You’ll have heard of the Biceps Brachii, better known as just Biceps. It’s the muscle at the front of your arm which produces flexion (bending) of the elbow joint. But maybe you may not have heard of its relationship to your shoulder pain. 
Let’s talk about the biceps to begin with. As the name itself suggests, the muscle is split into two parts. 
Biceps short head 
Biceps long head 
The long head of the biceps attaches directly above the shoulder joint and, therefore, has some involvement in shoulder movement, particularly flexion. This is the action of raising your arm up in front of you. This also means that long head of biceps may also present as shoulder pain. There are certain tests that your therapist may perform, such as the Speed’s Test, to assess for biceps’ involvement in your shoulder pain. 
The long head of biceps is partly protected and guided on its way up to the shoulder through a depression in the bone known as the bicipital groove, as shown below. You can also see here how the biceps long head comes up and over the shoulder joint, and why it would cause movement at the shoulder. 
Where the long head of biceps tendon sits within this groove, is also where your therapist may palpate when feeling around your shoulder to assess for any reproduction of symptoms and further confirm the involvement of biceps in your shoulder pain. 
Biceps tendinopathy can be caused by a number of things, with sudden increases in activity, increased work loads and protracted (rounded) shoulders. If you have rounded shoulders it causes more loading to be placed in the front of the shoulder during exercise than in the back. 
Most rehabilitation programs, therefore, will focus initially on reducing and modifying activity where possible to reduce the load on the tendon (i.e. use the other arm to walk the dog or pour the kettle). 
You should then be put through a gradual tendon loading exercise program in order to a) further reduce pain and b) improve strength. Tendons carry a lot of load and store a lot of energy which assist in movement. We don’t want to ignore this. We need to reintroduce it gradually. 
If you have been told you have protracted / rounded shoulders, it is also advised that you focus some attention on strengthening the muscles underneath and around the shoulder blade and shoulder joint, to reduce the loading on the front of your shoulder. 
Upper trapezius, lower trapezius, and serratus anterior are 3 very important postural muscles and for shoulder performance and general health. Speak to your therapist for specific exercises to work these muscles. 
Non-steroidal anti-inflammatory medication may also help if there is any inflammation present. 
You should make sure you’re educated on your condition. As you can imagine, the main reason people don’t comply with their rehab is because they don’t understand why they are doing it. Speak to us for further information and we can point you in the direction of further helpful resources. 
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