People gesture up and down the front of the shoulder and complain of “biceps tendon pain.” When I ask if there is a motion that creates the pain, they lift their arm in front of them. It bothers them more as the elbow moves above the shoulder. They may not get that rotating the palm up causes more pain until I ask them to try it.
They often point out that the shoulder rolled forward. They usually haven’t noticed that it comes from the habitually bent elbow.
Activities like reaching up to close the hatchback or change a light bulb are painful. The pain may wake them from sleep if hands are close to their face so that the elbows are sharply bent.
If they have an activity that they associated to the pain, it involves jarring or jerking the shoulder. Research talks about onset from a powerful backhand in tennis. My clients usually had some overload while lifting something with the elbow bent. They may have been carrying bags in the yard or tried to move a heavy piece of furniture with the elbow bent. One woman was handed an unexpectedly heavy child. In these cases, there is an underlying shoulder joint problem, and this is an injury waiting to happen.
When the pain around the elbow is present, they have trouble straightening the elbow completely. People seldom complain of the pain in the front of the elbow. There are usually other pain patterns that dominate around the elbow when the biceps when this part of the referral pattern is present.
There are two standard biceps stretches. The one that is used by AIS simply takes the arms straight back along your sides. Do this while watching yourself in a mirror. The problematic arm will tend to flare out to the side or bend at the elbow. Don’t let that happen.
The second one is more aggressive. Grasp a doorway just above your shoulder level with the elbow straight and the thumb down. Rotate your body so that your other shoulder moves toward the hand on the doorway. Be gentle. This stretch can be difficult and painful when the trigger points prevent straightening of the elbow.
Ice and stretch technique will dramatically help either of these stretches.
This problem usually occurs when there are underlying joint problems in the shoulder and radial head. It is generally quick to resolve once those joints are mobilized. There are only a few places that I use a T-bar, but it is a very effective tool for quick relief in the lateral bed of the supraspinous fossa where the supraspinatus and biceps tendon live.
The lower referral pattern seems directly connected to the mobility of the humeral/ulnar joint and the mobilization of the radial head. Gently easing the radial head into place while extending the elbow and supinating the forearm consistently deactivates bicipital tension.
Tony Preston has a practice in Atlanta, Georgia where he sees clients.
He has written and taught about anatomy, trigger points and cranial therapies since the mid-90s.