By Laurie Melrose-Doering, Osteopath & Applied Kinesiologist
Biceps brachii is a digastric muscle, meaning it has two bellies – a long head and a short head. In biceps tendinopathy, the tendon of the long head of biceps becomes inflamed.
Biceps tendinopathy is a very common cause of anterior shoulder pain and usually co-exists with other shoulder pathologies, e.g. rotator cuff injuries, shoulder instability, labral tear, and muscle imbalances.
As with all tendinopathies, biceps tendinopathy is a result of tendon overuse. In the case of the biceps long head, it is overhead activities that place the most strain on the tendon. You are, thus, at increased risk if you play cricket.
Often, there are additional underlying causes that predispose to injury from repetitive use, such as:
Luckily, any tendon can gradually adapt to the stress placed on it. This is why gradually increasing activity is better than starting from a low baseline and jumping straight into overhead activities several times a week.
The pain is usually over the anterior shoulder and bicipital groove, where the tendon runs. Symptoms are aggravated by repeated activation of the biceps muscle, i.e. shoulder and elbow flexion, or overhead activities.
There may be audible ‘snapping’ or ‘clicking’ if the tendon is subluxating out of the bicipital groove.
If the pain is very acute, you may have a tendency to want to hold your shoulder to relieve pain.
Usually, the case history combined with palpation, and active and passive range of movement tests reveals the pathology.
Because there is overlap with other shoulder pathologies, ultrasound imaging may be useful to find out whether there are labral or rotator cuff tears.
As an osteopath who uses AK, I find muscle testing very useful.
This is dependent on the severity of the injury. Usually, pain can resolve in 2–4 weeks, with full recovery in 6-8 weeks. With the right treatment, you can expect faster and better results.
There are a number of different treatments that can help biceps tendinopathy:
If the injury is acute, you should protect and rest the shoulder, i.e. avoid aggravating movements.
Icing, ideally 5 to 15 minutes for the first 48 hours, helps control the inflammation. Ice can also numb pain, so make sure you keep the shoulder rested. You do not want to further irritate the tendon by moving your shoulder because you think the decreased pain is suggesting the shoulder is fine.
You can start exercising the shoulder after the acute phase has passed. You must not push through pain or you may further irritate the injured tendon.
Exercising should start with gentle stretching of the biceps tendon and circumduction. In practice I show patients a pendulum exercise that is a good technique to mobilise the shoulder.
After this, you can start with isometric, then concentric, then eccentric, and, finally, sport-specific exercises.
A Swiss ball is fantastic for proprioceptive exercises. You can try rolling a Swiss ball or a small ball up a wall, for example.
Massage can reduce tension and resolve trigger points in associated muscles. However, massage should not be too gung-ho.
An acupuncturist will focus on local shoulder points, and GB34 and LI4.
A herbalist can prescribe herbs that reduce inflammation and support connective tissue
Some patients may get pain relief from TENS machines. And ultrasound treatment can help the tendons.
Surgery is very rare and only indicated if there are co-existing pathologies.
Osteopathy, especially when coupled with specific diagnosis based on AK muscle testing, is effective in the treatment of biceps tendinopathy.
Specific muscle testing allows me to ascertain whether the tendon of biceps long head has moved within its bicipital groove. Once found, it is then easy to manipulate the tendon back into place.
In addition to treating the position of the tendon, I treat all other functional muscle weaknesses and joint dysfunctions in the shoulder.
If you think you may have biceps tendinopathy, please get in touch.
To book a session with one of our herbalists, click here. Alternatively, you can contact us at 020 8942 3148 to learn how our treatments can benefit you.
Aston Clinic London is a third-generation complementary health clinic located in New Malden, serving Kingston, Norbiton, Wimbledon, Raynes Park, Surbiton, Chessington, Worcester Park, Sutton, Richmond, and other areas of southwest London and Surrey.
By Laurie Melrose-Doering, Osteopath & Applied Kinesiologist
