Shoulder and biceps pain

I'm a recreational climber that climbs once a week.  I had been bouldering since 2014, started lead climbing in 2019.  For the last several years I have been dealing with tendonitis in my shoulder and biceps.  Lead climbing has made my shoulder worse (those static hangs with one arm) and I came to the point where I am giving 100% rest a try to see if the pain goes away.   I've had an MRI of my shoulder which showed nothing however via examination I have been diagnosed with supraspinatus and biceps tendonitis.

In the last two months I've climbed only one time which was one month ago so basically one month with zero climbing.  My shoulder pain has definitely gotten a lot better but the rate of improvement has slowed.  It does seem that life has possibly negatively impacted the shoulder, e.g., picking up my two young children.  

Where should I go from here?  I know shoulder stuff can take a long time to heal.  At what point should I start climbing again?  I feel good enough now where I'd be comfortable trying, but don't want to reset the benefits of the last 1-2 months of rest.

If you can afford a physical therapist get thee hence. If not, there are exercises I know of that involve simply twisting a rubber thinngy that work. Google that. Good luck! 

Having had a number of overuse tendonosis-type injuries myself (including proximal biceps tendonosis in my R shoulder), I'll say in my experience that rest alone won't do the trick.  You'll feel transiently better but run a high risk of recurrence.  

I've found that some regular rehab is key.  Get some therabands and start doing regular shoulder strengthening exercises and eccentric training.  Plenty of beta out there on different regimens.  Eccentric exercises have been very helpful in rehabbing my tendon issues.  

I've also found that training antagonists and other less-used muscle groups has helped quite a bit.  I used to avoid lifting weights at all costs (preferring to just be out there climbing/skiing/biking/running etc), but over the last 15 months or so I've been doing some regular light weight training at the gym and I've found it's helped quite a bit in healing these injuries.  

Thanks for the responses thus far.  I’ve tried some basic eccentric exercises in the past but the ones that I’ve tried haven’t worked well.  Are there any regimens that anyone could recommend to try?  Also what’s the better path:

1.  Rest until its calmed down.  Spend X weeks/months doing solely rehab exercises.  Then start climbing again and continue rehab exercises
2.  Rest until its calmed down.  Start climbing again, ramping slowly as you also do rehab exercises.

Thanks

I had tremendous biceps pain and biceps tendonitis to the degree that i couldn't do a single pullup for about 8-10 months. I finally caved and saw a physical therapist. On my second session after spending a whopping $130 total, she tied a strap around my upper arm and wrenched the piss out of it. 2 days later, no pain. 2 months later i was doing weighted pullups +70 lb x5.

Now, this might not be your problem and may not be your solution, but you should really just cough up the dough to see a legit PT. I'll never make myself suffer that long again and i hope you wont have to either. Good luck!

EDIT: This was over a year ago now and i've been able to prevent the recurrence of any biceps tendonitis through PT exercises, stretching and antagonist work.

Ben FR wrote: Thanks for the responses thus far.  I’ve tried some basic eccentric exercises in the past but the ones that I’ve tried haven’t worked well.  Are there any regimens that anyone could recommend to try?  Also what’s the better path:

1.  Rest until its calmed down.  Spend X weeks/months doing solely rehab exercises.  Then start climbing again and continue rehab exercises
2.  Rest until its calmed down.  Start climbing again, ramping slowly as you also do rehab exercises.

Thanks

If you had a clean MRI then #2 is probably fine but I agree it would be best to see a real PT for some input.  

I can relate as I am in the process of healing up from the same general injury. Mine is bicep tendonitis with associated brachioradialis tendonitis, and I have had some pain in the shoulder region as well.

My understanding of the causes in my case are:

(1) I spend too much time at a computer using a mouse, which causes the bicep and brachioradialis to shorten, which causes a light bend at the elbow and it pulls the shoulder forward and out of alignment, thereby putting pressure on various rotator cuff muscles because the shoulder going forward causes the scapula to lift and shift. Then, during the stretching that happens during normal climbing use when I straighten my arm, a lot of pressure is put on the bicep, brachioradialis, and rotator cuff. This IMO is the primary cause.

(2) The lateral head on my tricep was not getting enough antagonist work so the bicep and brachioradialis were having to overwork themselves to keep my elbow/arm stable. The imbalance could also extend to the rotator cuff muscles, which would contribute to (1) above. This IMO is a secondary cause.

The best solution would be likely found by visiting a climbing specific PT. If that is not something you can do, you can also follow some advice found on youtube:

massage the injury  (hopefully they find a cure for a broken heart soon :( )

Strengthen the lateral head of the tricep

Stretch the brachioradialis

Strengthen the rotator cuff (I do these on a bench, and with weights, and shoot for 15-20 reps to failure for each position. Look at some other videos of I's Y's and T's to find the explanation of how to do these while keeping your shoulders down, your arms straight, and moving your scapula)

​Stretch the shoulders/pecs​​​ (the easiest way I have found to avoid the problems discussed in the video is to keep my palm as well as my elbow against the door frame)

Rest won’t be enough, heat and NSAIDs help, and PT is your best solution. I’m currently dealing w/ bicep tendonitis only on my dominant arm. At 50+ the MD wasn’t surprised. You don’t state your age, but two youngsters – likely <50. MD said I could do anything, even go to the gym, so long as I didn’t activate my bicep. That’s tough to avoid. Since your exams showed nothing, definitely try PT. A good physical terrorist can do amazing things. And analyze your car seat position, how you pick up your kids, ergonomics at work, etc.

Brandon Fields wrote: I had tremendous biceps pain and biceps tendonitis to the degree that i couldn't do a single pullup for about 8-10 months. I finally caved and saw a physical therapist. On my second session after spending a whopping $130 total, she tied a strap around my upper arm and wrenched the piss out of it. 2 days later, no pain. 2 months later i was doing weighted pullups +70 lb x5.

Key word: Legit.

I'm not familiar with the specifics of what you describe, but I have dealt with tendonitis & similar repetitive stress injuries. My 2 cents on that:

• Just rest with ice/elevation is OK, but not the best way to heal fast. THe thing is that it will get inflamation down (which likely causes the acute pain) but isn't particularly good at promoting actual healing for any underlying injury to the tissues.
• I've personally had better results with alternating hot & cold, compared to just ice. Unless you're still in a pretty acute pain/inflamation phase, I would suggest to try out alternating them instead. Get a rubber pouch thing you can fill with hot water (those beans bag are worthless, imo) and decent flexible ice packs. I've stopped following a fixed protocole (e.g. X minutes each) and instead favored switching once I've had time to fully acclimatize to the hot/cold (so a few minutes each). If you're still feeling pain day to day, end with the cold (to calm any inflamation down)
• I've had good results with acupuncture. No need to go crazy, but once every 2nd week or so can help.
• Generally speaking, I feel it's better to keep active under the threshold of pain. E.g. it's fine to do whatever activity, as long as it doesn't generate excessive pain, and as long as you're not overcompensating with other muscle groups/body parts to do stuff they shouldn't do. But given those caveats, moderate activity I feel is the best way to go.
  • Of course, practicing your activity is more fun and more motivating, but that's what caused the issue in the first place, so riskier.
  • Doing other exercises (look up whatever works for your ailment) is better. Again, just don't elicite too much pain doing so