Long head of biceps tendinopathy: understanding your shoulder pain and getting back to activity

What is long head of biceps tendinopathy?

Long head of biceps tendon anatomy

The long head of biceps is one of the two heads of the biceps brachii muscle. Its tendon originates inside the shoulder joint, passes through a bony groove (the bicipital groove) at the front of the arm, before joining the muscle belly. This particular anatomy, with an intra-articular path followed by a narrow groove, makes this tendon particularly exposed to friction and overload.

Why does this tendon become painful?

Pain appears when the long head of biceps tendon undergoes repeated friction in its groove or overload during elbow flexion movements combined with shoulder rotation. This tendinopathy is often associated with other rotator cuff issues or shoulder impingement, since the tendon shares the same sub-acromial space as the other structures.

Which sports contribute to long head of biceps tendinopathy?

Any sport that combines elbow flexion and shoulder rotation movements places strain on this tendon:

• Weight training, particularly pressing and pulling movements
• Swimming, especially front crawl
• Climbing and gripping sports
• Volleyball and handball
• Throwing sports
• Gymnastics on rings and bars

Treating long head of biceps tendinopathy in rehab with a sports physio

The goal of treatment is to reduce friction of the tendon in its groove while progressively strengthening its capacity to absorb load, also working the associated rotator cuff structures.

1. 1Reducing pain and managing load
2. 2Shoulder and shoulder-blade mobility
3. 3Isometric strengthening
4. 4Progressive concentric strengthening
5. 5Eccentric strengthening
6. 6Rotator cuff work
7. 7Correcting sporting technique
8. 8Strengthening under sport-specific load
9. 9Progressive return to your sport
10. 10Return to competition

Why the physio’s initial assessment matters

During the initial assessment, the physiotherapist aims to identify the movements that reproduce the pain (elbow flexion, shoulder rotation), and systematically checks the state of the rotator cuff, often associated with this tendinopathy.

“The long head of biceps tendon never works alone: rehabbing it always means rehabbing the whole shoulder.”

Overall strengthening, the cornerstone of treatment

Strengthening the biceps is combined with comprehensive work on the rotator cuff and shoulder-blade stabilisers, since long head of biceps tendinopathy is rarely an isolated issue. Good shoulder mechanics reduce friction of the tendon in its groove.

In brief

• Progressive strengthening of the biceps
• Associated rotator cuff work
• Improving shoulder-blade mechanics
• Gradual return: mobility, then load, then sport

Should you rest or keep playing sport?

Total rest is generally not necessary. It’s better to temporarily adapt the movements that clearly reproduce the pain, while starting progressive strengthening of the biceps and cuff.

When should you see a specialist?

If the pain persists for more than three to four weeks, or if you feel a pop or notice a muscle deformity (suggestive of a tendon tear), a medical opinion is recommended.

The HOPP care programmes to treat your long head of biceps tendinopathy and get back to sport

This tendinopathy requires combined work on the biceps and the rotator cuff. HOPP offers you a precise exercise programme, allowing you to get back to your activities as quickly as possible.

The programme runs from 3 to 9 weeks depending on the injury and ends with a reconditioning phase allowing a return to competition in the best possible conditions. Each programme is designed by the HOPP team, made up of two sports physiotherapists who are experts in assessing and treating athletes. You’ll also find theoretical content throughout your progression, so you master every aspect of your recovery and can adjust your treatment independently. If needed, our team of physiotherapists is on hand to support you.

A programme that adapts to you every day

Every day, how you feel (RPE) is factored in to automatically adjust the rest of your programme: more load if all is well, a bit less if your shoulder is complaining. This daily personalisation is what makes the difference compared to a fixed, paper-based programme.

Ready to start your programme?

Join the HOPP support programme designed by sports physios.

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