Biceps tendonitis common causes and prevention

Whether you're a seasoned gym user or just starting your fitness journey, the nagging pain in the front of your shoulder may have cropped up at some point. One possible cause of this can be tendonitis in your biceps tendon which attached the bicep muscle to your upper arm. Here I'll discuss the common causes and, more importantly, how to manage biceps tendinitis to prevent it interrupting your daily activity, whether that be cleaning the kitchen... or a barbell!

Biceps tendonitis is one of the most common causes of shoulder pain, so I'll outline the signs and symptoms of this condition, exploring the factors that often contribute to its onset. From overzealous weightlifting to repetitive motions, I'll try and help you identify the causes of biceps tendinitis.

What is biceps tendonitis?

Biceps tendinitis, a prevalent concern within the active people (especially male gym users) is essentially inflammation in the long head of the biceps tendon. To understand this condition comprehensively, an appreciation of the anatomy within the shoulder/joint is important. The biceps brachii, a prominent muscle in the anterior upper arm, comprises two heads: short and long. The main one here is on the long head, originating from the supraglenoid tubercle of the scapula.

Progressing through the bicipital groove of the humerus within the shoulder joint, it extends down to merge with the radial tuberosity near the elbow. The culmination of these anatomical structures exposes the tendon to vulnerability during repetitive or strenuous activities, such as weightlifting or overhead motions. Consequently, overuse can lead to the degeneration of the biceps tendon, instigating the onset of biceps tendinitis.

What are the signs and symptoms of Biceps Tendonitis?

Pain in the Front of the Shoulder

Persistent, localised shoulder pain at the front of the joint is a hallmark symptom of biceps tendinopathy.

Worsening Pain with Overhead Movements

Discomfort tends to intensify during activities that involve raising the arm overhead, such as reaching for items on a high shelf or performing overhead exercises.

Weakness in the Arm

Individuals with biceps tendinopathy may experience weakness in the affected arm, particularly noticeable during activities that engage the biceps muscle.

Tenderness at the Bicipital Groove

Palpable tenderness or soreness at the bicipital groove, where the biceps tendon travels, is a common clinical finding.

Crepitus or Clicking Sensation

Some may notice a clicking or popping sensation in the shoulder joint during certain movements, indicative of tendon irritation.

Swelling and Inflammation

Inflammation of the biceps tendon can lead to localised swelling, contributing to the overall discomfort.

Pain Radiating Down the Arm

The pain associated with biceps tendinopathy may radiate down the arm, affecting the forearm or even reaching the elbow.

Pain Aggravated by Repetitive Movements

Activities involving repetitive or forceful use of the arm, such as lifting weights or throwing, can exacerbate symptoms.

It's important to note that individual experiences may vary, and consulting with a healthcare professional for a comprehensive evaluation is advisable if these symptoms are present.


What are the common causes of biceps tendonitis?

Biceps tendonitis often emerges as a consequence of repetitive stress and overuse of the biceps tendon, a resilient yet vulnerable structure. One primary contributor is intense and repetitive overhead activities, such as weightlifting, swimming, or throwing, which subject the tendon to constant strain. Poor lifting techniques, especially when performing exercises that engage the biceps, can further exacerbate the risk. Additionally, sudden increases in workout intensity or frequency without adequate conditioning can overload the tendon and lead to inflammation. Aging also plays a role, as the tendon naturally undergoes degenerative changes over time, becoming less pliable and more prone to injury. Anatomical factors, such as shoulder instability or abnormalities in the acromion (the bony process over the shoulder joint), may create mechanical issues, contributing to the development of tendonitis. Inflammatory conditions, like rheumatoid arthritis, can also heighten the susceptibility of the biceps tendon to inflammation. Collectively, these factors underscore the multifaceted nature of biceps tendonitis, necessitating a holistic approach to prevention and management that addresses both lifestyle and biomechanical considerations.

Acute management of biceps tendonitis

The acute management of biceps tendonitis involves a multifaceted approach aimed at alleviating pain, reducing inflammation, and promoting optimal healing. Rest is paramount, necessitating a temporary cessation or modification of activities that exacerbate symptoms, particularly those involving repetitive overhead motions. Ice application in 15 to 20-minute intervals can effectively reduce swelling and provide immediate relief. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to manage pain and inflammation; however, their prolonged use should be monitored closely. Physiotherapy plays a pivotal role, focusing on gentle stretching and strengthening exercises to enhance flexibility and stability in the shoulder joint. Modalities such as ultrasound or electrical stimulation may be employed to promote tissue healing. In some cases, a brace or sling may be advised to limit movement and offer support during the initial stages of recovery. It is imperative that individuals consult with a healthcare professional for personalized advice, as the severity of biceps tendonitis can vary, and a tailored treatment plan ensures optimal outcomes in the acute phase of management.

Long term management of biceps tendonitis

Chronic management of biceps tendonitis revolves around a comprehensive strategy to address underlying factors, promote long-term healing, and prevent recurrence. Physical therapy continues to be a cornerstone, focusing on targeted exercises to strengthen the shoulder muscles and improve overall joint mechanics. Eccentric strengthening exercises, which involve controlled lengthening of the biceps muscle, are often incorporated to enhance tendon resilience. Modification of activities to avoid prolonged or repetitive overhead movements is crucial in preventing ongoing stress on the tendon. Therapeutic modalities, including heat applications and ultrasound, may be employed to promote blood flow and facilitate tissue healing. In some cases, corticosteroid injections may be considered for their potent anti-inflammatory effects, although their repeated use is generally approached with caution due to potential side effects. Lifestyle adjustments, such as maintaining a balanced workout routine and incorporating adequate rest periods, become integral in preventing overuse. Surgical intervention is reserved for refractory cases or instances where structural abnormalities contribute significantly to the condition. Chronic management, therefore, is a collaborative effort between the individual, healthcare professionals, and rehabilitation specialists, with a focus on sustained improvements in function and quality of life.

Surgical treatment of tendonitis of the biceps tendon

Surgical intervention for tendonitis of the biceps tendon is considered when conservative treatments prove insufficient, and the condition persists, causing significant impairment. One common surgical approach is biceps tenodesis (which I know all too well...), a procedure where the damaged portion of the tendon is removed and the remaining tendon is anchored to a stable location, typically the humerus. This aims to alleviate pain and restore function while preventing further irritation. Another option is tenotomy, where the damaged portion of the tendon is simply cut, releasing tension and reducing symptoms. Surgical treatment may be performed arthroscopically, involving minimally invasive techniques with small incisions for reduced trauma and quicker recovery. While surgery is often effective in providing relief, it is essential to consider potential risks and undergo a thorough evaluation to determine the most appropriate course of action. Post-surgical rehabilitation is crucial to ensure optimal recovery, typically involving a carefully guided exercise program and gradual return to normal activities under the supervision of a rehabilitation specialist.

Recovering from Biceps Tendonitis

Recovering from biceps tendinopathy through physiotherapy is a comprehensive and targeted process designed to restore strength, flexibility, and function to the affected shoulder. The initial phase often involves pain management and reduction of inflammation through modalities such as ice application and, if necessary, anti-inflammatory medications. As the acute symptoms subside, the focus shifts to gentle stretching exercises to improve the flexibility of the shoulder joint and surrounding tissues. Progressive strengthening exercises, with a particular emphasis on eccentric exercises for the biceps, are introduced to rebuild the tendon's resilience. The physiotherapist works closely with the individual to correct any biomechanical issues contributing to the condition, offering tailored exercises to improve overall shoulder stability. Functional exercises that mimic daily activities or sports-specific movements are incorporated to ensure a seamless return to normal activities. The physiotherapy process is not only about physical recovery but also about education, empowering individuals with the knowledge to prevent future injuries and maintain a balanced and sustainable exercise routine. Regular progress assessments and adjustments to the rehabilitation plan ensure that the recovery trajectory aligns with individual needs, ultimately leading to a restored and resilient shoulder complex.

How to prevent biceps tendonitis

Preventing any injury is always better than the cause, and preventing shoulder pain is no different. First and foremost, individuals should prioritize a well-rounded and balanced exercise routine that incorporates strength training, flexibility exercises, and cardiovascular activities. When engaging in weightlifting, proper technique is paramount to avoid unnecessary stress on the biceps tendon. Gradual progression in intensity and duration of workouts allows the tendons to adapt without undue strain. Adequate warm-up before exercise, including dynamic stretches for the shoulders, can enhance blood flow and reduce the risk of injury. Cross-training, or varying the types of exercises and activities, prevents overuse of specific muscle groups. Regular rest days are crucial to allow the body, including the tendons, to recover. Additionally, maintaining good posture and ergonomic practices in daily activities, such as proper desk ergonomics, contributes to overall shoulder health. Lastly, staying attentive to any early signs of discomfort or pain and seeking timely medical advice can prevent minor issues from developing into more severe conditions. In essence, a mindful and balanced approach to fitness, coupled with a keen awareness of body signals, serves as the foundation for effective prevention of biceps tendonitis.


In summary, the prevention of biceps tendonitis demands a systematic and informed approach within the realm of physical fitness. Acknowledging the contributory factors, such as overuse and biomechanical issues, underscores the significance of precision in exercise practices. The adoption of a well-rounded fitness regimen, meticulous attention to form, and a comprehensive understanding of shoulder health collectively serve as the bedrock of injury prevention. This approach is not merely a precautionary measure but a strategic investment in sustained physical well-being. As we conclude, the emphasis remains on the cultivation of resilience through knowledge, discipline, and a commitment to the principles of effective prevention in the pursuit of enduring musculoskeletal health.

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Arun Gray sports therapist strength and conditioning coach skegness

The author

Arun Gray is a sports therapist and strength & conditioning coach with over 15 years experience in the industry. He also has a personal history with chronic shoulder and back pain along with a range of other sporting injuries.

Arun writes about common injuries and aims to help people understand and manage their pain to prevent having to rely on national healthcare.

Read more about Arun