Bicep/Shoulder Tendonitis

Good day, well sorta.....

I have been experiencing some shoulder/bicep discomfort after completing my workouts. My chiro believes it is some tendonitis. I'm not exactly sure what I should and shouldn't do training wise in order to heal and prevent it from getting any worse. I was away for two weeks and had been playing on the rings a little too much possibly an overtraining, poor recovery issue. I had a similar issue approximately two years ago. I am currently using F1 and H1 along with some OLY lifting.  Anyhow, I know there are a lot of members with some good knowledge on this topic so if anyone could make some suggestions it would be deeply appreciated.  

Don't do exercises that hurts not even the slightest! Do exercises that create blood flow. All the iM's from HbP are good but again don't do anything where you can feel any sort of discomfort.

Hey Mike,

Be cautious! The longer a pain issue persists, the longer it takes to heal, and often twice-over if not more. Give us some more information (where does it hurt, when, doing what, how much, etc.). I would also heavily caution you regarding your Olympic lifts. Perhaps limit it to cleans and snatch pulls for now (nothing overhead until your tendon issues clear up).

Best,

Chris

It doesn't really hurt till after my workout is complete. Then it's achy all day. Almost like a burning sensation. I don't feel like it's week at all. It hurts mainly at insertion at the shoulder. I'm thinking it's more bicep then shoulder. Also my chirp and fst guy both agree it's biceps tendon at the shoulder. Dips would be the most aggravating at this point. Let me know if there is any more info required. Thanks everyone.

Best thing would be to rest compleatly on exercises which target biceps (stretching also). If you really want to train then do as Mats said above + put some ice moderately on inflamed area.

What is your training schedule and what level of F1 and H1 are you perfroming?

Pafke said:

Best thing would be to rest compleatly on exercises which target biceps (stretching also). If you really want to train then do as Mats said above + put some ice moderately on inflamed area.

Don't put ice!

Long head of the biceps pretendonitis was my case and what Mike described was very similar to what I had ...in the very beginning.

Mike said: "It doesn't really hurt till after my workout is complete". That's because when the area is warmed, Mike doesn't feel pain. It gives the illusion that everything is okay. But training and tiring the inflamed area can actually make the situation worse than better. Rest for at least two weeks, keep your shoulder/biceps (passively) warm and avoid exercises that can cause pain(pull-up/chin-up variations and dips(when the biceps/front shoulder is stretched)

Just let it rest and heal. Again don't put ice.You ice injuries(sprained ankle, for example) not muscles. Correct me if I'm wrong.

In a biggest part of cases the problem is due to the pushup variation.

to stay hollow there is an impressive activation of little chest and pectoralis major. unfortunately strong  chest and elevation are not big friends of the long head bicep tendon.

I had different occasions where people feel pain in front delt exactly where long head bicep is pinched by the chest tendons.

by chance the same people do not have strong depression during the descent portion of the movement. especially if we talk about pseudo planche push up. Basically rest and be sure that your activation is good, if it is good maybe a good release of chest muscle is welcome.

I'm doing f1 5 4ays/week... I'm used by the new moderated schedule but I'm using PE4 for most movements, a little behind on SLS due to mobility. I'm doing H1, I've inky just completed the first cycle. This is supposed to first week of HS/PE2.

So, I shouldn't be doing any stretching either? I stretched a lot today. And I recently have been working on my German hang as well. I wonder if this could be an aggravating factor??

HB_Ron said:

Don't put ice!

 

Long head of the biceps pretendonitis was my case and what Mike described was very similar to what I had ...in the very beginning.

 

Mike said: "It doesn't really hurt till after my workout is complete". That's because when the area is warmed, Mike doesn't feel pain. It gives the illusion that everything is okay. But training and tiring the inflamed area can actually make the situation worse than better. Rest for at least two weeks, keep your shoulder/biceps (passively) warm and avoid exercises that can cause pain(pull-up/chin-up variations and dips(when the biceps/front shoulder is stretched)

 

Just let it rest and heal. Again don't put ice.You ice injuries(sprained ankle, for example) not muscles. Correct me if I'm wrong.

You can ice anything. If the area is inflamed, that means there is too much blood, so you would ice the area to reduce the inflammation, and allow proper healing. That works as well on musculature as it would on the other injured areas as you indicate. 

HB_Ron said:

Again don't put ice.You ice injuries(sprained ankle, for example) not muscles. Correct me if I'm wrong.

Tendon is not muscle. In tendonitis case orthopedist will always advice to put ice moderately on inflamed area or he will give you anti-inflammatory drugs.

Not a doctor or PT or anything. So feel free to ignore this.. I had some biceps and rotator cuff tendinitis that I ignored and it got really bad. Here's what I learned.

First, see a doctor to make sure it isn't anything structural. Probably just tendinitis but you never know.

Then, take a break. A week is a good idea. Ice it during this time to reduce the inflammation. Inflammation is both good and bad for tendinitis but right now is a problem.

Then, start light. Dan Pope has a good set of isometric exercises to do. Just isometric external and internal rotations, etc. Good to get blood flow and there is medical evidence that isometric exercises are effective for tendinitis. Do this for a few days. Basically, a week of rest plus a week of almost rest.

If you can't afford a physical therapist find an online plan for rehabbing a rotator cuff injury. They are usually pretty similar. Internal and external rotation exercises, scapula stability work, etc. The exercises promote blood flow to the tendons which get little. Frequent icing helps the excessive inflammation. Stretching helps to.. Kit Laughlin has a great dowel stretch. Lots of other good stretches out there. In all of this, listen to your body. There will be days where you push too hard even with easy rehab exercises and you'll feel stupid the next day. It will get better but don't push it.

Some passive and active hanging may help but go really slow. The RC PE1 hold is great here too. But it may be a while before you get there.

Expect to live with this for a long time. Months. Maybe longer... You need to work the muscles and the tendons but they will be sensitive to overuse for a long time. It's been 9 months and some days I wake up thinking that yesterday's activities were to much and I'm going to be in pain for another month, but a day or two later, the pain is gone. It forces you to take the long view. But I do get weekends where I can do a foundation workout, split wood, and kayak. On Monday I'm sore and the tendons hurt, but by Tuesday I'm ready for more.

Hopefully your experience will be better than mine. But don't just ignore it...

mike_e_eh said:

I'm doing f1 5 4ays/week... I'm used by the new moderated schedule but I'm using PE4 for most movements, a little behind on SLS due to mobility. I'm doing H1, I've inky just completed the first cycle. This is supposed to first week of HS/PE2.

So, I shouldn't be doing any stretching either? I stretched a lot today. And I recently have been working on my German hang as well. I wonder if this could be an aggravating factor??

What about the Olympic lifting? What work do you do?

I would stop the german hangs. They do come up in the ring series so are are along way from doing these.

Pafke said:

Tendon is not muscle. In tendonitis case orthopedist will always advice to put ice moderately on inflamed area or he will give you anti-inflammatory drugs.

 

Anti-inflammatories are counter productive for healing.  Acute inflammation is your body attempting to heal the area.  Chronic inflammations is what's bad.  If ice is used it should in short intervals and superset with heat.  The idea is to encourage fresh blood flow through the area, not stop the blood flow.

Too much conflicting advice that is confusing and not accurate.

For starters there is no such thing as biceps tendonitis. It is called tendinopathy as there is a lack of inflammatory cells in the damaged tendon.

It is all about load. Unless there is a traumatic cause the tendon injury is due to too much load too often. So it will come down to too much volume over the week or performing exercises too intensly for what the tissue can cope with. Usuall with rotator cuff and biceps tendon we also spend too much time in internal rotation.

Bad technique will also be a factor which again leads to too much load.

mike_e_eh said:

... I was away for two weeks and had been playing on the rings a little too much ...

Leave the rings alone.  

Yours in Fitness,

Coach Sommer

- Don't train through pain
- Don't overtrain
- Avoid playing, focus on training
- Eat and drink well, in my opinion nothing is better than Paleo. Vitamins, minerals, sodium/potassium ratio, omega-6/omega-3 ratio and EPA and DHA (omega-3 fatty acids) are crucial
- Sleep well, at least 7 hours
- Give your tendon enough time to recover
- Very high reps are very useful to help to recover. For example 60r Bicep Curl with a broom handle coupled with 60r Tricep Pushdown with Resistance Band
- Gradually come back with easier exercises or/and lower volume
- Check this : Coach Sommer - Gymnastic Bodies, Tendon strength, business #7
- Remember this : The metabolic rate of connective tissue (tendons and ligaments) is approximately 1/10th that of muscular tissue. This means that connective tissue improves it's strength and flexibility at 1/10th the speed of muscular tissue; and that it also heals TEN times slower

I agree with Mark's and most of Krel's comments.

Tendons NEED load in order to recover. But they like constant/isometric load, not short, sharp, quick loads (oly lifts!).

The usual tendon rehab protocol is to have a week off to allow sharp pain to go away.  Any more than 7-10 days and the tendon begins to lose strength.

After the sharp pain is gone, isometrically load the tendon. Do this every day. No other upper body training.

Do 1 plank against the wall, stopping when your upper body is close to the wall (like a wall pushup but you don't push away again)

Wait til next morning.

Do your shoulders feel ok?

-> Yes, try 5 x 30 seconds of just this "wall plank".

-> If the shoulders hurt (same as before or worse) go back to 1 x 30 seconds.

Wait til next morning....

repeat...

Yes, this is a very small load compared with your usual training, but you've hurt yourself and you have to scale back. A lot.

Every 2-3 days, IF the shoulders feel ok the morning after your training, increase the load a little. Add a set of 5 x 30 seconds and/or do planks at 45 degrees (lean on a chair). Then planks on your knees. Then planks on your feet. All of this is isometric, no movement.

Once you can do 2-3 sets of 30 second planks with NO pain in the shoulders, do a wall pushup. Wait til next morning etc. If no pain progress to wall pushups, then 45 degree pushups, etc etc. Progress only every few days, and increase the load very slowly, WAY MORE SLOWLY than F1/H1. For now.

Learn patience! But if you don't let yourself recover, and carefully load the tendon in a slow, progressive way (which is how foundation is structured, mostly), and you tear the long head of biceps tendon, or give yourself a SLAP lesion, then the discomfort from this will slow you progress much more than this rehab will. And if you need surgery, you will set yourself back at least a year.

If you're at all concerned, I'd see a physiotherapist

Thanks everyone for the replies. Ive taken about a week off other than doing some pre-Hab/rehab band work for my shoulders etc. I'll get back into it slow and just have to judge by how feels. I'll definitely give the isometric exercises a go.

Been to the chiro twice. Did some muscle flossing. I'll start out slow and see how it feels and take it from there.

Coach Sommer, I'll stay off the rings for a while.

I have no comment to make about chiros, but I would also go and see a good physiotherapist, to get a second opinion. The isometric rehab is current best practice as I understand it (looking at research from Jill Cook, Ebonie Rio, Craig Purdham, though their research is based mostly around achilles tendon rehab).

What is muscle flossing? What are you flossing muscles *through*?? (You floss between your teeth, and a nerve floss aims to get neural tissue, usually in the arms or legs, mobile. I haven't heard of muscle flossing.)