Bicep Tendinopathy Recovery:
Acupuncture, Chinese Medicine & Rehab
A bicep tendinopathy is where the tendon (or tendon sheath) of the long head of the biceps becomes inflamed and/or begins to degenerate, resulting in dull and achy (sometimes sharp) pain at the front of the shoulder, particularly when raising the arm to shoulder height and overhead. It is common with activities involving a lot of overhead movements such as tennis which can cause repetitive strain to the tendon, but most often will occur in conjunction with another shoulder dysfunction such as shoulder impingement or rotator cuff injury.
The bicep tendon is particularly sensitive to shoulder imbalances that affect the position and movement of the humerus. Forward shoulder positions and imbalances within the rotator cuff muscles can cause increase friction and irritation to the tendon, predisposing it to inflammation and degeneration. If left unchecked, the tendon will become more prone to tearing and rupture in the future.
Standard care for a bicep tendinopathy will be physiotherapy to address underlying rotator cuff imbalances, and if needed cortisone injections to reduce inflammation.
So how could acupuncture and Chinese medicine help your recovery process?
At Village Remedies clinics in Sydney CBD and Balmain, we work with a wide range of people recovering from various injuries such as bicep tendinopathy. This page is a resource of recovery advice and exercises for those concurrently undergoing treatment with us or another healthcare professional. It is important you take your shoulder recovery seriously as a poorly rehabilitated shoulder will be prone to future injury, so make sure you're working with a professional who can tailor the advice to your specific circumstances.
Our goal with acupuncture and Chinese medicine is to help support your recovery process and hopefully speed things up for you. At Village Remedies we use a very safe style of acupuncture where points distant to the injured area are used to trigger the body's innate healing response. This means that during the initial phases of healing and inflammation, we can still safely treat the injured shoulder without causing further trauma to the area by working on it directly. As treatments and your recovery progress, we may layer on other techniques to address imbalances and further promote tissue healing.
Your practitioner will also be looking to treat you as whole person, rather than just an inflamed biceps tendon. This means we look at how we can help support your body's overall ability to heal by looking to reduce the stress response (which is often elevated in pain and injury), improve sleep quality and promote health digestion. To help support this and your bicep tendinopathy recovery, your practitioner may also recommend Chinese herbs. The benefit here is that you'll be getting a little treatment daily from the inside, and we find that it can help boost the effects of acupuncture.
Watch the videos below for an idea of what the treatment and recovery process would be like if you were to come and work with us at Village Remedies, as well as some simple acupressure points for pain:
Below we will summarise the different phases of recovery you can expect to go through and the associated exercises to work on. Depending on the severity of your bicep tendinopathy and any complicating factors (such as a shoulder impingement, rotator cuff tears, etc), full recovery can be anywhere from 2 weeks to 3 months or more, which is why it's important to work under the guidance of your acupuncturist or other trained health professional, progressing through phases gradually as you can perform the exercises consistently without pain.
PHASE 1: DAMAGE CONTROL
This phase is for recent acute or particularly painful chronic bicep tendinopathy injuries (7 or more out of 10 on a pain scale).
The goals initially are:
To reduce pain and inflammation
Improve range of motion
In the clinic we'd be using distal acupuncture (points distant to the injury) to stimulate your body's natural healing processes. Our goals will be to help reduce pain and swelling. Certain Chinese herbs can also be useful in reducing pain and swelling, and promoting circulation.
Outside of the clinic you want to work on very gentle range of motion to promote circulation and healing, while avoiding any stretching which will aggravate this injury. You can also apply some cross fiber friction massage. See the video below for the details.
The main thing to keep in mind is to use pain as your guide. If you are experiencing shoulder pain (other than general muscle soreness from exercise) during an exercise or you pain flares within 24 hours afterwards, then what you're doing is too much load for now. It will get better, but not if you keep pushing through it, so do a little less or give yourself more time to recover in between.
When you can raise your arm to shoulder height without major pain, you are ready to move onto phase 2.
PHASE 2: RESTORING STRENGTH
By this stage you've managed to reduce pain levels (5/10 or less) and increase your range of motion to be able to raise your arm to shoulder height with minimal discomfort.
Phase 2 goals are:
Stimulate tendon healing
Restore shoulder strength
In the clinic we'd be using distal acupuncture again, combined with gentle movement of the injured shoulder with the goal of helping to rebuild neuromuscular connections. We may also be incorporating some local acupuncture with electro stimulation to further stimulate healing and recovery of the injured tendon, as well as restore healthy muscle function to the rotator cuff and surrounding muscles that affect the position and movement of the humerus. Tendons do not have good circulation and so are naturally slow to heal, but they are electrically conductive, so we find electro acupuncture useful in encouraging tendon repair. Chinese herbs can also be useful to help support overall health and recovery.
Outside of the clinic you'll start working on eccentric (where you work the lengthening strength of the muscle) exercises for the biceps every day. This will help re-strengthen the muscle and tendon while also stimulating healing of the tendon. Too much concentric (contracting) exercise at this stage will likely be too aggravating for the tendon. See the video below for exercises.
PHASE 3: FULL RECOVERY & PREVENTING RE-INJURY AFTER RECOVERY
By this stage you should be mostly free of pain in the shoulder. Continue to use exercises from the previous phase as needed, but now is when you can start incorporating concentric type exercises and increasing the load, as well as some stretching to open up the front of the chest and shoulder. See video below for more details.
It's important you continue to strengthen this area as weaknesses in the tendon will be more prone to tear or rupture in the future. Maintaining healthy shoulder balance and mobility through exercise is also important for your overall shoulder longevity.
In addition to your exercises, you'll also want to make sure you're getting enough quality rest and quality nutrition, as lack of sleep will leave you more prone to injury and lack of certain vitamins and minerals will make you more prone to inflammation and compromise the quality of your tissues.
Regular check up sessions for acupuncture or with your healthcare professional can be useful to make sure things are keeping in good condition, giving you a chance to catch any imbalances or issues early. The main focus will be on addressing any forward shoulder position, and maintaining rotator cuff balance, thoracic and neck mobility.