Proximal Biceps Tendonitis

[mbdonner]

I know this has been discussed previously, and I have tried to read through the posts, but doing so has led me to more questions. About a month ago I started developing some stiffness on my bicep and shoulder generally. I started adding in some chins, as I have a previous un-repaired full distal medial bicep rupture. I know chins help.

The stiffness got worse, and eventually started having some significant pain, located on the anterior part of the shoulder. Had a video appointment with an orthopedist I trust. Based on my range of motion he diagnosed tendonitis and recommended chins, curls, anything with a narrow grip. Basically a Starr type protocol, light weights, multiple reps, gradually increasing weight as my strength and pain allows.

Rip, you have recommended chin-up pin firing for this, and in the past 90° curls. Are you still recommending curls, and do you agree with the recommendation for high rep bench at this point.

I do know if have to figure out my grip on the squat, because it seems like that must have been the cause of the problem, but I’ll get to that later. Right now I can’t quite get myself under the bar after 30 chins, 25 curls and 30 empty bar bench press.

PS-I can’t take NSAIDS because I'm on blood thinners. I couldn't tell if you are recommending NSAIDS when pin firing, although it seems counter-intuitive to the goal of inflammation. I did not cry, although I wanted to.

Thank you Rip and Will for being on the boards and responding to questions like this.

[Nick D'Agostino]

Hey mbdonner,

I wouldn't do the protocol right away from a proximal tendinopathy. Also, it would be hard for me to take my squat grip too after all that upper body work. See what happens if you just squat first instead and do the squat stretch in the beginning. When you take your grip first make sure you are gripping the bar correctly on squats. There are a bunch of videos on the site about how to do this. When you take your grip it is extraordinarily important that you feel the weight of the barbell on your back and not in your arms. Prioritize this sensation. For a proximal tendinopathy I would recommend a curl progression. Starting with 3-4 sets of 15 reps with a controlled tempo done 2x/week. Every 2 weeks drop the reps. Go from 15 to 12 to 10 to 8 to 6. It is ok to feel pain during the rehab process but you do not want to push through it and cause an exacerbation. These things can take awhile to go away and the process is rarely linear. Expect to have good days and bad days.

Hope this helps!

[mbdonner]

Thanks Nick. Very helpful. Are you suggesting only curls? What about high rep chins, bench, pushups. I'm assuming I should continue my deadlift and squat, albeit making sure my squat grip is correct.

[mbdonner]

PS It was tendonitis, not tendinopathy, if that makes a difference.

[Nick D'Agostino]

I would just do the curls for now. If it's bothering you on bench you can try setting up linear periodization scheme starting at between 12-15 reps and working your way down back to 5s over time. If you do this just work up to a top set and bench 1-2x/week. Go from 15 to 12 to 10 to 8 to 5 dropping the reps every 1-2 weeks.

Tendinopathy is the new word for it. They changed the term because "itis" is associated with inflammation and these situations are not associated with a typical inflammatory response.