Stuart Hinds demonstrates some techniques for treating biceps brachii and pectoral pain.
Bicipital tendinitis is a condition caused by irritation and inflammation to the biceps brachii, a tendon that lies on the front of the shoulder and allows elbow flexion and supination of the forearm.
Overuse of the biceps brachii can result in inflammation and irritation of the tendon of the long head of biceps occurs as it moves up and down in the intertubercular (bicipital) groove of the humerus. Inflammation can be to the tendon itself or to the tendon sheath or paratenons.
This condition is commonly seen in golfers, weightlifters, rowers, and those engaged in throwing sports. This is because the musculo-tendinous junction of biceps brachii is highly susceptible to injuries brought on by overuse, particularly following repetitive lifting activities.
Cause of Injury
Bicipital tendinitis is caused by poor technique, particularly in weightlifting, a sudden increase in duration or intensity of training, or as part of shoulder impingement syndrome.
Signs and Symptoms
This condition commonly manifests as a pain over the bicipital groove when the tendon is passively stretched and during resisted supination and elbow flexion. It also causes pain and tenderness along the tendon length and stiffness following exercise.
Trigger points in the biceps are commonly involved in this injury. Where the injury has occurred as a result of trauma or overuse, additional triggers may become active as part of the body's natural "protect and defend" mechanism.
These triggers, their affect on pain signal delivery, and their reducing the range of movement are sometimes referred to as "holding patterns".
Complications if Left Unattended
If left without care and treatment, bicipital tendinitis generally worsens as the biceps brachii tendon becomes increasingly irritated and inflamed. Movement and the ability to perform athletically without pain will be increasingly hampered. Exercising without adequate healing and rehabilitation can lead to tearing of the tendon and tendon degeneration over time.
Apply the RICER regimen to relieve painful inflammation, then recommend anti-inflammatory and analgesic medication to moderate any ongoing discomfort. Following that, use heat to promote blood flow and healing.
Rehabilitation and Prevention
The condition is self-limiting given rest and minimal medical attention. Following full recovery, exercises directed at improving flexibility, proprioception and strength may be undertaken. Thorough warm-up and stretching exercises and a steady athletic regimen that avoids sudden, unprepared increases in activity can help avoid this injury, as can attention to proper sports technique.
A full return to athletic activity may generally be expected given adequate time for tendon recovery and reduction of inflammation. However, the injury frequently recurs. Surgery is generally not required. Corticosteroid injections are sometimes used to reduce pain, though they must be applied cautiously as they increase the risk of tendon rupture.
About the author
Stuart Hinds is one of Australia’s leading soft tissue therapists, with over 27 years of experience as a practitioner, working with elite sports athletes, supporting Olympic teams, educating and mentoring others as well as running a highly successful clinic in Geelong.
Stuart has a strong following of practitioners across Australia and globally who tap into his expertise as a soft-tissue specialist. He delivers a range of highly sought after seminars across Australia, supported by online videos, webinars and one-on-one mentoring to help support his colleagues to build successful businesses.
In 2016, Stuart was awarded a lifetime membership to Massage & Myotherapy Australia for his significant support and contribution to the industry.
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This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.