Shoulder and Biceps Tendinitis

by George Turner

Although itís thought of as a shoulder injuryóbecause thatís where it hurtsóbiceps tendinitis is in fact the result of the biceps tendons riding out of the bicipital groove in the knob end of the humerus, the larger upper-arm bone. In 95 percent of cases, when bodybuilders displace the biceps tendon, itís displaced laterally. The pain emanates from under the front-delthead,which is why itís incorrectly presumed to be a shoulder problem.- Quite often, biceps tendinitis is misdiagnosed as bursitis or a rotator cuff tear. If the biceps tendon is left out of place, it will become a shoulder problem. When itís properly in place, it stabilizes the shoulder joint. When itís out of place, the lateral and posterior aspects become overstressed and subsequently,inflamed and painfuL ultimately, the condition may lead to separation of the shoulder joint.

What causes this very common and very painful injury? For bodybuilders the answer is almost always chest work. Inclines and bench presses head the List of offenders. Pullovers and flyes are also culpable, especially when performed on a pec-deck, where your hands are raised, gripping the handles, while you squeeze your elbows together. If youíve ever had this injury, you should avoid pec-decks like the plague.

Does that mean you have to avoid chest exercises? Not at all. Itís not the exercisesí fault that youíre doing them incorrectly. First, as I advised above, you must warm up and seat the tendons properly Second, on benches and inclines donít go too wide with your grip. Keep it shoulder width or slightly wider. Third, keep your elbows back so that when youíre pressing, your hands, elbows and the touch point on your chest are all in a straight line directly under the weight. When you touch the bar lower on your chest or let your elbows drift in alongside your body, the fulcrum changes from the pec insertions to the front deltoid and the underlying biceps tendon in its bicipital

Once the biceps tendon is out, any additional work causes friction as the tendon attempts to regain its solid position within the groove. The friction causes inflammation and swelling in the tendon, and the inflamed tendon wonít fit back into its groove. Any exercise or movement simply irritates the tendon again, and you have a self-perpetuating injury. If you continue trying to work out, not only will the pain increase to the point where all your upper-
body movements cause pain, but you will destabilize the entire shoulder joint.
I saw an X-ray of a chronic biceps tendinitis victim whose tendon had been out so long that it had literally cut a new groove in the humerus parallel to the original groove.

So, what should you do if that kind of injury strikes? First, you must stop
performing chest work or any other exercises that cause pain. Next, you must reduce the inflammation so that the tendon shrinks back to its original girth. Take an anti-inflammatory such as indocin, relafen or ibuprofen and apply ice packs two to three times day for approximately 20 minutes at a time. Once the inflammation is reduced, which usually takes eight to ten days, you need to put the tendon back into its groove. Unfortunately, that is easier said than done. Very few medical people are familiar with the problem, and even fewer know how to reseat the tendon. Anyone who attempts to reseat it by flipping your arm or otherwise manually moving the tendon over the bone doesnít know what he or she is doing. You must manipulate the knob end of the humerus under the tendon.

If you actually find someone who can reseat it, good. If not hereís how to do it yourself.
Once the swelling is reduced, roll up two bath towels together tightly so that the roll is about six inches in diameter. Place the roll under the armpit of your injured arm, forcing it as high into the armpit as possible. Bend your elbow and place your hand at your shoulder, where it would be at the top of a one-arm curl. Now place a doubled-up towel or cushion against a wall and position the elbow of the injured arm against the cushion. Press your elbow against the wall hard. If you do this properly, youíll definitely feel the humerus move.

When the tendon is reseated, you may resume your training with the following caveat: Donít use a grip that is wider than shoulder width on any exercise. Where possible, do your lat pulldowns and chins with your hand palms up. Do your seated dumbbell presses for shoulders with your palm facing each other. Those adjustments will keep the biceps tendon seated in its groove.

The tendon may remain slightly loose for a while. To tighten it, do slow strict barbell curls. As the biceps regains tone and the belly of the muscle becomes fuller, the hypertrophy will pull the tendon tight in its groove. Just stay the hell away from pec decks.