T Nation

Bicep Tendonitis? Painful, Waited too Long


I don't know what the exact issue is and I know most here are skeptical of giving their arm-chair analysis, but I think that would actually be a good place to start.

This has been an issue for over a month now, seems to have crept up out of nowhere- as in I can't pinpoint any isolated incident that would've triggered it. I experience pain/weakness in my left shoulder/armpit ONLY when doing pull-down movements for back exercises. Overhand/underhand/pronated grip all have the same effect. Oddly enough, I don't seem to have issue doing bent over back work or seated rows...only overhead pulling down movements. I can feel it throughout the day...it's not really pain, but it feels like my shoulder is just out of place and/or significantly weakened. Like when I go to open or door or sometimes pick up something with just my left arm...even when I do the movements that exacerbate the pain I can usually work through it-(however I don't do this because I know it's going to become worse down the road if I continue to do that and end up abandoning all pull down movements)

I had about two or three weeks off from the gym because of being on tour, thinking it would be a good chance for my shoulder/tendon/ligaments whatever to rest and take a break, but it seems to have only gotten worse during that time, not better. It has gotten to the point now where I can't ignore it or expect it to heal on its own.
I know the answer is to see a physiotherapist, but I am very skeptical as I've had bad experiences in the past seeing them (waste of money; inconclusive analysis) and because I'm currently un-insured. Thanks to obamacare I won't have a choice as to whether or not I'm insured in the next couple months so that won't be an issue, but for the moment I'm just looking for advice as far as what could be the problem, what to avoid, if foam-rolling will help at all, shoulder dislocates, or anything that could be of any use. Thanks


A picture pinpointing where the pain is would help, your not diabetic are you?


No, I'm not diabetic. I also don't see how a picture is going to help any more than the description I already gave, but here you go:

It's somewhere within that area and more in the armpit. Again, it feels like it's pulled out of place and weaker.


Uhh because the shoulder is a vastly sophisticated structure in which many anatomical structures lie within close proximity to one another.

Have you been on any anti-inflammatories? If not I would start taking some ibuprofen at recommended doses throughout the day. Second, it could be bicep pain, it could be subacromial impingement, it could be a SLAP, it could be a bankart, many different things. You should avoid all exercises that exacerbate the pain. The next thing you should do is long duration cuff and shoulder exercises to generate blood flow into the area and to restore normal glenohumeral rhythm and stability. Lastly, I would get an object in which you can dig into the bicipital groove with and strum the bicep tendon.


It looks like the injury is in the long head of the bicep or potentially the rotator cuff. Are there any particular exercises that you can't perform at the moment for your other body parts e.g. front raises, presses, deadlifts with a mixed grip? Can you rotate your arm outwards with your elbow pinned to your side?

I've had a similar injury before and can no longer do pullups, as it pulls the bicep and recently had to give up chins as it further aggravates my bicep. Sometimes certain grips and straight bars don't fit your body type. If you find a straight bar uncomfortable for curling, then underhand rows for example will feel unnatural most of the time.


U123 - I had a similar issue this past Summer, caused by a tight lat / per minor that crept into the shoulder area. Felt it in my armpit and along my upper bicep. I think mine was caused by too many chins (pull down movement), not enough proper stretching, poor posture, and lack of mobility work.

I caved and finally went to a chiropractor that also does ART (described on this site) and it worked wonders after only a couple of sessions. Have also implemented foam rolling, a variety of t-spine stretches (also described on this site) and it also helped a lot. Should dislocates like you mentioned are now a staple in my everyday routine.


Just tried doing some stiff-legged deadlifts tonight and that was pretty rough on my arm- even with being out of the gym for 4 days straight. Pull-ups and lat-pulldowns are pretty much out of the question. I can do them, but the pain is there nagging at me. I can get through it if I want, but I know that'd only make it worse. I've played around with different grips and none of it seems to help. It seems to mostly be above the head pulling down movements that cause most of the pain, where as seated rows and bent over rows I didn't have an issue with. I think that's changing now though as even sometimes just grabbing dumbbells out of the rack makes that arm/shoulder feel out of place.


That could be it. I have slacked in my foam rolling lately. I still do it, but it's just a lazier version of what I did before. I had to start doing it in the first place due to tight pecs. Your situation/ailments sound similar to mine. I haven't been to a chiro in a while...quite a while. I know what ART is, but because I don't have insurance currently- it's not really an option.

I'll try to start doing some more mobility work and t-spine stretches, but I know it takes time for that stuff to work and I don't know if in the meantime it's going to help or if continuing to go to the gym is only going to make it worse. I suppose I don't have much to lose since taking time off from the gym doesn't help at all. It only became an issue about a week or two before that picture I posted was taken- like mid-September.

Thanks again for the help.


SLAP tear or severe bicep tendonopathy


This is what it is looking like to me. Are there any specific rehab exercises/stretches I should be doing- or an article/thread on here that could help me out with this particular injury? I've gone through all the neanderthal no more articles awhile ago, I just don't recall ever coming across something for bicep tendonitis.
Also, if I end up seeing a specialist, what kind of specialist should I try to see? Just a physiotherapist or someone else?


It depends, you need to establish an accurate diagnosis. In order to do this, you need to learn the differences in pain between the two. Generally, muscular pain is more of an ache that gets worse and worse with activity and will ache even after activity. SLAP pain usually is described as being deep in the joint (although not always) and hurts with activity (sharp pain) but usually subsides pretty quickly when activity ceases. Your chances of full recovery are pretty good for a muscular condition as long as you lay off painful exercises as continual irritation will result in subsequent thickening of the tendon. SLAP rehab can be successful it depends on the type of tear and level of activity. Considering your mechanism of injury, you would most likely have a type 2-4 tear. As long as your not an avid overhead athlete or presser then you can successfully get on with life as the tear calms down and eventually you will most likely only get mild pain with overhead lifting etc (possibly pain-free). I would look at some rotator cuff exercises and perform them with long duration (1 minute or greater sets) to promote blood flow to the area to improve healing. I'm not a huge proponent of stretching for recovery, only very very light stretching at this time to avoid irritation.


A good bet would be to go see a primary care sports specialist, as they tend to do better evaluations than your typical primary care they can then either direct you to physiotherapy or recommend further imaging etc. If you do commit to PT make sure you do some research and don't go to a cookie cutter type deal, you need someone who is willing to put their hands on you (no homs) and really put together a solid plan (depends on your insurance as well)