If you're experiencing pain at the front of your shoulder when lifting, reaching overhead or carrying heavy objects, you may have biceps tendinopathy. The good news is that most people recover well with physiotherapy and progressive strengthening, without requiring injections or surgery.
At The Addison Physiotherapy, we regularly assess and treat biceps tendon injuries in gym-goers, swimmers, racquet sport athletes and manual workers. Our aim is to reduce pain, restore strength and address the underlying cause so you can return to the activities you enjoy.
Key Takeaways
- Biceps tendinopathy causes pain at the front of the shoulder.
- It commonly develops due to repetitive overload rather than a single injury.
- Rotator cuff weakness and shoulder mechanics often contribute.
- Most people recover without surgery.
- Progressive strengthening is the key to long-term recovery.
What causes biceps tendinopathy?
The long head of the biceps tendon runs through the front of the shoulder before attaching inside the shoulder joint. It helps stabilise the shoulder during lifting and overhead movements.
Biceps tendinopathy develops when the tendon is repeatedly overloaded and doesn't have sufficient time to recover.
Common causes include:
- Heavy gym training
- Repetitive overhead lifting
- Swimming
- Throwing sports
- Poor shoulder strength
- Rotator cuff dysfunction
- Sudden increases in training load
Often, the tendon becomes irritated gradually rather than tearing suddenly.
What are the symptoms of biceps tendinopathy?
People commonly experience:
- Pain at the front of the shoulder
- Tenderness over the biceps tendon
- Pain lifting overhead
- Pain during bench press or shoulder press
- Discomfort carrying heavy objects
- Pain reaching behind your back
Clicking or discomfort during shoulder movement
Symptoms may gradually worsen if the underlying overload isn't addressed.
When should I see a physiotherapist?
It's worth booking an assessment if:
- Front shoulder pain persists for more than one to two weeks.
- Pain is affecting work or training.
- You're noticing shoulder weakness.
- Symptoms developed after increasing your training.
- Pain is becoming progressively worse.
A thorough assessment helps determine whether the biceps tendon is the primary source of pain or whether another shoulder structure is involved.
Do I need imaging?
Usually, no.
Most cases of biceps tendinopathy can be diagnosed through a clinical assessment.
Ultrasound or MRI may be recommended if:
- There has been significant trauma.
- A tendon rupture is suspected.
- Symptoms fail to improve despite rehabilitation.
- Another shoulder injury is suspected.
Imaging findings should always be interpreted alongside your symptoms and physical examination.
How is biceps tendinopathy treated?
Treatment focuses on reducing tendon irritation while gradually rebuilding its ability to tolerate load.
Treatment usually includes:
Education
Understanding why the tendon became overloaded and how to avoid repeatedly aggravating it.
Load Management
Temporarily reducing painful activities while maintaining shoulder function where possible.
Progressive Strengthening
Specific exercises targeting the rotator cuff, shoulder blade muscles and biceps tendon help improve strength and tendon capacity.
Return to Activity
Gradually progressing back to work, sport and gym exercises once symptoms improve. The aim is to build a stronger, more resilient shoulder rather than simply reducing pain.
Can I keep exercising?
Usually, yes.
Most people don't need to stop training completely. Instead, temporary exercise modifications can help reduce irritation while maintaining overall strength.
Depending on your symptoms, your physiotherapist may recommend reducing heavy pressing, pull-ups or overhead lifting until the tendon becomes more tolerant to load.
As rehabilitation progresses, these exercises are gradually reintroduced.
How long does recovery take?
Recovery depends on how long symptoms have been present and how consistently rehabilitation is completed.
