Biceps Tendonitis | Exercises For Myofascial Pain

Biceps Tendonitis | Exercises For Myofascial Pain

Are you having pain in the front of your shoulder or down near your elbow? Well, you might have biceps tendonitis.

Hi, I am Dr. Joe DeMarco, chiropractor and owner of Ocramed Health, and today I'm going to discuss a real, real common injury for weightlifters. 

And what is it? It's called biceps tendonitis. And oftentimes it presents itself in one of two ways: either pain in the front or anterior part of the shoulder, or pain down near the elbow. 

Anatomy Of The Biceps

So before we go any further, let's take a look at the anatomy of the biceps brachii. So the biceps brachii muscle—which we're simply referring to as the biceps for the remainder of this video—has two heads, both originating off the scapula, or what we commonly refer to as the shoulder blades.

First off, we have the long head. Now this portion of the biceps attaches to what's called the supraglenoid tubercle of the scapular, which runs along a groove in the humerus.

The groove of the humerus is there to keep the biceps tendon in position and not moving around too much. 

Then we have the short head, which actually comes up and attaches to the coracoid process of the scapula. 

Both of these heads come down and converge into what's known as the belly of the biceps, inserting themselves into what's called the radial tuberosity of the radius (the radius bone is one of the two bones in the forearm). 

Types Of Biceps Tendonitis

All right, you know the anatomy of the biceps, but what do the biceps do? Well, the biceps flex the elbow, and they also supinate the forearms, which naturally turns the thumbs out. 

When performing biceps curls, you want to curl the dumbbell up, and at the top, you want to supinate the forearms, really turning your thumbs out. This gives a full contraction in the biceps. 

So why does exercising the biceps lead to so many cases of biceps tendonitis? Why do people come into my office with anterior shoulder pain and elbow pain?

Now, I used to think, well, these people must have tight biceps. The tight biceps are tugging on their tendons.

I used to think that…However, over the years—and I've been doing chiropractic for over 28 years treating soft tissue injuries—I've found there's two main reasons causing people to develop biceps tendonitis. So what are they?

One, tightness in the pronator teres muscle of the forearm. This muscle pronates the forearm, which is the opposite of supination. 

Second, tightness in the internal rotators of the shoulders. We're dealing with the subscapularis, which is one of the four rotator cuff muscles, including the pec major, the latissimus dorsi, the anterior delts, and the teres major. 

How Does A Tight Pronator Teres Cause Biceps Tendonitis?

First off, the pronator teres. Before we go on, let's take a quick look at the anatomy of the human body. The pronator teres has two heads at the top.

The humeral head—which is the larger of the two heads, to just generalize its media—originates off the medial epicondyle of the humerus. Basically, the inside of the elbow.

And then the second head of the pronator teres is what we call the ulna head. It originates off the medial side of what's called the coronoid process of the proximal ulna. 

Now, both of these heads converge to form the pronator teres which passes obliquely across the forearm, inserting in the middle of what's called the lateral surface of the body of the radius (One of the two bones that make up the forearm). 

All right, so that's the anatomy of the pronator teres. So why is this little muscle giving us so much trouble and causing biceps tendonitis? 

Well, the pronator teres pronates our forearm and can cause lower biceps tendonitis, resulting in excruciating elbow pain. 

Everyday we're prontating our forearms. We're at our computer, we're using the mouse, we're at the keyboard; we're driving a car; we're pronating in a chair, at a desk, hovering over a screen, constantly in a pronated position.

When are we in a supinated position? Unless you're Italian like me, talking with your hands, supinating them while yelling with the rest of your family—because that's what us Italians like to do—you're not usually in a supinated position. You're usually pronated. 

And so what happens to your bicep when you're constantly in a pronated position? The muscle fibers of the pronator teres become shortened, and when you leave a muscle in a shortened position, muscle fibers get shorter, and when they get shorter, you get tightness.

So we get these tight pronator muscles. Sit like I am right now…What's more comfortable? What's easier to do? Turning your hands into full pronation or full supination? 

I don't know about you, but when I do this, I really make a conscious effort to pull my forearms into supination without flopping them into pronation. 

Pronation is a much more comfortable position because those pronator muscles often get tight. So why is that important? 

Well, think about it…You've been at your desk all day working on your computer. You decide to go work out. You don't warm up, arriving at the gym for bicep day, grabbing the bar to do bicep curls, immediately forcing your forearms into supination with the weighted bar pulling down on them.

The weight is forcing your tight muscles into a supinated position. Even worse, if I'm hanging from a chin-up bar, once again, I'm forcing the biceps into supination, now with the added weight of my body pulling them down, further irritating the biceps tendon.

Biceps Tendonitis Treatment For The Elbow

So what can we do to treat and prevent biceps tendonitis? Well, of course, I’d strongly advise properly warming up before performing any strength or cardio exercises. But there is a possibility you may have a really tight pronator muscles needing myofascial release. 

If you're currently suffering from or prone to biceps tendonitis, your pronator teres muscles need regular soft tissue therapy.

Roll A Massage Ball On Your Biceps Tendon

Okay, so you've noticed recently you're prone to biceps tendonitis. You go to supinate, you feel the restriction, the tightness.

First off, we've got to do some myofascial rolling exercises. We could either use a foam roller, a massage bar, or an OcraMed Health Tai Chi ball on the pronator teres, but today, we’re going to use the Tai Chi massage ball because the firm trigger points are excellent for getting deep into the fascia. 

And as we learned earlier, the pronator teres comes from the inside of the forearm. The humeral head comes off the humerus which is up here, and the ulna head is down lower and runs across the forearm attaching to the radius, which again is why the forearm pronates.

So we're going to take the massage ball and roll it around the length of the pronator teres, getting the blood flowing. And as I'm doing this, I'll comfortably turn the forearm back and forth between supination and pronation, rubbing the pronator teres with the fascia ball using as much pressure as I can for about 30 to 60 seconds.

Massage The Pronator Teres With Your Thumb 

Now we simply grip the forearm with our hand, using our thumb to massage the pronator teres, putting pressure into the muscle by not only pressing down, but simultaneously pulling towards the inside of my forearm.

From this position, I'm going to supinate and extend the forearm, while still holding pressure with my thumb. 

Now I'm in a pronated state, with my thumb pushing down into the pronator teres muscle, pulling the tissue towards the inside of my elbow. 

The pronator teres is a relatively small muscle, so I might only move my thumb an inch or two in any direction across my forearm. 

But as I'm holding the pressure where I've put my thumb—while still pulling the soft tissue towards the inside of the elbow—I'm going to be supinating and extending out the forearm, treating and relieving symptoms of bicep tendonitis.

Try A Trigger Point Massager

Another myofascial release technique you can try involves using an OcraMed Health Necklax or any other shiatsu type massager. With the Necklax, you can rotate the clamps and easily target the pronator teres and other muscles on the legs, arms, and neck. 

I'll flex my elbow up and squeeze the handles of the Necklax onto the pronator teres. While in a pronated position, still squeezing, I'm going to supinate and extend out the forearm, targeting the pronator teres, breaking up stubborn fascial adhesions.

So either way, you can manually perform myofascial release with your thumb, or you can use a massage ball, Necklax, or any other fascial care tool to break up and release the pronator teres. Now you’ve solved problem number one, the bicep tendonitis in your elbow.

Biceps Tendonitis Treatment For The Shoulder

All right, so let's move on to the second problem, tightness in the internal rotators of the shoulders which causes bicep tendonitis as well as pain in the front of the shoulder. 

We're tight. We walk into the gym, we're going to do biceps. The first thing we do is we grab a big heavy barbell. We force our shoulders in external rotation, putting a tremendous amount of stress on the bicep tendon—in particular the long head—and we start doing sets of biceps curls.

The long head of the biceps inflames causing anterior shoulder pain and bicep tendonitis. We want to loosen up those internal rotators. 

Use A Massage Ball On Your Shoulder

Grabbing our Tai Chi massage ball, it’s time to do a little myofascial release work. We're going to go transversely across the tissue of these internal rotator cuffs. 

This actually feels really good, and if you currently suffer from biceps tendonitis, this is a great self myofascial release exercise to perform at home. 

Carefully go across your deltoid moving into the front of the shoulder, now across the biceps tendons and into the pecs, back and forth for about 30 to 60 seconds. 

And as I’m massaging, I'll try to rotate the shoulder, internally and externally, continuing to perform the transverse friction massage while I'm turning the shoulder, giving a ton of blood flow to the internal rotator cuffs. 

Stretches For Biceps Tendonitis In The Shoulder

Now we're going to move on to stretches for internal rotators of the shoulders. I have a couple of different stretches for you, and for one of them, you're going to need a broomstick.

Broomstick Stretch For Shoulder Impingement 

I'm going to hold the broomstick in this position and I'm going to bend my elbow at 90 degrees. The broomstick is behind my arm with my other arm. 

I'm going to grab the broomstick and I'm going to pull away, stretching my shoulder. I'm going to hold the stretch for about 30 to 40 seconds, and I'm going to do this fascial release exercise three times on each side, holding it nice and easy.

Let your shoulders stretch out, but don't overstretch, keep everything nice and comfortable. Do that on each side, as this is an excellent stretch for warming up the shoulders.

Favorite Stretch To Treat And Prevent Shoulder Injuries

Next, we're getting up against the wall here and we're going to turn the shoulder into external rotation. 

Placing my hand flat against the wall with my shoulder externally rotated, I'm going to press in and stretch my shoulder open the best I can—and as far as I can—holding the stretch for roughly 30 to 40 seconds. I'm going to do the stretch three times per shoulder.

Both those exercises are super effective for releasing tension in the internal rotators of the shoulders, but remember to always roll your muscles and get the blood flowing before performing these two fascial release stretches.

Treat Biceps Tendonitis With OcraMed Health

I hope you found this information about biceps tendonitis treatment helpful. Like we've talked about in our other myofascial release therapy videos, if the problem is fascial tightness, you need to do fascial release work. 

You're not going to perform myofascial release work for one day and fix a soft tissue problem. Consistently perform fascial release therapy on your bicep tendons and you’ll find the pain caused by biceps tendonitis will fade away. 

If you're looking for an exercise program which incorporates myofascial release treatment, definitely sign up for a health and fitness video consultation where I’ll customize you a calisthenic and weight training program designed to build lean muscle without the bulk.

Also, available on our website is my ebook, The Accommodation Avoidance System, teaching you how to perform intensive weight training while avoiding common plateaus faced by many professional weightlifters. 

If you're benefiting from our myofascial release videos, please subscribe to Ocramed Health on YouTube, and if you have any questions about an injury or exercise, feel free to leave a comment or message me directly. 

I always get back to everybody who writes in. And don't forget, Ocramed Health is here to keep you fit forever.

Back to blog

Leave a comment