Biceps tendinopathy: returning to sport step by step

Why it happens

Repeated movements with the arm raised, pull-ups, weightlifting, swimming, rapid increase in volume.

Coming back in four stages

1. 1

   Relative rest from painful movements, gentle pain-free shoulder mobility.

2. 2

   Strengthening of the shoulder, biceps and shoulder blades prescribed or approved by your physiotherapist.

3. 3

   Sport movements with light load, short sessions, no heavy pulling or overhead movements.

4. 4

   Loads, pull-ups and explosive movements regained gradually.

Move on to the next stage after 2 sessions in a row with discomfort of 2 out of 10 or less and no pain the next day. Each stage usually lasts 1 to 2 weeks, depending on your healthcare professional’s advice. For the biceps, pain at the front of the shoulder when carrying a bag or lifting the arm in front of you is the guide: it should stay stable or ease.

Movements to postpone

• gestes au-dessus de la tête from stage 4
• charges lourdes from stage 3

Strengthening exercises

• Isometric biceps hold

  from stage 1 of the plan

  Elbow at 90 degrees, palm up, push against your free hand or a table without moving, 20 to 30 seconds.

  To start: 5 holds of 20 seconds, once a day.

  Variations, mistakes and progression

  Easier

  Push at half strength.

  Harder

  30-second holds at different elbow angles.

  Common mistakes

  • Shrugging the shoulder.
  • Holding your breath.

  Moving on

  When 5 × 30 seconds is pain-free at the front of the shoulder or elbow.

• Scapular retraction (band row)

  from stage 1 of the plan

  Band anchored in front of you, pull the elbows back bringing the shoulder blades together, return over 3 seconds.

  To start: 3 sets of 12, 3 seconds back, every other day.

  Variations, mistakes and progression

  Easier

  No band, just bring the shoulder blades together.

  Harder

  Stronger band, with a 2-second hold at the back.

  Common mistakes

  • Shrugging the shoulders to the ears.
  • Pulling with the hands rather than the shoulder blades.

  Moving on

  When 3 × 15 with a medium band is easy.

• Slow biceps curl

  from stage 2 of the plan

  With a light weight, bend the elbow over 2 seconds and lower over 3 seconds, without swinging the trunk.

  To start: 3 sets of 10, 3 seconds down, every other day.

  Variations, mistakes and progression

  Easier

  Lighter weight, or a band.

  Harder

  Slightly heavier weight, 5 seconds down.

  Common mistakes

  • Swinging the trunk.
  • Moving the elbow away from the body.

  Moving on

  When 3 × 12 is easy and pain-free the next day.

• External rotation with band

  from stage 2 of the plan

  Elbow against the body, bent to 90 degrees, rotate the forearm outwards then return slowly.

  To start: 3 sets of 12, 3 seconds back, every other day.

  Variations, mistakes and progression

  Easier

  No band, or lying on your side without weight.

  Harder

  Stronger band, then with the arm out at 90 degrees.

  Common mistakes

  • Lifting the elbow away from the body.
  • Turning the trunk to help.

  Moving on

  When 3 × 15 is easy with no shoulder pain.

• Prone Y raise

  from stage 3 of the plan

  Lying face down, arms in a Y, lift them a few centimetres, thumbs up, hold 2 seconds.

  To start: 3 sets of 10, 2 seconds at the top, every other day.

  Variations, mistakes and progression

  Easier

  Arms in a T, or one arm at a time.

  Harder

  With a small water bottle in each hand.

  Common mistakes

  • Lifting the head and arching the neck.
  • Going too high at the cost of a pinch in the shoulder.

  Moving on

  When 3 × 12 is easy with a small weight.

The doses are starting points. Stay at 2 out of 10 discomfort at most, during and the next day; otherwise switch to the easier version or go back to the previous exercise.

Rehab’s advice

Avoid pull-ups and overhead movements at first. Increase repetitions before load.

What the Rehab plan does for this injury

The plan starts at 35% of your previous training volume and builds up to 85%, with a consolidation week every three weeks. If your discomfort reaches 5 out of 10, it stops and refers you to your doctor or physiotherapist.

In which sport?

• SwimmingAvoid strong arm pulls and paddles at first.