Suffering from severe bicep tendinitis and/or brachioradialis area tendinitis? Try these solutions and alternative exercises to give your tendons a rest.
About six months ago I began suffering from severe bicep tendinitis in both arms. Many people will relate to bicep tendinitis of the upper bicep location where the tendon and muscle attach to the shoulder. Mine however, was in the distal bicep tendon (lower bicep right in the elbow crease) and the brachioradialis area tendon that runs from the lower bicep through the forearm (extensors).
After months of research and finally visiting a highly specialized sports doctor, namely Ty Affleck from Santa Rosa Sports Medicine, I was told by Dr. Affleck that cortisone shots were out of the question due to the fact that they actually weaken the tendons and increase the risk of tearing completely. My prescription was simple:
- Eccentric curls with light weight – 2 sets of 20 daily
- Dixie cup ice massage – Once per day minimum, up to 3 times a day
Physical Therapy for Bicep Tendinitis and Brachioradialis Tendinitis
Eccentric curls focus strictly on the negative portion of the movement. The goal here is to slowly lower the weight. I’m currently using a 4 to 5 second count when I lower the weight. The theory behind this is that it increases the blood flow to the tendon and helps elongate it. I was instructed to do 18-20 reps or just until it starts to hurt. Using 10 pound dumbbells I was able to knock out about 12 reps my first try before the pain set in. I’ve been able to increase this in about two weeks to the full 18-20 reps, although it varies depending on the day and what other strains I have put on the tendons during the day.
Dixie Cup Ice Massage for Bicep Tendinitis
This consists of filling up small Dixie Cups with water and freezing them. Then, peel off about half to two-thirds of the paper and aggressively massage the areas that are experiencing pain for eight to ten minutes. It’s slightly uncomfortable at first as the sensation of ice on the skin creates a burning sensation. This quickly subsides though.
The recommendation from Dr. Affleck was to do this at least once a day. If the pain was severe that day, it was recommended to do the ice massage up to three times a day. The theory here is that tendinitis is simply micro-tears in the fibers of the tendon and that the ice massage helps the fibers lay back down in their original position. The cold from the ice massage will simultaneously decrease inflammation and push any fluid out from between the fibers.
I would recommend placing at least two dish towels underneath your arm. As the ice melts it creates quite a puddle. Additionally, I noticed that my fingers would freeze while holding the frozen Dixie Cup. This was easily solved by holding the cup with a wash cloth.
The Dixie Cup Ice Massage method is time consuming but it yields amazing results. When I didn’t have time for the ice massage and needed to ensure I was pushing the fluid out of my tendons and reducing inflammation, I would use a gel ice pack for 20 minutes at a time. There were many days when I would simply apply the gel ice pack multiple times, up to three or four times a day. This would drastically reduce the amount of pain I was experiencing at any given time. I’ve included a link to the gel ice pack I used for easy purchasing from Amazon.
If you are experiencing bicep tendinitis, tennis elbow. or forearm tendinitis in both arms, then it may be wise to pick up two of the gel packs. This way you can save time when icing your tendons and don’t have to run back and forth to the freezer. I found that waiting for the gel pack to get cold again was extremely frustrating when trying to ice both of my arms throughout the day.
Fish oil for tendinitis
After doing massive amounts of research and consulting with several athletes and body builders that have experienced similar forms of bicep tendinitis and brachioradialis tendinitis, the conclusion was that large doses of fish oil will help the recovery process. Mega-dosing fish oil for at least 10 days appears to be the magic number.
My current dose is 20 grams of fish oil per day. Yes, 20 grams. That’s 20, 1,000 mg pills a day. I slowly worked up to this to let my body adjust to the large amount of oil that would be in my stomach. I started with three pills, three times a day for a few days. Then I increased to four, three times a day. Then I increased to five. Finally I’m at seven in the morning, seven in the afternoon, and six at night. After just three days at this mega dosage of 20 grams per day I’ve noticed improvements in my pain levels. With the slow increase in dosage, I haven’t noticed any adverse effects on my stomach nor have I had the “fish oil burps” that are so common when people quickly increase their dose.
I scoured the web and found a fantastic deal on Now Omega 3 softgels, which can be found on the above-left. Amazon has some of the best prices on supplements and 99% of my supplement shopping is done through them.
KT Tape (kiniseo taping)
I tried KT Tape for the first time this week and actually found some relief from the pain. There is very limited information on the web about brachioradialis tendinitis and KT Tape but I was able to piece together a few articles and experiment until I found a taping method that actually provided some relief.
Keep in mind that this isn’t a solution but rather just a way to make the pain manageable.
There are two options for distal biceps tendinitis. One is found on the KT Tape forums here.
The other is one that I came up with after discussing my situation with several trainers and combining it with the previous article. Starting at the upper bicep, take one piece of tape and anchor it with zero stretch just on the outside of the midline of the bicep. Then run it down and around the outside of your inner elbow and finally back around to in-line with your original anchor. I used about 50 % stretch on the tape when running it down my arm and zero stretch on the bottom anchor, midway down my forearm. For the inner bicep, I did the exact same thing, just mirroring the tape on the outside (see picture).
I also recommend using only the “pro” version of the KT Tape. The basic type tends to peal off as soon as the body gets sweaty. The pro type, however, will last several days and through showers. I’ve included a few links below to trusted stores on Amazon.com with great seller feedback. They are also the cheapest price available on the internet.
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Exercises to avoid pain with bicep tendinitis and brachioradialis tendinitis
I found that as my pain level in my arms went from manageable to severe, my strength started to decrease due to my inability to hold onto the weights without experiencing acute pain. This was especially noticeable in compound movements with a barbell and when I needed to rotate my wrists (supinate) to raise dumbbells to my shoulders. An example would be kicking up the dumbbells from my knees for a shoulder press or for an overhead triceps extension. Pulling motions were excruciating as well. I noticed this mostly on overhand barbell rows, wide grip lat pull downs, cable rows, and dumbbell rows. So basically, all my favorite back exercises. Also, chest flyes were out of the question. That specific position put a huge amount of stress on the tendons. Finally, out the door went dumbbell front and side raises for shoulders. They were simply too painful.
After reaching my breaking point to where I couldn’t even hold my daughter’s small stuffed animals, I determined that I needed to rest my tendons and that I wasn’t invincible. I spent a week experimenting with exercises that DIDN’T cause pain. It took a lot of thought and experimenting but I dialed it in. Here are my suggestions:
- Decline barbell bench press – 3 sets of 15
- Focus on keeping the elbows close to your body rather than flaring.
- If this still is painful, try using light weight dumbbells for high repetitions
- Flat bench dumbbell press – 3 sets of 15 with two drop sets
- Use lighter weights and slowly increase the weight until you get to the “work set” weight.
- Your total set number would be somewhere in the five set range with warm ups.
- For the drop sets, when you finish your last work set, drop the weight and bang out another 12-15 reps. Then drop the weight one more time and shoot for another 12-15 reps.
- Decline hammer strength press – 4 sets of 10-12 reps with two drop sets
- I can typically do my work sets with three plates on each side. For the drop sets, I will just pull a plate of each side for each drop set.
- I use an extremely wide grip to avoid bending my wrist horizontally and putting pressure on my brachioradialis tendon.
- Free motion cable flyes – 3 sets of 20
- Set the arm height to just about your shoulder height.
- Grab both cables and take two large steps forward, stopping at the second step and using a split leg position.
- Slowly and carefully pull the cables together. You will need to select a LIGHT weight and carefully adjust the angle that you bring the cables together until you find the angle that doesn’t cause pain.
- If you can’t do this exercise due to pain, I would recommend trying a pec deck for the same rep scheme.
Note: I use wrist wraps (straps) in all pulling exercises to avoid putting strain on my tendons.
- Reverse grip barbell row – 4 sets of 10
- By using a reverse grip (underhand grip) and using a slightly less wide grip than usual, I am able to do this exercise without pain. I had to decrease my weight from 315 lbs to a range of 225lbs to 275lbs. If you experience pain, skip this exercise all together.
- Single arm cable rows – 3 sets of 12
- Again, the weight is slightly decreased compared to normal.
- Adjust your grip so that there is no pain at all. You can rotate your hand during the motion (thumb facing up to slightly underhand) if necessary to avoid pain.
- Keep elbows tight against the body and avoid flaring them out or you will increase the strain on the bicep and brachioradialis tendons.
- Straight arm pull downs – 3 sets of 12
- Use a wide grip with a lat-pull down bar
- I don’t experience any pain in my bicep tendons or my brachioradialis tendons.
- Hammer strength lat pull downs – 3 sets of 15
- I use a grip with my thumbs facing up and grabbing the side of the handle. The overhand grip is too painful and I use a lot of under hand grip movements in the other exercises.
- Hammer strength shoulder press (wide grip) – 4 sets of 12
- Cable side raises (light weight) – 3 sets of 12
- Place the cable at the lowest position
- Select a weight for a single arm and experiment until there is no pain.
- If the weight is too light to feel a pump at the end of your set with no pain in your arm, increase the reps to 12-20 to compensate for the lack of weight.
- As a note, I currently am using 30 lbs on an arm
- Machine shoulder press – 4 sets of 12
- Adjust the seat so that your starting position does not cause pain in your tendons on the first lift/push.
- Rear delt crossovers with Free Motion machine – 4 sets of 10
- Set the arms of the Free Motion machine to between a 7 and 8 setting so that they are above your head.
- Grab the left cable with your right arm and vice versa.
- Start with the cables above your head and slightly forward with your hands together.
- Pull apart mimicking a bent over rear delt raise.
- I have absolutely no pain in my biceps tendons or brachioradialis tendons when doing this exercise.
The only exercises I’ve experienced pain with are laying triceps extensions and overhead dumbbell extensions (severe pain when kicking up the dumbbell from my knee due to the supination). I’ve simply eliminated these two exercises from my workout and increased the number of sets on other exercises to make up for the volume.
I’ve completely discontinued biceps workouts for now. I attempted a bicep workout with extremely light weight only to experience a HUGE setback with extreme amounts of pain in both bicep tendons and brachioradialis tendons. For now, I’m resting my biceps – as frustrating as it may be.
Barbell shrugs seem to aggravate my bicep tendinitis so I’ve cut those out. Instead, I’m doing just dumbbell shrugs using wrist wraps (straps) and hammer strength shrugs.
It should be noted that dead lifts, when done with proper form, will recruit the trap muscles in a big way. Heavy dead lifts are one of my tricks to keeping my traps during my recovery from tendinitis.
No issues here.
So after three weeks there is a noticeable improvement. This will mark the end of week one for me using these alternative exercises. I have to say, as frustrating as it is, using lighter weight with these alternative exercises has allowed for some immediate improvement in my bicep and brachioradialis tendinitis.
I truly believe that the cumulative effect of all of the treatments and recommendations in this article will lead to my ultimate recovery and that leaving out any one of them will extend the recovery period – which by the way, I am told (by Dr. Affleck) can be three to four months.
Update – 4 months later
After keeping with this bicep and forearm tendinitis rehabilitation program for just over four months, I’m happy to say that I’m about 95% recovered. There are still exercises that aggravate both the bicep tendons and the forearm tendons but I stay clear of them. I’m finding that straight bar curls are the worst offender and incline dumbbell curls are a close second. With the incline dumbbell curls though, I can limit my range of motion and just avoid a full extension to alleviate any pain in the tendon. My arms are growing again and I’m once again enjoying my workouts without pain. I do have a few extra pieces of knowledge to pass on though.
Always warm up the tendons
One thing that is worth noting is that I ALWAYS spend five to ten minutes warming up my tendons NO MATTER WHAT muscle group I’m working (except legs, of course). Once the blood is flowing to my arms and bicep tendons, they don’t feel like an old squeaky machine part. Rather, they are ready to be pushed to the limit.
I’ve also been experimenting with high volume training for biceps that manifested due to this injury. As my tendons healed, I was able to slowly increase the weight but I kept the reps fairly high 16-20 reps). I’ve actually gained 1/4″ on my arms in just two weeks from this AND training them just about every day. Please note, that I was about 80% healed when I started this high volume training, so don’t rush into it.
After hearing only good things about this procedure from friends of mine on the bodybuilding circuit and other pro athletes, I decided to give it a shot. The procedure is performed by a licensed prolotherapy doctor and includes injecting the injured area with a sterile solution of dextrose and water (sugar water). This solution aggravates the injured area and causes swelling, which causes your body’s natural defense and healing mechanisms to kick in.
Tendons don’t get good blood flow so this prolotherapy procedure creates a significant amount of it. The blood flow carries vital nutrients and oxygen to repair the injured area.
Most people go once a month for about 3 – 6 sessions. I got lucky and only needed one. This procedure, however, I believe catapulted me in to my final recovery phase where I am now. You can find a list of licensed prolotherapy doctors here: www.getprolo.com
My specific prolotherapy doctor was Dr. Justin Hoffman who can be found here: http://truhealthmedicine.com/santa-rosa-ca-prolotherapy-and-non-invasive-pain-relief
I’d love to hear your comments on this! If you’ve experienced or are currently experiencing bicep tendinitis or brachioradialis tendinitis, please leave a comment and let me know!