Beyond Tape: Bicep Tendinitis
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What is an Bicep Tendinitis?
The long head of the biceps tendon runs in a groove at the top of the humerus before attaching to the front and top part of the scapula that forms the socket. Repeated use of the biceps muscle creates friction as the tendon moves through this groove. This friction can lead to tendinitis, dislocation of this tendon from the groove, and even complete rupture of the tendon. Tendinitis means inflammation is occurring, which is the body trying to heal itself. By not addressing the injury soon enough, new tissues and cells within the area can change into scar tissue, which will prolong or prevent healing. Addressing this issue early can help prevent a complete rupture of the tendon.
What does it feel like (Symptoms)?
Pain in the front of the shoulder will be felt. Popping or catching may be noticed during rotation of the arm as the tendon dislocates with movement. When a complete rupture of the biceps tendon occurs, a snap or pop is typically felt and a ball of muscle is seen on the front of the arm above the elbow.
Prevention
Tendinitis is typically an overuse injury. Be aware of repetitively performing actions that use the bicep muscle. For example, working on boulder problems or crux sections of projects requiring underclings or even performing more rope maintenance (coiling or organizing/belaying at belay stations) than the body is used to can cause an increased amount of friction where the tendon runs through the humeral groove. The keys to preventing this injury include:
a. Ensuring the body is properly warmed up before working a project (about 4 routes or 120 moves of easy climbing).
b. Gradually increasing the number of trials per session and sessions per week.
c. Varying the style of climbing while working these particular projects (mix it up with face, slab, or crack climbing that does not involve underclings nor jams that require bending the elbow with the palm facing up).
Treatment
Address the issue as soon as possible in order to avoid further damage that will prolong rehabilitation time. For example, a complete rupture of the bicep from its attachment at the elbow will most likely require surgical intervention as elbow flexion strength is reduced by 30 to 40% and supination strength by greater than 50%. A full return to climbing should not be expected until six months after this surgery. A rupture of the bicep from its attachment at the shoulder does not typically require surgery for the general population, but may be considered for climbers as elbow flexion and supination strength is decreased by 8 to 21%. A full return to climbing typically takes 3 months after this surgery.
Listen to the body and avoid any activities that feel like they are aggravating the injury. This may mean underclings, jams that require bending the elbow in the palm up position, or any other movements that cause pain. Check for range of motion (see Box 1 below and Figures 1-4 in the Exercise Box), strength (see Figures 5 and 6 in the Exercise Box), and trigger points/myofascial restrictions compared to the other arm according to the trigger points mentioned above (especially those of the biceps brachii). First regain range of motion, then strength, and finally gradually resume climbing while paying close attention to any discomfort.
