Tendonitis is an inflammatory condition that can affect the tendons of the body in response to overload. Overload can occur through repetitive or sustained loading that overcomes the tissue or by adverse postures and positions that strain the tendon. There are two biceps tendons. The most commonly effected tendon is the long head of the biceps that runs across the front of your shoulder joint.
Causes
An often-overlooked cause of biceps tendonitis is the stress caused by postural faults at the shoulder blade or scapula. Forward shoulder position or forward movement of the shoulder blade is caused by chest muscle tightness combined with weakness in the muscles which draw the scapula back. This muscle imbalance impairs the shoulder blade's ability to move back or retract.
Effects
The shoulder joint is designed to have the ball of the joint remain centered within the socket. Normally, when the arm moves, the shoulder blade follows, and the joint remains centered. When the shoulder blade becomes anchored in a forward position, it no longer draws back when the arm is moved back behind the body, resulting in loss of the centered joint position. This adverse movement pattern results in strain to the front of the shoulder joint. An important secondary role of the biceps tendon is to oppose this forward-directed force and stabilize the head of the humerus in the socket. Repetitive strain from this movement pattern will result in biceps irritation.
Prevention/Solution
Aggravating movements with the shoulder blade in this posture include reaching back behind you, overhead lifting directed behind the mid-line of the body and stretching the chest muscles by walking into a corner or through a doorway. In each case, the stress of the movement will be directed to the biceps because the arm and shoulder blade are not moving together. Improving scapular posture and mobility can alleviate this problem.
Chest Stretching
The muscle that can anchor the scapula forward is the pectoralis minor. It is stretched when the shoulder blade is drawn back, not when the arm is extended behind you. To stretch this muscle, lie on your back on a foam roll, with the roller supporting you from your head to buttock. Bend your knees to support your back. The roller will help elevate your shoulder blades off the ground so they can draw back more easily. In this position, place your arms at your sides and actively draw your shoulder blades back and together. It is important to avoid pain in the front of your shoulder.
Shoulder Blade Stabilization
The middle and lower trapezius muscles are responsible for drawing the shoulder blades back and holding them in a good position. Rowing exercises do not target these muscles very well. Lie on your stomach on a bench or with your chest on an exercise ball. Raise your arms to your side with at least a 90-degree angle at your shoulders. With your thumbs pointing up, raise your arms upward, carefully, avoiding pain. Add light weights to your hands as you are able.
Tendon Specific Loading
When the pain of tendonitis subsides you can begin exercises that strengthen the tendon. Eccentric exercise is the negative portion of the exercise which occurs when the muscle is lengthening with resistance. Eccentric exercises provide greater load to the tendon and help realign damaged tissue. When doing biceps curls, focus your effort on lowering the weight, slowly, with control.
Warning
If you have persistent shoulder pain, it is recommended you see your physician or physical therapist for a more detailed assessment.
