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What to do when biceps go bad—and how to keep them from acting up again.
If you’re experiencing pain at the front of the shoulder, several inches below the collarbone, you might have biceps tendinitis. It usually gets worse when lifting or during overhead exertion, like when you’re swimming freestyle.
Here’s what’s going on: A big part of the socket in your ball-and-socket shoulder joint is the labrum, a thick rim of cartilage that surrounds the ball of the humerus and helps keep it in place. The labrum also happens to be the anchor point for the upper biceps tendon. So that tendon is close to moving bone, rotator cuff muscles and other connective tissues—that’s a lot going on in a small area, which means a lot of things can irritate and strain the biceps tendon.
The most common issue is overuse. But other shoulder maladies, which are also common in swimming, can affect the biceps tendon, such as rotator cuff problems, shoulder impingement and shoulder dislocation.
Don’t ignore this pain or try to train through it. Chronic irritation of the biceps tendon can lead to a rupture—and you’ll know it when that happens. You generally hear an audible pop or tearing sound, and the biceps can ball up under the skin. Obviously, this is not good, so address the pain as soon as you feel it.
Employ dynamic rest. Avoid lifting and overhead exertion. Use lower-body and core workouts to maintain fitness.
Ice it. Apply ice to the area for 15 minutes 4–6 times a day for the first 2 days.
Try an NSAID. An anti-inflammatory like ibuprofen or naproxen can help with swelling and inflammation.
Rebuild the area. Basic exercises that work the biceps and shoulder muscles will help get you back to pre-injury form. At left are three exercises you can try. Be conservative with the number of sets and reps you do, depending on the severity of your injury.
Build strong and supple muscles. Powerful and flexible arms and shoulders relieve connective tissues like tendons of a massive amount of stress. Make sure your upper-body regimen employs balanced resistance training that includes both pushing (push-ups, bench presses) and pulling (pull-ups, rowing) movements.
Perfect your form. Lousy form can cause an injury. If you’re in an overhead sport like swimming, always consult with your coach about how to maintain proper form. Everyone’s body type is different, which means proper form needs to be achieved individually. Work on it.
With your elbow against your side and your arm bent at 90 degrees, apply light resistance with your other hand (or rubber resistance bands) as you bring your forearm across your belly and then return to the starting position. Be sure to change the direction of the resistance as you change the direction of the movement so you work the muscle with both pushing and pulling.
Stand facing a wall that is about 6 inches away. Lift your arm straight out to the side and put the side of your thumb against the wall, palm down. Keeping your arm straight, turn away from the outstretched arm (keeping your hand against the wall) until you feel a stretch in the biceps and shoulder. Hold for 20 to 30 seconds, breathing normally.
Start doing this movement with no weight and move on to light weights as you get stronger.
When To Call A Doctor
Biceps tendinitis usually heals by itself over several weeks. However, if your pain is severe, and especially if you have pain in other areas of the shoulder, see a doctor to reveal the extent of the tendinitis and any complications.
Physical therapy can help. A doctor can also administer corticosteroid injections to help with pain and inflammation, but injections need to be precisely placed—injecting directly into the tendon can bring on a rupture.
Some facilities offer ultrasound-guided injections, in which the doctor uses an ultrasound image to guide the needle. This is incredibly helpful in situations where accuracy counts.
New York City sports medicine specialist Jordan D. Metzl, M.D. is a 33-time marathon finisher and 13-time Ironman. His book, The Athlete’s Book of Home Remedies, has more than 1,000 tips to fix all types of injuries and medical conditions.