Bicep tendonitis and shoulder impingement

I'm currently dealing with a pissed off bicep tendon in my shoulder and likely shoulder impingement. It's been 6 weeks of pretty regular pain. Raising my arm past 90 often leads to pain in my anterior deltoid region--getting food out of my pantry is the worst! My scapular mechanics seem to be out of whack too, likely because my muscles are protecting the bicep tendon, but the altered ROM seems to lead to issues of its own. 

What I can do: I can load my bicep and shoulder muscles quite a lot (inverted rows, landmine press, rotator cuff band stuff, etc) as long as my arm isn't overhead. It's been a lot of experimentation, but it seems best to do exercises 3x a week. On good days, the loading leads to more mobility, but then the smallest thing--like sitting at my desk--will make it pissy again.

What I can't do: Stretching. My bicep pain was tolerable for the first month, and then I stretched it (like this) and I've had problems since. Scapular wall raises also suck. Deadhangs from a bar also bad. Essentially, any mobility exercise I've tried has led to reduced ROM.

What I want: For those who've dealt with shoulder impingement/bicep tendonitis, comments about what worked and didn't.

I had a weird injury in highschool where I seemed to damage my shoulders/back and it caused severe migraines from upper body workouts. I would be incapacitated from doing 10 push-ups. Physical therapist said that I did too much high intensity stuff(lots of wrestling) without doing any lower intensity workouts

Sorry if I say thing wrong/uneducated... He believed that I ignored my secondary muscles that help keep your body aligned; while working heavily on outer muscles(the ones we can see when we flex)... this was due to never doing any easier workouts. I only did hard stuff. I went to physical therapy for about 3-4months in order to get it to go away. We never really specified what my exact issue was since he was confident in the process for healing. They think I damaged the muscle that connects your neck, shoulders, and lower back.

I still have my shoulders/biceps flare up pretty bad when I overdue it. Usually from rock climbing 4+ days a week. I find that eating lots of protein, staying hydrated, and knowing when to quit pushing myself are my biggest assets. I have to quit climbing for a few weeks if I end up causing my biceps to feel like they’re about to rip off of me. I also unfortunately just have to avoid climbs that involve dynos 

I’m also aware that true tendonitis is a big deal and not easy to get rid of. You’ll need to see a doctor if you have tendonitis. A friend on the wrestling team had to quit wrestling because he developed tendonitis in his ankle and it just kept coming back.

Have you had issues with raising your arm overhead? I mostly have full ROM, it just feels like my shoulder gets pinched in the process and then it hurts.

I am experiencing nearly the same issues as a consequence of breaking my shoulder (the ball at the top of my humerus) in early May. I have been working with a physical therapist and doing about a dozen range of motion exercises three times a day. It took months to get any apparent progress. Five months after the skiing accident that started this, I have been cleared by a doctor to begin gentle gym climbing, "Hello V0 and V Intro." I have good health insurance so I was able to get an MRI that found no tear to my rotator cuff but plenty of tendonosis (tendonitis that has been there a long time). think you need need a physical therapist at a minimum and ideally an orthodpedic physician. I am told I will get full range of motion, "just be patient." 

Gird yourself for a long journey and best of luck.

Luke—my issue is that the range of motion exercises just end up pissing it off even more. And I’m honestly not that restricted, it’s just painful ROM. Was this your experience? If so, how’d you get past it to the point of tolerating mobility drills? What are your drills too?

I also don’t think I tore anything (yet). There Was nothing acute, so prob just aggravated tendons.

If something isn't torn, I've had good luck with a lacrosse ball on the floor, especially in the capsule/meaty part over or outside the shoulder blade. And ice.

I've been dealing with bicep tendonitis for the better part of this year and finally getting ahead of it. I have also had the anterior delt flare up at times too. The number one thing that has helped me has been massaging across the tendon at the bony prominence of the shoulder - see youtube videos. You need to rest and stop weightlifting IMO but I'm no PT. I've read you can start doing bicep curls with low weight once you're out of the woods of acute pain as rehab. Climbing doesn't bother mine and I can do dead hangs (for core work, pullups aggravate mine) with a wide, palms out grip if and only if I have my shoulders engaged and not hanging slack. If you're still climbing you can focus on having good technique by engaging your shoulders. This has also motivated me to work on my shitty posture which may or may not be a confounding issue for you, regarding the impingement. I believe this has helped me some too.

It has been my experience too that trying to stretch an aggravated tendon will do you no good- there is likely scar tissue that needs to be broken up via massage and potentially increasing bloodflow while you're at it. Even though I've been dealing with this for about 6 months, the muscles of my scapula/back feel stronger than ever (I've added bent over rows/flies, doesn't aggravate the tendon), maybe this has let me keep the shoulder more engaged (or "retracted" while pulling) and puts less strain on the biceps, but that's me conjecturing. My understanding is either bad biomechanics, more probable as the tendon runs over bone at a funny angle, or overuse/increased load. If sitting at your desk makes it flare up maybe its a positional issue. Also maybe pay attention to how you sleep - if you spend a third of your life sleeping on your front like I do and wake up with your shoulders all hunched in, I don't think it helps either. Just my 2c.

It sounds like you really really need to rest the biceps muscle, like for a month. If you can, I would also recommend doing push ups if it doesn’t kill your shoulder.  You probably should see a PT though because the shoulder impingement piece could be a bigger issue. 

I went to a physical therapist and did exercises while I was still experiencing significant pain from my injury. PT itself didn’t cause pain, though.

I also felt like the correct stretches were very helpful for recovering my shoulders/biceps. Massaging them was also super helpful. Definitely try to target scar tissue. 

there are so many possibilities of what could be the problem, so I highly suggest seeing a doctor.  The shoulder alone has a lot of different muscles.

You’re body will do whatever it can to recover, and you likely will without doctors aid, but you’ll never know exactly what the issue is so that you can properly heal.

I personally tore my ACL 100% while drunken skateboarding and I was walking the very next day. Had to get surgery for a new ACL. I was able to operate at like 99% without it.

Lisa from my experience it sounds like you might have a torn labrum. An MRI is the only way to be certain. And surgery is necessary to fix it. PT will only aggrivate it more. I had surgery on my right shoulder 18 months ago and now my left one 2 weeks ago. 

Thanks all for the first-person experiences. For clarification, I’m seeing an ortho next week and I’ve been receiving guidance remotely but intend on seeing a PT in person to check on my mechanics. I’ve also torn my labrum before on my other arm, so pretty sure (fingers crossed) it’s not that as I don’t feel unstable in any way and there was no acute injury. The only sudden change happened when a PT (was seeing for a knee sprain) suggested I stretch, and that’s when shit hit the fan.

Lisa Rosenthal wrote:

Luke—my issue is that the range of motion exercises just end up pissing it off even more. And I’m honestly not that restricted, it’s just painful ROM. Was this your experience? If so, how’d you get past it to the point of tolerating mobility drills? What are your drills too?

I also don’t think I tore anything (yet). There Was nothing acute, so prob just aggravated tendons.

Yeah, I ran into that too. I was pushing past pain and that turned out to cause more harm than good. I stopped doing some and made sure to not push past pain on anything. What got me past this was a cortisone injection in my shoulder, the spot was targeted through an MRI -- the benefit of having good insurance and a doctor. That provided a breakthrough for me.

I found these instructions that describe the exercises I have been doing for five months: https://www.hopkinsmedicine.org/orthopaedic-surgery/_documents/patient-information/patient-forms-guides/shoulder-rom.pdf

I stopped doing the cane exercise when I couldn't do it without pain. I resumed three weeks ago when I tried after the injection. Best of luck.

Thanks Luke! I honestly wouldn’t be opposed to a cortisone shot atm. I once had a frozen shoulder after dislocating it (other one) and the cortisone was a godsend. These drills take me back to those days. I just changed jobs, which is why it’s been slow to seeing a doc, but I’ll definitely be using my new insurance!$$$

I had symptoms close to yours. Perhaps my story will help.

I had minor problems with my right shoulder for over a decade. Nothing that would get in my way, but every year or so it would ache for a couple of weeks, then return to normal. Then in early 2020 the ache didn't go away. In late 2020 it became painful, so I decided to try to take care of it. The pain was in the anterior deltoid region and was only pronounced when doing overhead exercises with significant external rotation. Two PTs, two sports medicine doctors, and an orthopedic surgeon were all leaning toward it being an impingement since that was aligned with all my symptoms and I didn't have any instability or obvious event that caused it. An MRI showed there was possibly a torn labrum, but it was interpreted differently by everyone overseeing my care. After almost a year of very diligent PT, all the while obsessing over it, reading journal papers and so on, I decided to have the surgeon scope it about a month ago, and he ended up fixing a fairly large anterior labral tear. Prior to the surgery, I was mostly convinced that it was my long head of the biceps owing to the location of the pain, but I'm told that shoulder pain can sometimes refer down the arm.

I'm not trying to convince you that you have a labral tear, but rather to be open to the idea that you and those overseeing your care can sometimes misdiagnose shoulder issues since they can be very complicated. That said, you might be correct that your bicep is causing you issues. As you can see from the above responses, there's a million different protocols that have been developed for such cases, and different things work for different people. All I can recommend is that you stick to whatever plan your PT prescribes for a couple months before switching the protocol up (if necessary), because it can take a long time to show progress. You might have to iterate to find a protocol that works, which is frustrating, but it's the nature of the beast.

Hopefully that wasn't too discouraging, and that it's something you can clear up in a couple of months. Best of luck.

Reducing inflammation helps impingement.Some people have little clearance in there and even a tiny bit of swelling can mess things up. MRI can show stuff like that.

Ask the Doc if it might be time for a cortisone shot as both a temporary fix and as a diagnostic tool. PT at the same time so you don't overdo it when it feels better.

I had bicep tendonitis several years ago. It shut me down for months. Here's what got me back climbing: 1 month rest (no climbing), acupuncture, then overhead Push-press lifting to strengthen my deltoids and improve my posture. It was the imbalance of strength in my upper body from too much steep sport climbing, and poor antagonist exercising that gave me the climber hunch back, and then tendonitis. 

Go see a PT. They trained to deal with this. Find one who appreciates not just meeting but exceeding expectations.

Hi Lisa, 

Having gone through an impingement and labrum tear among other shoulder issues, I’ve felt your pain. It’s a lot of active work to try and remedy them. A PT will help a lot! Also, lots of ROM exercises and for an impingement, self stretching and external rotational exercises/passive stretches will help. It will be “painful”, but that’s part of the work in undoing the damage that’s been done. Also, posture posture posture!!! Focus on sticking your chest out (I know, many women don’t like the idea of this, but it makes a world of difference), shoulders back, and tucking your scapula into the pocket to get full benefit. Always stretch before and after a climb. I hope the best for you! Reach out to me if you have any questions. I’d be more than happy to give some pointers on stretches, but honestly I’d leave it to the professionals (find a great PT that works for you).

Best,

Pancrazio

I had a strange impingement that lasted about three months. I couldn’t really raise my arm above my head with a lot of effort.  I rolled it out all the time with a lacrosse ball and rolled it lots at the gym to no avail. I was traveling for work, so when I was finally home I ended up using a Theracane on my scapular area. Within a few minutes, I felt something pop or move, and my ROM and ability was restored instantaneously.  

Im finally seeing a pt in person. Hopefully it’ll help. Also have any ppl had scapular mechanical issues and fix them? Or maybe that just comes with the territory of impingement. ever since this started 5-6 wks ago, my left scapula pokes (“wings”) out and as a result the shoulder hunches slightly forward. PT said my rhomboid is overly active and the muscles are firing at different rates compared to the good side.