spot, you’ll be able to continue to engage your biceps muscles without raising the risk of more injury. 

You can see a physical therapist in person or use a program like Hinge Health to access a PT via a telehealth or video visit. 

Most of the time, these conservative measures are enough to treat bicep tendinitis, reassures Dr. Smith. But if, after a few weeks, you're not seeing any improvements in pain or your pain is getting worse, consider seeing a doctor. They can help determine which factors may be contributing to your symptoms and recommend other treatment options, such as steroid injections.

The above exercises and stretches are recommended by Hinge Health physical therapists to improve the symptoms of biceps tendinitis. By incorporating moves that strengthen the shoulders, chest, back, and arms overall, you’ll build support around the biceps so they don’t have to work as hard. When your entire upper body is strong, your biceps are less susceptible to strain and injury.  

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Modify Your Weight Lifting Regimen 

You can still do upper body resistance training if you have biceps tendinitis but be strategic, says Dr. Smith. You don’t have to avoid any specific exercise — instead, make adjustments that support both your healing and strengthening goals. This can include scaling back weight, reducing range of motion or reps, or modifying a move. For instance, if shoulder presses with your usual amount of weight are too painful, try dropping the weight by five to 10 pounds. If push ups feel out of the question at first, sub in a banded chest press. The goal is to work back up to your normal exercises as your biceps recover and feel stronger.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.  

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Simons, S. M., & Dixon, J. B. February 21, 2023. Biceps tendinopathy and tendon rupture. UpToDate. https://www.uptodate.com/contents/biceps-tendinopathy-and-tendon-rupture 

2. Taylor, S. A., & O’Brien, S. J. (2016). Clinically Relevant Anatomy and Biomechanics of the Proximal Biceps. Clinics in Sports Medicine, 35(1), 1–18. doi:10.1016/j.csm.2015.08.005

3. Clayton, R. A. E., & Court-Brown, C. M. (2008). The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury, 39(12), 1338–1344. doi:10.1016/j.injury.2008.06.021

4. Zabrzynski, J., Gagat, M., Paczesny, L., Grzanka, D., & Huri, G. (2020). Correlation between smoking and neovascularization in biceps tendinopathy: a functional preoperative and immunohistochemical study. Therapeutic Advances in Chronic Disease, 11, 1–13. doi:10.1177/2040622320956418

5. McFarland, E. G., & Borade, A. (2016). Examination of the Biceps Tendon. Clinics in Sports Medicine, 35(1), 29–45. doi:10.1016/j.csm.2015.08.004

6. Athwal, G.S. October 2021. Biceps Tendinitis. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/biceps-tendinitis