Your Biceps Tendon Pain Isn't Going Away Because You're Missing the Bigger Picture
If you're struggling with persistent pain at the front of your shoulder, you've likely been told it's "biceps tendonitis." You might be diligently doing bicep curls and stretches, but the pain just won't quit.
What if the real problem isn't your bicep tendon at all?
As a Physiotherapist, I've seen this a lot over the years: biceps tendon pain is often a consequence of a broader mechanical breakdown in the upper body. Focusing solely on the site of pain is like mopping the floor without fixing the leaking pipe just next to it.
In this article, I'll reveal the three most overlooked root causes of biceps tendon pain and provide the specific exercises you need to address them for a lasting solution.
Why Your Biceps Tendon is Just the "Canary in the Coal Mine"
Your shoulder is a complex, precision-engineered system. For it to work pain-free, all parts need to move in harmony. The biceps tendon, particularly the long head that travels through the shoulder joint, is exceptionally vulnerable to changes in this harmony.
Ask yourself:
- Why is the pain only at the front of my shoulder?
- Why is it only on one side?
- Why does it hurt during a specific movement, like reaching behind my back or lifting overhead?
The answer is rarely "because your bicep is weak." It's almost always: "something has fundamentally changed the way you load your biceps tendon."
Hidden issues like joint stiffness or muscle weakness in surrounding areas force your shoulder to find "workarounds." These compensations place abnormal, repetitive stress on the biceps tendon, opening the door to the pain you feel.
So, let's dive into the three most common culprits I find clinically.
Root Cause #1: The Critical Missing Link of Shoulder Internal Rotation
Clinically, a lack of shoulder internal rotation is arguably the biggest mechanical driver of biceps tendon overload that I see with my patients.
Internal rotation is your ability to rotate your arm inward—think about reaching your hand behind your back to scratch your spine.
Why is this so important? This motion is essential for maintaining a stable, centred ball-and-socket joint during movement. When you lose it, your entire shoulder is forced to roll forward to compensate. This forward translation directly changes the way we load the biceps tendon.
Visual Explanation: See the Mechanism
This video demonstrates exactly how a lack of internal rotation forces the shoulder forward, putting the biceps tendon under direct stress.
The Fix: Regain Your Internal Rotation
This simple doorway stretch is one of the most effective ways to gently restore the internal rotation range of motion. Focus on a gentle, sustained stretch.
Root Cause #2: Posterior Shoulder Capsule Stiffness
This issue is a close cousin to the first, but it deserves its own spotlight. The shoulder capsule is a tough, fibrous envelope that surrounds your shoulder joint.
When this capsule becomes stiff and tight at the back - often from poor stationary postures, it acts like a taut rope pulling the head of your humerus (upper arm bone) forward. Guess which tendon gets caught in the crossfire? Your biceps tendon.
This stiffness often goes hand-in-hand with a loss of internal rotation, creating a perfect storm for anterior shoulder pain.
The Fix: Mobilize the Posterior Capsule
The "Sleeper Stretch" is a gold-standard exercise for targeting this specific tissue. Be gentle and consistent—this is not about forcing a painful range.
Root Cause #3: The Hidden Role of Upper Back (Thoracic) Stiffness
This is the most overlooked factor. Your shoulder blades (scapulae) glide on your rib cage, which is connected to your thoracic spine (upper back).
If the joints of your upper back are stiff, your shoulder blades lose their stable foundation. They can't retract (pull back) or upwardly rotate properly. To reach, lift, or pull, your entire shoulder complex can then dump forward, again, overloading the biceps tendon.
This isn't just about muscle tightness; it's more about joint mobility. No amount of band pull-aparts will fix a stiff spinal joint.
The Fix: Unlock Your Upper Back
Using a lacrosse ball or peanut to mobilize the thoracic spine is incredibly effective. This directly addresses the joint stiffness that is robbing your shoulders of proper mechanics.
Pulling It All Together: A Holistic Approach to Biceps Tendon Pain
Rehabilitating your biceps tendon isn't just about strengthening the tendon itself. It's about fixing the faulty environment that caused it to complain in the first place.
Your Action Plan:
- Assess & Address Mobility: Systematically work on the three areas above. Spend 2-3 minutes on each mobility drill daily.
- Then, Integrate Strength: Once mobility improves, reinforce it with strength. Focus on:
- Scapular Stabilisers: Rows, scapular retraction drills.
- Rotator Cuff: External rotation exercises.
- Eccentric Bicep Work: Only introduced once pain is significantly reduced (e.g., slow, controlled negative on a bicep curl).
By following this two-phase approach—first restore the mechanics, then reinforce with strength—you create the conditions for a permanent resolution, not just a temporary fix.
Conclusion: Look Beyond the Pain
If you take one thing from this article, let it be this: Your biceps tendon pain is often a consequence of something else. It's telling you that something somewhere else is breaking down.
Chasing the pain with isolated bicep exercises is often a frustrating dead end. Instead, investigate the root causes. By unlocking your shoulder internal rotation, releasing your posterior capsule, and mobilising your upper back, you can change the entire mechanical landscape of your shoulder and give your bicep tendon the environment it needs to feel and function normally long-term.
Disclaimer: This information is for educational purposes. If your pain is severe, involves numbness or weakness, or does not improve with self-care, please consult a healthcare professional like a Physiotherapist or doctor for a full assessment.