Shoulder pain can sneak up on you and this could be a sign you’re dealing with Biceps Tendinopathy. Maybe it starts as a mild ache after lifting, pushing, or overhead work. At first, it’s easy to brush off—but when it sticks around or gets worse with training, it’s a sign something deeper is going on.
As a physiotherapist, I see this often. Your pain usually sits at the front of your shoulder and flares up with lifting or reaching. This happens when the long head of your biceps tendon becomes irritated from overuse or poor movement. It’s common in weightlifters, overhead athletes, and active adults dealing with Biceps Tendinopathy.
In fact, studies show up to 30% of shoulder injuries involve the biceps tendon, often alongside rotator cuff problems1. The good news? With the right treatment, you can fix the pain—without surgery.
Understanding Biceps Tendinopathy
Bicep Tendinopathy is a condition where the tendon of the long head of the biceps—the part that runs through the front of your shoulder—becomes irritated, overused, or begins to wear down over time.
This tendon helps stabilize your shoulder and allows you to bend your elbow and rotate your arm. When it’s under too much stress, it can become painful and limit your movement.
This isn’t usually a sudden injury. It builds up slowly, often from repetitive overhead movement, poor lifting technique, or training errors. You might feel a dull ache or a sharp pinch in the front of your shoulder, especially when lifting, pushing, or reaching behind your back.
How Common Is Biceps Tendinopathy?
While exact numbers are hard to pinpoint, studies show that the long head of the biceps tendon is involved in up to 30% of shoulder injuries, often alongside rotator cuff or labral tears1,2. It’s one of the most common sources of front shoulder pain, especially in active adults and athletes.
MRI and ultrasound studies also reveal that tendon changes—like thickening or fraying—can show up before pain even starts, especially in people who lift weights or play overhead sports like tennis, swimming, or baseball3.
Who Gets Biceps Tendinopathy?
Biceps Tendinopathy is most common in:
- Adults over 35
- Athletes who do repetitive overhead movements (e.g. swimmers, throwers, CrossFit athletes)
- Weightlifters and gym-goers who load their shoulders heavily
- People with poor posture or weak shoulder control
- Those with a history of rotator cuff problems or shoulder instability
As we age, tendons naturally lose some of their strength and blood supply. This makes them more likely to break down if they’re overused or not given enough time to recover. That’s why biceps tendinopathy tends to show up more in adults than in younger athletes2.
A “Hidden” Problem
One tricky thing about Biceps Tendinopathy is that it rarely happens in isolation. It often comes with other shoulder conditions like:
- Rotator cuff tendinopathy
- Labral tears (especially SLAP lesions)
- Shoulder impingement
- Postural issues that increase shoulder strain
This makes it harder to spot at first—but it also explains why the pain lingers if it’s not treated properly5.
Common Signs and Symptoms of Biceps Tendinopathy
- Pain in the front of your shoulder: A deep, dull ache where your upper arm meets your shoulder.
- Soreness during or after lifting: Especially with overhead movements like shoulder press, snatches, or pull-ups.
- Pain when lowering weights: Often worse during the downward phase of curls or presses.
- Tenderness in the bicipital groove: Discomfort when pressing on the front of your shoulder.
- Pain when reaching behind your back: Like fastening a bra or grabbing a seatbelt.
- Clicking or snapping in the shoulder: Especially when rotating your arm or lifting overhead.
- Pain that fades with warm-up but returns after activity: A classic sign of tendon overload.
- Morning stiffness or pain after rest: The shoulder may feel stiff or sore after being inactive.
- Reduced arm strength: You may feel weaker during curls, rows, or overhead presses.
- One-sided shoulder pain: It usually affects one arm more than the other.
Why Does Biceps Tendinopathy Happen?
If you’re feeling pain in the front of your shoulder—especially when lifting, reaching, or lowering weights—there’s a reason. Your body is trying to tell you that your biceps tendon is overloaded. As a physiotherapist, I want to walk you through what’s really happening under the surface, in simple terms.
What the Biceps Tendon Does
You have two biceps tendons near your shoulder, but the one that usually causes problems is the long head of the biceps tendon.
It runs from deep inside your shoulder joint down the front of your upper arm. Its job is to help stabilize the shoulder and assist with arm movements like lifting, turning your palm, and bending your elbow.
Every time you do an overhead press, bench press, pull-up, or even reach behind you, that tendon works hard. Over time, it can become irritated—especially if you do too much without enough rest.
What Actually Goes Wrong
Biceps tendinopathy doesn’t come from one big injury. It builds up slowly when you repeat the same movements too often—like lifting weights, throwing, or doing overhead work—without giving your shoulder time to recover.
This creates tiny changes inside the tendon. It stops being smooth and springy and starts to fray or thicken. The tendon isn’t torn, but it’s not as healthy or strong as it should be. This is called degenerative tendinopathy4.
Why You Feel Pain in Biceps Tendinopathy
You don’t always feel pain just because something is damaged. In fact, some people have changes in their tendon on scans and feel no pain at all1.
But when the tendon is stressed over and over again, little nerve endings and blood vessels can grow into the damaged area. That’s what makes it sensitive and sore—especially with certain movements like lifting, lowering, or reaching overhead4.
Why This Happens to Active People
Tendons are strong, but they don’t like sudden changes. If you increase your training too quickly—like adding more reps, sets, or weight—your biceps tendon might not be ready for the load. This is one of the most common causes of biceps tendinopathy3.
Things like poor posture, shoulder weakness, or bad technique during workouts can also make the tendon work harder than it should.
What Other Conditions Could It Be?
Pain at the front of the shoulder is common—and it’s not always caused by Biceps Tendinopathy.
As a physiotherapist, I always rule out other possible issues before making a clear diagnosis. Here are five other conditions that can feel very similar, and how you can tell the difference:
This is one of the most common shoulder injuries and often happens alongside biceps problems. It causes pain during overhead movements, reaching, or lying on your shoulder.
The key difference? Rotator cuff pain is usually felt more at the side or top of the shoulder, not right at the front. It’s also more likely to cause weakness when you lift your arm to the side4.
Shoulder Impingement Syndrome
Shoulder impingement feels a lot like biceps tendinopathy, but it comes from soft tissue getting pinched under the shoulder blade when you raise your arm. The pain is often sharp and worsens during movements like reaching overhead or behind your back.
Unlike biceps tendinopathy, this pain may feel more spread out around the shoulder and comes on quicker when lifting the arm above shoulder height.
Labral Tear (SLAP Lesion)
A SLAP tear affects the ring of cartilage (labrum) that helps stabilize the shoulder. It can cause deep pain inside the joint, clicking, or even catching when you move.
This is different from Biceps Tendinopathy because the pain is deeper and may feel unstable, especially during throwing or fast overhead movements. It’s often found in athletes and lifters.
Biceps Tendon Tear
A partial or full tear of the long head of the biceps tendon can happen suddenly, often during heavy lifting or trauma. You may hear or feel a “pop,” followed by bruising and weakness.
The key difference? Tears usually cause a visible “Popeye” bulge in the upper arm and lead to sudden loss of strength, unlike tendinopathy which builds gradually over time3.
Cervical Radiculopathy (Pinched Nerve in the Neck)
Sometimes, pain in the front of the shoulder doesn’t come from the shoulder at all—it comes from the neck. A pinched nerve can cause pain that travels into the shoulder or arm, along with numbness or tingling.
If changing your neck position makes the pain better or worse, or if you feel weakness down the arm, this may be the cause—not the biceps tendon6.
Common Mistakes When Treating Biceps Tendinopathy
If you’ve been dealing with biceps tendon pain and trying to push through it—or hoping it just goes away—you’re not alone. As a physiotherapist, I often see people make the same mistakes over and over.
These mistakes can slow down your recovery, make the pain worse, and even turn a small issue into a long-term problem. Let’s walk through the most common ones so you know what to avoid.
Ignoring the Early Signs
That ache in the front of your shoulder after workouts might seem small at first. But if it keeps coming back, it’s your body telling you something isn’t right.
Many people wait too long before getting help. The longer you leave biceps tendinopathy, the more the tendon weakens. What could’ve been sorted in weeks might take months to fix if ignored.
Resting Too Much
When your shoulder hurts, rest might feel like the obvious solution. And yes, some rest in the beginning helps. But too much rest makes things worse.
Tendons need the right kind of movement to get strong again. If you stop using your arm completely, the tendon becomes even weaker—and you’ll feel the pain as soon as you go back to training.
Stretching the Pain
It’s common to feel tightness with biceps tendon pain. But aggressive stretching—especially behind-the-back stretches or forcing the arm overhead—can make the tendon even more irritated.
You’re pulling on tissue that’s already sensitive. What your shoulder really needs is controlled, targeted strength—not more stretch.
Training Through the Pain
This one’s tough, especially if you love training. But pushing through sharp or burning shoulder pain is a fast way to make biceps tendinopathy worse.
You might feel okay during your workout, but the pain often returns hours later or the next day. Without proper rehab, each session adds more stress to the tendon.
Skipping Rehab and Hoping It Goes Away
This condition doesn’t improve with rest alone. It doesn’t just disappear on its own. Without a plan that slowly rebuilds strength in the tendon, the pain will keep coming back.
And if it sticks around long enough, it can start to affect your other shoulder muscles and change the way you move—making recovery even harder.
What Happens If You Don’t Treat It?
If biceps tendinopathy is left untreated, the pain can become chronic. That means daily movements like lifting groceries, reaching overhead, or sleeping on your side can all become uncomfortable.
In some cases, the tendon can even weaken to the point of tearing. At that point, surgery may be your only option—and recovery takes much longer.
The Good News: It Can Be Fixed
The earlier you start the right treatment, the better your results. With a proper physiotherapy program, most people recover well and return to full activity without needing surgery.
You’ll build strength, improve control, and reduce pain over time. And once the tendon is strong again, the chances of it coming back are much lower—especially if you stay consistent.
Types of Scans for Biceps Tendinopathy
If you’re dealing with biceps tendon pain, getting the right scan can help confirm the diagnosis. As a physiotherapist, I don’t rely only on scans—your symptoms and how your shoulder moves tell me a lot.
But if your pain sticks around or we want to rule out other problems, a scan can give us helpful info. Here are the three most common types of scans used to assess biceps tendinopathy.
Ultrasound
This is often the first scan we use. It’s quick, safe, and cost-effective. An ultrasound can show us if your biceps tendon is thickened, inflamed, or if there are small tears.
It can also show changes in the tendon’s texture—if it looks frayed or uneven, that’s a sign of tendinopathy. The bonus is that we can see how the tendon moves in real time as you move your shoulder.
MRI (Magnetic Resonance Imaging)
An MRI gives us a more detailed picture of your shoulder. It shows the biceps tendon, the rotator cuff, the labrum, and other structures all in one scan.
We use this when we suspect more than just tendinopathy—like a tear or a deeper joint issue. MRI is especially helpful if your pain hasn’t improved with rehab or if your symptoms are unclear3.
X-ray
X-rays don’t show tendons, but they can help rule out other things. If we’re worried about bone spurs, arthritis, or changes in your shoulder joint that might be adding stress to the biceps tendon, an X-ray can help.
It’s not the first scan we go for with Biceps Tendinopathy, but sometimes it gives us useful background info.
Is Surgery Needed?
If you’ve been dealing with biceps tendon pain for a while and nothing seems to help, you might be wondering if surgery is your only option. The truth is—surgery is rarely the first choice for Biceps tendinopathy, or what Biceps Tendinitis is. But in some cases, it may be the right step.
Surgery is usually only considered if your pain has lasted more than 6 months, and you’ve already tried rehab, rest, and activity changes without getting better. If scans show your biceps tendon is severely damaged, thickened, or partially torn, your doctor may recommend surgery to clean up or remove the irritated part of the tendon3.
There are two main types of surgery for Biceps Tendinopathy:
- Tenotomy, where the damaged tendon is simply released
- Tenodesis, where the tendon is cut and reattached lower down the arm
Both options can reduce pain and improve function, especially in active adults. Some people choose tenodesis for cosmetic reasons, since tenotomy may leave a slight bulge in the arm (called a “Popeye” muscle)3.
What Happens After Surgery?
This is where long head Biceps Tendinopathy physiotherapy really matters. After surgery, your shoulder needs time to heal—but you’ll also need a plan to get your strength and movement back. We’ll guide you step by step to:
- Regain full shoulder movement
- Rebuild strength in your biceps and rotator cuff
- Improve shoulder control so the pain doesn’t come back
- Ease back into lifting, sport, or everyday life safely
With the right rehab plan, most people return to full activity within a few months—and many feel stronger and more confident than before.
Treatment Options for Biceps Tendinopathy
If your shoulder feels sore at the front, especially with lifting or reaching overhead, you might be dealing with Biceps Tendinopathy. The good news? Physiotherapy can help you feel better and get strong again—without surgery. Let’s break down what we can do to get you there.
This is the most important part of treatment. Rest won’t fix your tendon, but the right kind of exercise will. We usually start with simple holds (called isometrics) to reduce pain.
Then we slowly add strength exercises. The goal is to gently load the tendon so it gets stronger over time. Research shows this type of training helps tendons heal best3.
When your shoulder muscles feel tight, we use gentle hands-on techniques to loosen them in Biceps Tendinopathy. This is called myofascial release, and it helps reduce tension around your biceps and chest muscles. It also improves blood flow and helps your shoulder move better7.
If your shoulder, neck, or upper back is stiff, we may use manual therapy to help your joints move better. This takes pressure off the biceps tendon and makes your shoulder feel looser and more comfortable7.
This is a painless light treatment that helps calm down the Biceps Tendinopathy pain and support healing—especially in the early stages. Laser is often used together with exercise and can help reduce pain faster8.
If your shoulder feels like there are deep knots in the muscle, we may use dry needling. It involves inserting a very thin needle into tight spots to help them relax. It can feel a bit strange, but many people find it helpful for long-lasting tightness or pain9.
Taping and Strapping
If your shoulder needs support, we may use kinesiology tape or strapping. It doesn’t fix the problem, but it helps you move more comfortably during the day or while training. It’s great for giving the biceps tendon a break while we work on the deeper issues.
Putting It All Together
The best treatment isn’t just one thing—it’s the right mix of exercise, hands-on care, and support. We’ll guide you through each step, so your shoulder doesn’t just feel better—it comes back stronger than before.
Conclusion
If you’re dealing with biceps tendinopathy, you’re not alone—and you don’t have to push through the pain. That aching or sharp shoulder pain in the front of your arm, especially during curls or presses, is your body’s way of telling you something needs to change.
The good news? Biceps tendon pain responds really well to the right physiotherapy approach. With a mix of targeted strength exercises, hands-on care, and smart load management, you can get back to training without fear of making things worse. The key is consistency and starting before it turns into a bigger problem.
Whether you’re an athlete, a weekend lifter, or just someone who wants to stay strong and pain-free, early treatment for Biceps Tendinopathy can make all the difference. Don’t wait it out—treat it right. Your shoulder will thank you.
.svg "Biceps Tendinopathy: 10 Signs, Causes, and Proven Treatments 2"){kind=icon}
Make Your Booking
Have a question? Send a WhatsApp MessageReferences
- Redondo-Alonso, L., Chamorro-Moriana, G., Jiménez-Rejano, J. J., López-Tarrida, P., & Ridao-Fernández, C. (2014). Relationship between chronic pathologies of the supraspinatus tendon and the long head of the biceps tendon: Systematic review. BMC Musculoskeletal Disorders, 15, 377. https://pubmed.ncbi.nlm.nih.gov/25408141/
- Diplock, B., Hing, W. A., & Marks, D. (2023). The long head of biceps at the shoulder: A scoping review. BMC Musculoskeletal Disorders, 24(1), 232. https://pubmed.ncbi.nlm.nih.gov/36978047/
- Varacallo, M. A., & Mair, S. D. (2023, August 4). Proximal biceps tendinitis and tendinopathy. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Retrieved July 23, 2025, from https://www.ncbi.nlm.nih.gov/books/NBK533002/
- Millar, N. L., Murrell, G. A. C., & McInnes, I. B. (2017). Inflammatory mechanisms in tendinopathy – towards translation. Nature Reviews Rheumatology, 13(2), 110–122. https://pubmed.ncbi.nlm.nih.gov/28119539/
- Nho, S. J., Strauss, E. J., Lenart, B. A., Provencher, M. T., Mazzocca, A. D., Verma, N. N., & Romeo, A. A. (2010). Long head of the biceps tendinopathy: Diagnosis and management. Journal of the American Academy of Orthopaedic Surgeons, 18(11), 645–656. https://pubmed.ncbi.nlm.nih.gov/21041799/
- Magnus, W., Viswanath, O., Viswanathan, V. K., & Mesfin, F. B. (2023). Cervical radiculopathy. In StatPearls. Treasure Island, FL: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441828/
- Hafeez, M., Rahim, S., & Shahzadi, K. (2025). Manual therapy: A cornerstone in the treatment of shoulder injuries. In N. Rosenberg (Ed.), Shoulder injuries and treatment [Working title]. IntechOpen. https://doi.org/10.5772/intechopen.1011018
- Tumilty, S., Munn, J., McDonough, S., Hurley, D. A., & Basford, J. R. (2010). Low level laser treatment of tendinopathy: A systematic review with meta-analysis. Photomedicine and Laser Surgery, 28(1), 3–16. https://pubmed.ncbi.nlm.nih.gov/19708800/
- Kietrys, D. M., Palombaro, K. M., & Azzaretto, E. (2013). Effectiveness of dry needling for upper-quarter myofascial pain: A systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 43(9), 620–634. https://doi.org/10.2519/jospt.2013.4668
Leave a Reply