Today’s guest post, authored by Dr. Michael Infantino, focuses on a common but often overlooked source of shoulder pain: the bicep tendon. It can be frustrating to treat and ignoring it can stall progress for a long time. But not every bicep tendon issue is dramatic, and some problems can be tackled with simple fixes.
Bicep Tendonitis? Check These 5 Muscles If You’re Not Sure
There is a lot of information online about bicep tendon pain, but much of it isn’t practical. Our aim today is to offer actionable steps you can try on your own, without jumping straight to a six‑week rehab plan or surgery.
Before we get into a rehab plan, let’s try some quick fixes. A quick fix is not a half‑hearted attempt.
Step One: Make sure you’re a suitable candidate for this approach and rule out a rupture.
Seek immediate medical help from an orthopedic physician if:
– You heard a sudden pop at the shoulder with swelling or bruising around the bicep, usually when you tried to lift something heavier than you should.
– You notice a Popeye‑like bulge in the bicep, which can indicate a tendon tear.
Other concerns:
Weakness and pain in the bicep area when you flex or rotate your palm up with the elbow bent can happen with a partial tear, even if there isn’t a full rupture.
What could cause bicep tendon irritation?
The bicep tendon often generates pain because of where it sits. It can get pinched between the upper arm bone and surrounding structures in the shoulder (often the acromion or the coracoid process). Impingement is common. Cushions called bursae help absorb this pressure, but if compression is frequent or intense, the bicep tendon can become irritated. This is more common in people who do a lot of overhead work or sports.
Does rubbing the bicep tendon prove it’s the problem?
No. Simply feeling along the tendon is not a reliable test for diagnosing a bicep tendon injury. It’s a common mistake to rely on that alone.
What’s the best way to tell if the bicep tendon is injured?
Ultrasound by a physician is the gold standard for diagnosis. Isolating the biceps through specific tests helps, such as resisted biceps movements or a controlled reverse‑grip pull‑up. It’s possible to have tendon inflammation, and many tests for the bicep don’t have perfect accuracy. Diagnosing often depends on how the injury happened and which movements provoke pain.
Could front‑shoulder pain come from other sources besides the bicep tendon?
Absolutely. Several shoulder and neck muscles can refer pain to the front of the shoulder. Here are five muscles that commonly do this.
Note: A lacrosse or tennis ball works well for many of these drills, though some people prefer a ball like the ACUMobility Ball.
Deltoid
The deltoid’s fibers run over the bicep tendon. When you feel pain around the bicep tendon after pressing the area, the deltoid may be irritated.
Biceps
Pain around the bicep tendon often comes from the biceps itself. Overuse or a sudden force can cause trigger points. If you feel more discomfort in the biceps, a bit of soft tissue work and taking a few days off from heavy lifting can help.
Pectorals/Subclavius
Often the real issue is too many chest workouts and not enough leg work, or poor posture during daily life and exercise. Slumping can shorten the chest muscles and contribute to impingement and trigger points. The subclavius sits deep to the pectorals and can refer pain to the front of the shoulder; you can often address it while working on the upper fibers of the pecs.
Scalenes
These neck muscles help move the head and neck. Forward head posture or slight head tilt can engage the scalenes more than needed. This can lead to increased muscle tension, trigger points, and even affect breathing. After addressing them with soft tissue work, focus on better posture and diaphragmatic breathing.
Infraspinatus
This rotator cuff muscle sits on the back of the shoulder blade. Dysfunction here can alter timing and strength, changing how the shoulder moves during overhead activities and potentially causing impingement. It can be tricky to self‑treat, but don’t skip it.
Final thoughts
Sometimes soft tissue work around the shoulder is enough, but don’t overlook other factors that may have contributed to the injury. Your goal is to control what you can.
What can you control?
1) Normalize the tissues around the shoulder. Treat local trigger points, improve muscle flexibility, and reduce stiffness to restore better shoulder mechanics. Reducing tightness and trigger points helps optimize the timing and strength of the surrounding muscles to support stability.
2) Adjust your activity for now. If a movement makes your pain worse, back off. The shoulder may be inflamed and needs time to recover. This isn’t a fast pass to weeks off from training with a night of Netflix; it means more focus on soft tissue work and flexibility, plus a gradual return to exercise. It’s okay to feel some discomfort as you progress.
Poke the bear, but don’t take it to dinner. — Adriaan Louw
If you’re looking for ways to improve shoulder front‑line pain, there are practical steps you can take now.
