Biceps Tendonitis: who to see and what helps

Biceps Tendonitis · Kitchener, Waterloo & Cambridge

Biceps tendonitis is irritation of the long biceps tendon where it runs over the front of the shoulder. It commonly occurs with other shoulder problems, no quality studies show which treatment works best for it on its own, and a 2025 guideline handles it as part of rotator cuff tendinopathy, where an exercise programme comes first. At CARESPACE the first visit is with a physiotherapist, who assesses the shoulder and starts treatment that day.

What biceps tendonitis is

The biceps muscle has two tendons at the shoulder. The short one attaches to a bump on the front of the shoulder blade. The long one, called the long head, runs in a groove in the upper arm bone and attaches to the top of the shoulder socket. Biceps tendonitis is inflammation or irritation of that long tendon; a report may call it bicipital tendinitis or long head of biceps tendinopathy.

Early on, the tendon is inflamed and swollen. Later the tendon and its sheath can thicken, and occasionally the tendon frays or tears. It commonly occurs alongside other shoulder problems: wear or a tear in the rotator cuff, a labral tear, arthritis or a shoulder that keeps dislocating.

Where the pain sits is the main clue: biceps tendonitis hurts at the front of the shoulder, over the groove where the tendon runs. A feeling of popping, catching or locking points more toward a labral tear. Shoulder impingement is a neighbouring tendon problem that the 2025 guideline places under the same diagnosis.

Symptoms of biceps tendonitis

• Pain or tenderness at the front of the shoulder that gets worse with overhead lifting or activity
• Pain when reaching behind you, for a seatbelt or a coat sleeve
• An ache that travels down the upper arm bone
• Pain that is usually worse at night, especially when you lie on that shoulder
• An occasional snapping sound or sensation in the shoulder

What causes biceps tendonitis

In most cases, a lifetime of ordinary use. Tendons wear with age, and repeating the same shoulder movement speeds that up. Many jobs and household chores do it, and so do sports with repeated overhead motion: swimming, volleyball, tennis, baseball and pickleball. Locally that could be lane swimming through the winter or a standing pickleball game.

How biceps tendonitis is diagnosed

Mostly by examination. Tenderness when the groove at the front of the shoulder is pressed is the most common finding, and two resisted tests (lifting the straight arm forward, and turning the palm up with the elbow bent) check whether loading the biceps brings on the pain. A scan is not advised to confirm the diagnosis at the start. When one is needed, ultrasound is rated the best way to see this tendon outside the joint, with MRI if another shoulder problem is suspected. Scans are arranged through a physician or nurse practitioner.

When front-of-shoulder pain needs urgent care

Call 911 for chest discomfort (pressure, squeezing, fullness, pain, burning or heaviness), or for discomfort in the shoulder, arm, neck, jaw or back that comes with sweating, nausea, shortness of breath or light-headedness: these are signs of a heart attack. Go to an emergency department if you cannot move the arm; if the shoulder or arm looks out of place or has changed shape; if the shoulder, arm or hand has no feeling, or is cold, pale or bluish; or if you have injured the shoulder and it is painful, bruised or swollen. The shoulder may be dislocated or broken, and a nerve or blood vessel may be affected. Do not try to push it back in, do not drive yourself, and call 911 if you have no safe way to get there. Get medical care the same day, from a physician or nurse practitioner, an urgent care clinic or an emergency department, if there was no injury and the pain is sudden or very bad or the arm or shoulder is badly swollen; if the arm or shoulder is hot to touch; if you have pins and needles that do not go away; if both shoulders are severely painful; or if you feel feverish or unwell.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

One of those signs has a version particular to this tendon. The long biceps tendon can tear: a sudden, sharp pain in the upper arm, sometimes with a pop or snap you can hear, then bruising running toward the elbow and a bulge low in the upper arm (often called a Popeye muscle). A new bulge is an arm that has changed shape, so it comes under the emergency department advice above.

What the evidence says about treating biceps tendonitis

• The evidence is thin, and we say so. No quality studies have identified the most effective treatments for this tendon on its own. So the points below combine two sources: a 2025 clinical practice guideline on rotator cuff tendinopathy, which includes the long biceps tendon, and a 2022 consensus study in which about 30 physiotherapy experts rated physiotherapy treatments, with 75% agreement counting as consensus. “Should” is firmer advice than “may”.
• Exercise first. An active exercise programme should be the first treatment (strong evidence). The panel agreed on loading the biceps tendon progressively, matched to how irritable the pain is, along with strengthening the rotator cuff and shoulder blade muscles and practising the reaching, lifting and overhead tasks you need.
• Advice counts as treatment. Education on changing activities and training loads should be part of care.
• Hands-on treatment is an option. Manual therapy, which covers joint mobilization or manipulation, soft-tissue techniques and massage, may be used to reduce pain in the short term (moderate evidence). The panel agreed on joint mobilization of the shoulder, neck and upper back and on soft-tissue work for the biceps and rotator cuff muscles.
• Acupuncture and dry needling. Acupuncture may be added to an exercise programme (weak evidence). For dry needling there is too little evidence to reach a conclusion; the panel agreed on needling the biceps muscle and reached no consensus on needling the tendon.
• What is advised against. Shockwave should not be used for tendinopathy without a calcium deposit, and therapeutic ultrasound should not be used. The panel agreed against both, and against laser, TENS and interferential current.
• Injection and surgery come later. A steroid injection may be used for short-term relief and should not be the first treatment. Referral to a physician specialist is advised if pain or disability is still severe after up to 12 weeks of appropriate care; an older review for family physicians suggests considering surgery if conservative treatment has failed after three months.

What a doctor may offer

CARESPACE does not provide these, but it helps to know where they fit. A steroid injection is placed in the sheath around the tendon, not in the tendon itself, often with ultrasound guidance. Surgery is usually keyhole surgery: tenodesis removes the damaged section and reattaches the rest of the tendon to the upper arm bone, and tenotomy releases the tendon, which is the least invasive option and can leave a Popeye bulge.

How each CARESPACE service treats biceps tendonitis

Physiotherapy

A physiotherapist can test the biceps tendon and the structures around it, because this problem usually occurs along with others in the shoulder. The plan centres on loading: starting at a level the tendon tolerates, building it up in stages, and adding rotator cuff and shoulder blade strengthening. They can also help you decide what to change for now, such as how much overhead lifting you do at work or which strokes and serves to rest. Some CARESPACE physiotherapists offer dry needling; for this condition the support for it is expert agreement on needling the muscle, not trials.

See our physiotherapy team →

Chiropractic

A chiropractor can provide manual therapy for the shoulder and spine: mobilization of the shoulder joint, manipulation or mobilization of the upper back and neck, and soft-tissue work, together with exercises. For this diagnosis that is an option for short-term pain (moderate evidence), used alongside an exercise programme.

See our chiropractic team →

Massage Therapy

Massage and other soft-tissue techniques count as manual therapy, so they carry the same standing: an option for short-term pain. A Registered Massage Therapist can work on the biceps, the rotator cuff muscles and the muscles around the shoulder blade and neck.

See our massage therapy team →

Other services people ask about

Acupuncture may be added to an exercise programme, on weak evidence drawn from rotator cuff tendinopathy in general, not from the biceps tendon in particular. Shockwave therapy is advised against for this condition and is not offered at CARESPACE.

Where most people start

Start with Physiotherapy. A physiotherapist assesses the shoulder and begins treatment at the first visit.

How your team works together

The loading plan is the centre of care and one practitioner sets it. Hands-on treatment from a chiropractor or a Registered Massage Therapist can sit alongside it while pain is limiting the exercises. If the shoulder is not improving by about 12 weeks, the next step is your physician, for a scan or a specialist’s opinion.

Browse by service: physiotherapists, chiropractors and registered massage therapists.

What to expect at your first visit

1. What sets it off. Reaching back, lifting overhead, lying on that side, and what your work, gym programme or sport involves.
2. The front of the shoulder. Pressing along the groove where the tendon runs, and the resisted biceps tests.
3. The rest of the shoulder. Rotator cuff strength, movement and stability.
4. A first treatment and a plan: a starting loading exercise, what to cut back, and when to review.

What you can do at home

• Rest from the activities that cause the pain, overhead lifting above all, without giving up using the arm.
• Apply ice for 20 minutes at a time, several times a day. Do not put it directly on the skin.
• A pharmacist can tell you whether an anti-inflammatory or acetaminophen suits you.

How long biceps tendonitis lasts

Our sources give no typical recovery time. The American orthopaedic surgeons’ information page describes non-surgical treatment as very effective in most people, and surgery is for shoulders that do not improve, that relapse, or that have another problem needing an operation. After surgery, most people regain full, pain-free movement, though people in very demanding overhead sports may need to limit them.

Biceps tendonitis treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Chiropractic in Kitchener and Massage Therapy in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Chiropractic in Waterloo and Massage Therapy in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Is biceps tendonitis the same as a rotator cuff problem?

Not the same tendon, but closely linked. Current guidance places long head of biceps tendinopathy inside the diagnosis of rotator cuff tendinopathy, and the two often occur together.

Can I keep lifting weights with biceps tendonitis?

Cut back the lifts that bring on the pain, overhead ones especially, and build load back in stages with guidance. Rest from painful activity and a progressive loading plan are both part of the advice.

What is a Popeye muscle?

A bulge low in the upper arm that appears when the long biceps tendon tears and the muscle bunches toward the elbow. Most people do well without surgery, because the short tendon still anchors the muscle, but a new bulge is a reason to go to an emergency department, as the urgent section says.

Does shockwave or ultrasound therapy help biceps tendonitis?

Neither is supported. Therapeutic ultrasound is advised against, and so is shockwave when there is no calcium deposit. CARESPACE does not offer shockwave.

Where can I get treatment for biceps tendonitis in Waterloo?

Physiotherapy, chiropractic and massage therapy are all available in Waterloo. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Desmeules F, Roy J-S, Lafrance S, et al. Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care, and Rehabilitation: A Clinical Practice Guideline. Journal of Orthopaedic & Sports Physical Therapy, 2025.
• McDevitt AW, Cleland JA, Addison S, Calderon L, Snodgrass S. Physical Therapy Interventions for the Management of Biceps Tendinopathy: An International Delphi Study. International Journal of Sports Physical Therapy, 2022.
• Churgay CA. Diagnosis and Treatment of Biceps Tendinitis and Tendinosis. American Family Physician, 2009.
• American Academy of Orthopaedic Surgeons, OrthoInfo. Biceps Tendinitis and Biceps Tendon Tear at the Shoulder. No review date shown; read November 2026.
• HealthLink BC. Shoulder Problems and Injuries. Current as of November 2022.
• NHS (UK). Shoulder pain. Reviewed May 2023; its next review was due in May 2026.
• NHS (UK). Dislocated shoulder.
• Heart and Stroke Foundation of Canada. Signs of a heart attack.

Related conditions

Shoulder Pain · Rotator Cuff Tendinopathy · Shoulder Impingement · Calcific Tendonitis · Tendonitis

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