In my late 30’s I experienced pain in my upper bicep and prior to becoming a sports therapist always wondered what it was and why I got it.

The biceps muscle has two heads (hence the ‘bi’ bit), a short head that comes from the coracoid process of the scapula (located under the clavicle) and a long head which comes from the supra glenoid tubercle of the scapula (the top pf the socket of you like), and blends with the upper labrum (a fibrous lining that is there to deepen the socket in the shoulder joint). The muscle then inserts into the upper parts of the radius bone. (See first image)

The job of the Long head is to keep the head of the humorous depressed (it’s a terrible joke teller boom boom!…), as a dynamic stabiliser of the shoulder joint in conjunction with the rotator cuff muscles, it decelerates the elbow when extending and it assists to supinate the forearm. The short head meanwhile assists more in elbow flexion (think of a bicep curl).  Who knew one muscle could do so much?

The long head can develop tendinopathy because as we age, we suffer collagen matrix changes (degeneration) in our tendons, but it is also possible to completely rupture it as well, particularly under an intense contraction of the biceps. (See second image)

Biceps rupture Risk Factors

  • Age 40-60 with long standing shoulder problems.
  • Those who engage in overhead activity with high weights.
  • Men – this may be due to their higher participation rates in certain overhead activities.
  • Smokers (this can impact tendon nutrition).
  • Those who use corticosteroids (which can affect the collagen matrix of a tendon).

It is possible to live with a biceps rupture, but overhead athletes may chose to pursue a surgical re-attachment.

Biceps Tendinopathy

If a tendinopathy develops, as I’ve discussed before, tendinopathy is a continuum and with the right loading and type pf exercise its possible to reverse the changes in the tendon if caught in time. I prescribe a course of eccentric exercises that the tendon can adapt to as well as address the problems in the shoulder complex that are causing that tendon to be overloaded in the first place.

How it feels

  • Slow, gradual onset.
  • Deep throbbing pain in the upper part of the biceps.
  • Can be painful to sleep on that shoulder.
  • Overhead activities can aggravate pain.
  • Doing a biceps curl movement (elbow flexion)

Risk factors

  • Sudden increase or unaccustomed use.
  • Athletic population aged 35+ or general population aged 65+
  • Have an existing shoulder pathology.

What else could it be?

  • SLAP lesion to the labrum (Superior labrum anterior – posterior)
  • SAPS (Sub acromial pain syndrome)
  • Frozen shoulder (adhesive capsulitis)
  • Rotator cuff tear
  • Osteoarthritis (glenohumeral)
  • C Spine problem
  • AC Joint sprain

What can we do about it?

Personally, I would do a full shoulder examination and assessment to identify the cause of the problem withing the shoulder complex. I would look at the C Spine and the T spine as both can impact on the shoulder joint.  Eccentric exercise would be prescribed for the biceps muscle as well as a tailored approach to any other weaknesses causing the issue.

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