Exercises for Long Head of Biceps Tendon Pain

Do you have pain at the front of the shoulder?

This could be due to an injury to the Long Head of Biceps (LHB) tendon!

This blog post covers the best exercises for Long Head of Biceps Tendon pain.

Tests For Long Head Of Biceps Tendon Injury

How do you know if the long head of Biceps Tendon has been injured?

Check out the following tests:

a) Pain Location

Pain along the Long Head of Biceps Tendon is usually experienced at the front of the shoulder.

How to palpate (feel) the Long Head of Biceps Tendon:

Instructions:

• Locate the biceps muscle belly.
• Localize the outer biceps.
• Trace the fibers up to the front of the shoulder.
• Apply a firm pressure with your fingers.

Results: If you have pain when you firmly push into the front of the shoulder, this may suggest that you have an injury to the biceps tendon.

(Keep in mind – there are many other structures which are located at the front of the shoulder that could potentially be causing pain as well!)

b) Manual Muscle Test

This test requires you to activate the Biceps Tendon to see if it generates pain.

Instructions:

• Place your arm in front of you.
• Keep it completely straight.
• Have your palm facing upwards.
• Reach your arm forwards.
• Use your other hand to firmly push downwards onto the wrist for 5 seconds.
• Try to resist the downwards motion.

Results: If this test generates the pain at the front of your shoulder and/or you are unable to maintain the arm position, this may indicate that you may have a Long Head of Biceps Tendon issue.

c) Yergason’s Test

Instructions:

• Bend your elbow to 90 degrees.
• Keep the elbow by the side of the body.
• Have your palm facing upwards.
• Use your other hand to provide a force to turn the palm inwards.
• Resist this movement. (Supination)

Results: If this test reproduces pain in the front of the shoulder and/or you are unable to maintain the forearm position, this suggests that you may have injured the Long Head of Biceps tendon.

d) Get a Scan

A MRI or a Ultrasound scan to the shoulder will be able to detect if there are any structural abnormalities with your tendon.

Common injuries involving the Long Head of Biceps Tendon

• Biceps Tendonitis
• Partial or Full Thickness Tear
• Tendinopathy
• Tenosynovitis
• Rupture *

(*If you have a complete rupture to your biceps tendon, please see a shoulder surgeon as soon as possible to minimize further complications to the shoulder.)

How to Fix Long Head of Biceps Tendon Pain

Step 1: Avoid Aggravation
Step 2: Reduce Inflammation
Step 3: Releases
Step 4: Stretches
Step 5: Promote Blood Flow
Step 6: Strengthening Exercises
Step 7: Challenging Exercises
Step 8: Address Rounded Shoulders
Step 9: Surgery
Step 10: Common Questions

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STEP 1: Reduce Exposure to aggravating activities

If you are persistently subjecting your shoulder to the activities/positions/movements that aggravate the pain, it is going to be very difficult for your shoulder to make a full recovery.

Completely stop or reduce exposure to any aggravating activity until your shoulder injury has resolved.

Common movements that aggravate the Long Head of Biceps Tendon:

• Overhead activities
• Reaching with an outstretched arm
• Reaching behind your back
• Pushing/Pulling
• Lifting/Carrying objects

KEEP IN MIND – Do not completely stop using your shoulder! This can result in more stiffness and weakness in the long term.

Use your shoulder as much as you comfortably can without aggravating the pain in the Long Head Of Biceps Tendon.

STEP 2: Reduce Inflammation

A significant amount of inflammation in the Long Head of Biceps tendon can make the shoulder very sensitive and painful.

This may limit the ability to perform the suggested exercises on this blog post.

Here are some simple ways to reduce inflammation:

a) Anti-Inflammatory Gel

Apply an anti-inflammatory gel to the front of the shoulder.

Do this 3 times per day.

b) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

It is recommended that you take an anti-inflammatory medication consistently for at least 7-10 days.

Keep in mind – there are different strengths/types of NSAIDs and is best used if the prescribed medication is appropriate to the severity of the inflammation.

Note: Please consult your Primary Care Provider before taking any medication.

c) Cold Therapy

Apply an ice pack to the front of your shoulder for at least 10-15 minutes.

Do this 3-5 times per day.

Note: Do not apply the ice pack directly to the skin as you may develop an irritation on the skin.

d) Try Natural Products

It is suggested that taking turmeric, ginger, chia seeds and/or fish oil capsules are natural ways to help reduce the inflammation.

(To be honest – I am not 100% how effective this is! … But it might be worth a shot.)

e) Cortisone Injection

The cortisone injection consists of a steroid (cortisone) and an analgesic substance.

The aim of the injection is to reduce the inflammation and reduce the pain by numbing the area.

Talk to your Primary Care Provider to see if the cortisone injection is appropriate for your shoulder injury.

STEP 3: Releases

Releasing the Biceps can help reduce any tension within the muscle.

a) Long Head of Biceps Tendon

Instructions:

• Sit down in front of a table.
• Rest the entire weight of the arm on the table.
• Keep the arm completely relaxed throughout this exercise.
• Use the finger tips of your other arm to firmly press into the Long Head of Biceps Tendon. (See Target Area)
• Perform circular motions in this region.
• Continue for 1 minute.

Note: Releasing the Long Head of Biceps Tendon can be very painful! You may need to skip this step if you have a significant amount of inflammation surrounding this region.

b) Long Head of Biceps Muscle Belly

Instructions:

• Sit down in front of a table.
• Rest the entire weight of the arm on the table.
• Keep the arm completely relaxed throughout this exercise.
• Pinch and massage the muscle belly of the biceps.
• Aim to cover the entire muscle.
• Continue for 1 minute.

STEP 4: Stretches

Stretching the Biceps can help reduce any tightness in the muscle.

Note: If there is a significant amount of inflammation in the Long Head Of Biceps Tendon, stretching may aggravate your pain. DO NOT stretch into any pain!

With the following stretches, provide as much stretch to the shoulder as you are able to comfortably tolerate.

a) Long Head of Biceps Tendon Stretch

Instructions:

• Stand side ways to a rail that is approximately at hip height.
• Place your hand on the rail.
• Pull your shoulder backwards throughout this stretch.
• Keep your elbows pointing backwards.
• Slowly sink your body downwards. Your elbows should start to bend.
• Aim to feel a stretch at the front of the shoulders.
• Hold for 30 seconds.

b) Biceps Stretch

Instructions:

• Stand with your back facing towards a door.
• Hold onto the door handle with your palms facing upwards.
• Pull your shoulders backwards.
• Keep your torso up right.
• Lunge forwards.
• Do not flare your ribs out.
• Aim to feel a stretch in the Biceps.
• Hold for 30 seconds.

STEP 5: Improve Blood Flow

The following exercises will help promote circulation to the injured structures.

a) Heat Pack

Instructions:

• Apply a heat pack to the front of the shoulder.
• Leave for 10-20 minutes.

Note: Make sure that there is a protective layer between the heat pack and skin to minimize the chance of burning your skin.

b) Shoulder Raises

Instructions:

• Have your palm facing forwards.
• Raise your arm to shoulder height.
• Hold for 1-2 seconds at the top of movement.
• Perform 30 repetitions.
• Aim to feel a “tired feeling” at the front of your shoulder.
• Perform the exercise at slightly different angles

Note: If your are unable to lift your arm, you can provide support with your other hand. Make sure that the arm that you are trying to target is working as hard as it can.

STEP 6: Strengthening Exercises for the Long Head of Biceps Tendon

This is the MOST IMPORTANT part of this blog post. (PAY ATTENTION!)

Strengthening exercises will give the best opportunity for your shoulder to completely recover.

Things to consider when performing the strengthening exercises:

• Move your arm in the direction that you are specifically having difficulty with.
• Make sure that there is an adequate amount of load to the shoulder to stimulate your Long Head of Biceps tendon to become stronger.
• FEEL the specific contraction on the tendon without reproducing any pain.

I have listed the following exercises from easiest to most difficult.

Progress to the next exercise as appropriate.

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Isometric Contraction

An isometric contraction is where the muscle contracts without moving the joint.

Performing exercises which involve this type of muscular contraction is a good place to start when trying to strengthen a painful shoulder.

a) Against Wall

Instructions:

• Place your palm against the wall.
• You will need to perform this isometric contraction in 6 different shoulder positions:
  • 20-30 degrees shoulder extension
  • Neutral position
  • 20-30 degrees shoulder flexion
  • 60 degrees shoulder flexion
  • 90 degrees shoulder flexion
  • 120 degrees shoulder flexion
• Keep your arm straight throughout this exercise.
• Push your palm as hard as you can into the wall without reproducing any pain in the shoulder.
• Hold for 45 seconds.
• Repeat 3-5 times.

Progression: As this exercise becomes easier, aim to increase the amount of pressure being applied into the wall.

Eccentric Exercises

An eccentric contraction is where the muscle contracts whilst the muscle is lengthening.

a) Controlled Lowering of Arm (Shoulder in Neutral position)

Instructions:

• Stand up right.
• Keep your elbow by the side of your torso.
• Support your arm at the wrist with your other hand.
• Use your other hand to bend the arm.
• Let go of your arm.
• Slowly lower your arm until the elbow is straight.
• Use your other hand to bring your arm back to the starting position.
• Perform 20 repetitions.
• Progression: Hold onto an appropriate amount of weight.

b) Resistance Band

Instructions:

• Anchor a resistance band behind you at knee height.
• Hold onto the other end of the resistance band.
• Step forwards to increase the tension on the band.
• Provide assistance with your other hand to bring your arm in front of you.
• Keep your arm straight throughout this exercise.
• Let go of your arm.
• Allow your arm to be slowly pulled back towards the anchor point of the resistance band. Make sure to control this movement.
• Provide assistance with your other hand to return the arm back to the starting position.
• Perform 20 repetitions.
• Progression: Use more resistance in the band.

c) Controlled Lowering of Arm

Instructions:

• Stand up right.
• Hold onto an appropriate amount of weight.
• Support your arm under the elbow with your other hand.
• Have your palm facing upwards.
• Lift your arm up as high as you are able to.
• Let go of your arm.
• Slowly lower your arm until the arm is by your side.
• Use your other hand to bring your arm back to the starting position.
• Perform 20 repetitions.
• Progression: Use a heavier weight.

Concentric/Eccentric Exercises

a) Bicep Curl

Instructions:

• Stand up right.
• Hold onto a light weight.
• Keep your elbow by the sides of your body.
• Have your palm facing forwards.
• Bend your elbow.
• Lower the weight.
• Perform 10 repetitions.

b) Front Raise

Instructions:

• Hold onto a light weight.
• Have your palm facing forwards.
• Keep your arm straightened throughout this exercise.
• Raise your arm as high as possible without causing any pain.
• Hold for 1-2 seconds at the top of movement.
• Perform 10 repetitions.
• Aim to feel a “tired feeling” at the front of your shoulder.

c) Side Raise

Instructions:

• Hold onto a light weight.
• Have your palm facing outwards.
• Keep your arm straightened throughout this exercise
• Raise your arm out towards the side as high as possible without causing any pain.
• Hold for 1-2 seconds at the top of movement.
• Perform 10 repetitions.
• Aim to feel a “tired feeling” at the front of your shoulder.

d) Shoulder Flexion (From an extended position)

Instructions:

• Tie a resistance band to a stationary object at approximately knee height.
• Hold onto the other end of the band in your hand.
• Have your back facing towards where you anchored the resistance band.
• Keep your palm facing forwards.
• Walk a few steps forwards to place a firm amount of tension onto the band.
• Keep your shoulders wide and arms straightened throughout this exercise.
• Pull the resistance band forwards.
• Make sure that there is no pain whilst performing this exercise.
• Perform 10 repetitions.

e) Shoulder Raise (From raised position)

Instructions:

• Sit in front of a table that is approximately shoulder height.
• Hold onto a light weight.
• Have your palm facing upwards.
• Lift your arm upwards without causing any pain.
• Repeat 10 times.

STEP 7: Challenging Exercises

Once the pain in the Long Head of Biceps Tendon has significantly improved, challenge your shoulder with the following exercises.

Note: Please be careful with these exercises as they may re-aggravate your shoulder pain!

a) Add Speed

Perform any of the previously mentioned exercises with speed.

Increasing the speed of the exercises places more load on the tendon.

b) Bicep Curl (Shoulder Extended)

Instructions:

• Sit down with your back slightly reclined.
• Hold onto a light weight.
• Start with your arm vertical to the floor.
• Have your palm facing forwards.
• Bend your elbow.
• Lower the weight.
• Perform 10 repetitions.

c) Dips

Instructions:

• Sit down on a chair.
• Place your hands onto the side of a chair.
• Move your hips forwards so that they are not supported by the chair.
• Keep your shoulders back.
• Lower your body as far as possible.
• Perform 10 repetitions.

d) Chest Fly

Instructions:

• Lie down on a bench.
• Hold onto an appropriate amount of weight in your hand.
• Start with your arm straight and vertical to the floor.
• Slowly lower your arms as much as you can without causing any pain.
• Aim to feel a stretch in the front of the shoulder.
• Return to starting position.
• Perform 10 repetitions.

STEP 8: Address Rounded Shoulders

In my opinion – having Rounded Shoulders tends to position the Long Head of Biceps tendon in a sub-optimal position when moving the arm.

When the shoulders are in a slouched position, it is common to see the upper arm angled backwards.

This places the shoulder joint in a relatively more extended position which can push the humeral head (top of the arm bone) forwards.

This can directly push on the Long Head of Biceps tendon predisposing it to potential injury.

To keep your shoulder in a more ideal position, try this exercise.

a) How to position the shoulders

Instructions:

• Reach and stretch out your hands as far to opposite sides as possible. (see above)
• Retraction: Bring your arms backwards slightly. Make sure that you can feel a gentle contraction between your shoulder blades
• Posterior Tilt: Turn your palms towards the back as far as you can so that your thumbs are almost pointing towards the floor.
• Take note of your shoulder position. Keep this position! And gently lower your arms by your side.
• Think: “Wide and long shoulders”. 
• Do NOT over squeeze your shoulders back together.

If you would like to see my complete guide on how to fix Rounded Shoulders:

See Post: Rounded Shoulders Exercises

STEP 9: Surgery

If there is a significant amount of structural damage to the Long Head of Biceps tendon, surgical intervention may need to be explored with a shoulder surgeon.

The main surgery for the Long Head of Biceps tendon is called a Tenodesis.

This surgery is usually performed when the structure of the tendon has been severely compromised.

(For example – When there is significant fraying, full thickness tear or complete rupture of the Long Head of Biceps Tendon.)

A biceps tenodesis surgery involves re-attaching the tendon into the Humerus bone using a screw.

Common Questions

a) How long do Biceps Tendon take to heal?

This depends on the severity of the injury, strength of the tendon, past injuries to the area etc.

As a very rough guideline:

• 2-6 weeks for a strain
• 6-12 weeks for a partial thickness tear
• 8+ weeks for a full thickness tear

b) Is it OK to exercise with pain in the Long Head of Biceps Tendon?

Yes – As long as you are not significantly aggravating the symptoms in your shoulder during or after your exercises.

Generally speaking – the more you can move your shoulder without making your pain worse, the better it is for the recovery of your injury.

c) How should I sleep with shoulder pain?

To avoid placing direct pressure onto the shoulder, I recommend sleeping on the back with a pillow underneath the arm for support.

If you can’t sleep on your back for whatever reason, you can sleep on the side with the painful shoulder on the upper side.

You may also find resting the weight of your upper arm on a thick pillow in front of you will be more comfortable.

d) Is Pain in the Long Head of Biceps Tendon permanent?

No.

(… as long as you strengthen it with the appropriate load, intensity and direction.)

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Conclusion

Pain in the Long Head of Biceps Tendon can significantly affect the function of the shoulder.

The suggested exercises on this blog post will address this shoulder issue.

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Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. For more information: Medical Disclaimer.