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Proximal Bicep Tendinopathy

Do you have shoulder pain? Have you tried everything you’ve seen for shoulder problems, but it just isn’t helping? Well maybe that is because it is not actually a “shoulder” issue, but rather your bicep is the culprit. It may sound confusing, but it can be rationally explained as to why.

Your bicep has two heads. The short head goes from the coracoid process of the scapula (shoulder blade) to the radial tuberosity and antebrachial fascia (just past the elbow). The long head goes from the supraglenoid tubercle of the scapula (shoulder blade) to the radial tuberosity and antebrachial fascia (just past the elbow). While both heads work together, the short head is mainly responsible for flexion and supination of the forearm while the long head also plays a role in stabilization of the shoulder by depressing the humerus (arm) during shoulder flexion in order to increase subacromial space. The subacromial space is a very small “tunnel” in which several tendons run through. There is not a great deal of room in this space so the bicep’s action of depressing the humerus becomes of massive importance during shoulder flexion because this movement naturally decreases the area of the subacromial space.

If the bicep is not functioning properly it can cause impingement of other structures in the subacromial space, the most common being the supraspinatus tendon. The impingement can also affect the bicep tendon itself causing further dysfunction. Injuries to these two tendons often perpetuate each other because once the bicipital groove ends, the long head of the bicep tendon is held in place between two of the rotator cuff tendons (supraspinatus above, subscapularis below). Basically, if the long head of the bicep tendon is dysfunctional, it makes impingement of itself or the supraspinatus tendon more likely, and if the supraspinatus tendon is dysfunctional, it makes the long head of the bicep tendon more likely to translate out of its “normal” place and become impinged which then makes it predisposed to dysfunction and therefore the supraspinatus more likely to become dysfunctional. It may sound overwhelming, but the point is you need your bicep to effectively depress your shoulder during shoulder flexion to create more room in the subacromial space and avoid impingement of several structures.

I do not like to explain what something is without giving any recommendations that you can easily do that may help fix it. As with anything, you need to fix the underlying problems. First, you are going to want to strengthen all of the musculature around your shoulder blades to improve shoulder posture. By simply doing this, you can significantly increase the subacromial space. One good exercise for achieving this is a push-up-plus. Basically, you start in the top of a push-up position and push up just a little further by protracting your shoulder blades (google it and you will find it). Second, you are going to want to strengthen the rotator cuff muscles and make sure they are functioning optimally. So do a dumbbell raise with your arm at a 30-degree angle to your side. Then fasten a resistance band to something solid and hold the other end while you internally rotate your shoulder. Third, strengthen the actual bicep but do it while trying to perform its action of depressing the shoulder during shoulder flexion. Start by holding a plate (weight) with both hands out in front of you and performing an isometric contraction for 30 seconds. Then lift the weight up in front of you repetitively to perform a concentric contraction. Finally, hold it in front of you and slowly lower it to perform an eccentric contraction. These movements will undoubtedly recruit other muscles like the anterior fibers of your deltoid, but stay focused on pushing your shoulders down throughout the movement.

One last thing to keep in mind is whether you were doing a certain movement that aggravated it. A common way to injure your shoulder is with improper bench press technique. So, check out our post on bench pressing to avoid shoulder injury if this applies to you. Anyhow, give this a try and move better so that you feel better

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