Bicep tendonitis is an irritation or inflammation of the long head of the biceps tendon, which connects the biceps muscle to the shoulder socket (glenoid). This tendon travels through the shoulder joint, making it susceptible to wear from repetitive overhead motions and overuse, a common issue for weightlifters and athletes. The condition typically causes pain in the front of the shoulder that may radiate down the upper arm, and it is often aggravated by movement. While the initial reaction may be to stop all training, strategic modification and a cautious approach to loading the tendon can allow for continued exercise while promoting healing.
Training Decisions Based on Pain Level
The decision to work out must be guided by a simple, practical assessment of pain, distinguishing between muscle soreness and tendon aggravation. A good rule of thumb is to use a 0-10 scale, where 0 is no pain and 10 is the worst pain imaginable. If a movement causes sharp, immediate pain or registers above a 2 or 3 on this scale, it should be stopped immediately to prevent further injury.
A mild discomfort that remains stable and does not increase during the set, or a non-sharp pain at a 2/10 or less, may allow for light, controlled movements. The most telling sign of overdoing it is if the pain worsens after the workout or persists for more than an hour following the session. Tendons generally need gentle loading to heal, but excessive stress can cause the condition to flare up, setting back recovery.
Training other body parts, such as the lower body and core, is generally safe and encouraged, provided the injured arm is completely protected from accidental loading. This allows you to maintain fitness without stressing the inflamed tendon. The priority is always to avoid any activity that reproduces the specific pain in the front of the shoulder.
Specific Movements to Avoid and Safe Substitutes
Movements to Strictly Avoid
Any exercise that involves heavy overhead movement places significant stress on the long head of the biceps tendon, often leading to painful impingement against surrounding shoulder structures. Overhead pressing movements, like military presses or dumbbell shoulder presses, fall into this category and should be strictly avoided. Similarly, heavy pulling exercises, such as wide-grip pull-ups or bent-over rows, can place excessive strain on the tendon, especially at the bottom of the movement where the arm is fully extended.
Any movement that requires the bicep to stretch under a heavy load is also highly problematic, including incline dumbbell curls or the bottom portion of a bench press where the chest is stretched. When the arm is fully extended, the bicep tendon is elongated and is under maximum tension, which can constantly irritate the inflamed tissue. Even high-repetition curls with light weight can be damaging because they cause constant, repetitive friction on the tendon.
Safe Alternatives
Lower body and core exercises are the safest alternatives, including squats, lunges, and planks, as they do not require any engagement of the injured bicep or shoulder. For the upper body, the goal is to maintain muscle activation without stressing the tendon insertion points. You can achieve this by modifying range of motion and choosing exercises that stabilize the shoulder.
Machine exercises that restrict the movement path, such as a chest press machine with a neutral grip, can be safer than free weights, but only if performed without pain. For bicep work, focus on mid-range curls, avoiding the full extension at the bottom where the tendon is stretched. Extremely light, controlled isometric holds or gentle, pain-free mobility exercises, like shoulder flexion or forearm twists, are good starting points to promote circulation without aggressive loading.
Recovery Timelines and Professional Guidance
Recovery for bicep tendonitis depends on the severity of the irritation and adherence to protective rest. Mild to moderate cases often see a noticeable reduction in pain within two to four weeks with conservative management like rest, ice, and anti-inflammatory medication. However, the tendon itself continues to heal for several weeks after the pain subsides, meaning a return to full, heavy training might take four to eight weeks, or longer for more severe cases.
Non-workout recovery steps should include the consistent application of ice to reduce local inflammation and avoiding everyday activities that require lifting the arm above shoulder height. The gradual return to activity must involve slowly increasing the load, starting with very light resistance and focusing on perfect form to prevent recurrence.
You should seek professional help from a doctor or physical therapist if pain persists beyond two to four weeks despite rest, or if symptoms worsen. Criteria for professional evaluation include:
- A noticeable weakness.
- An inability to lift common household items.
- Any clicking or snapping sensation in the shoulder.
A professional can accurately diagnose the issue, rule out more serious co-existing conditions like a rotator cuff tear, and guide a structured rehabilitation plan.