Biceps Tendon Irritation (Front-of-Shoulder Pain): Overhead Mechanics & Tendon Stability

Biceps Tendon Irritation (Front-of-Shoulder Pain): Overhead Mechanics & Tendon Stability

1. What the Biceps Tendon Actually Does

Climbers often think the biceps is “just an elbow flexor,” maar biomechanisch gezien:

The long head of the biceps tendon functions as:

  • a shoulder stabilizer
  • a decelerator during dynamic movement
  • a secondary rotator (helps with internal/external rotation)
  • a tension guide for overhead positions

It runs through the bicipital groove — a narrow channel at the front of the shoulder.

If alignment is off → the tendon rubs, snaps or compresses.

2. How Biceps Tendon Irritation Happens (Mechanics)

Biceps tendon irritation is usually created by friction + compression due to poor shoulder positioning.

De drie kernmechanismes:

1. Internal Rotation Under Load

Internal rotation = elbow flares outward, shoulder rolls inward.

Effect:

  • biceps tendon shifts forward
  • tendon rubs against groove edge
  • friction ↑
  • irritation ↑

Happens during:

  • gastons
  • sidepulls with flared elbow
  • compression climbing
  • poor technique deadpoints

2. Uncontrolled Dynamic Catches

The biceps tendon acts as a shock absorber.

If scapula is not set → the tendon takes the load alone.

Force spike → tendon gets slammed into the groove wall.

3. Overreaching in Overhead Positions

At end-range shoulder flexion (arm overhead), stability is low.

If you pull or rotate from that position:

  • humeral head drifts
  • tendon gets pinched

This is common on:

  • big moves on overhangs
  • bad foot positions
  • high heel-hooks that rotate the torso
  • reaching too far in lock-offs

3. Pain Pattern: What Biceps Tendon Irritation Feels Like

Het pijnsignatuur is zeer herkenbaar:

  • pain at the front of the shoulder
  • sharp or pinching pain when lifting arm
  • pain during underclings
  • pain during overhead pulling
  • pain catching swings
  • pain when rotating arm outward
  • tenderness in bicipital groove
  • weakness in overhead moves
  • discomfort putting on a jacket (external rotation)

The absolute classic test:

Press fingers into the front shoulder groove → if painful = biceps tendon involvement.

4. Yellow & Red Flags

Yellow Flags (light load reduction)

  • mild front-of-shoulder ache
  • pain only in certain angles
  • clicking without pain
  • pain improving during warm-up

Red Flags (stop climbing temporarily)

  • sharp catching pain
  • pain radiating down biceps
  • weakness lifting arm
  • instability sensation
  • swelling or heat at tendon

5. Technique Errors That Cause Biceps Tendon Irritation

1. Elbow flaring under load

Internal rotation = most dangerous vector.

2. Catching dynos with arm extended

Biceps tendon =
shock absorber → overloaded.

3. Pulling before scapula is engaged

Shoulder loses alignment → tendon shifts.

4. Gastons without trunk rotation

Shoulder isolated → tendon stress ↑.

5. Overreaching in overhead positions

End-range = minimal tendon stability.

6. Rounded upper back during movement

Scapula loses space → biceps tendon pinched.

6. Immediate Actions (0–7 Days)

1. Reduce overhead & dynamic climbing

Avoid positions that stress the groove.

2. Scapula-first drills

Stability before movement.

3. Light external rotation isometrics (20–40%)

Centers the humeral head → reduces tendon friction.

4. Avoid internal rotation under load

Elbow should point forward, not outward.

5. Gentle pec + lat mobility

Tight pecs pull the shoulder forward → tendon pinching.

7. Rehab Plan — The Three-Phase Model

Phase 1 — Stabilization & Pain Reduction (1–2 weeks)

Goal: center humeral head, stop friction.

Exercises:

  • scapular depression holds
  • scapular retraction pulses
  • external rotation isometrics
  • “packing drill” (shoulder set before movement)
  • pendulum swings (gentle mobility)

Criteria to progress:
→ no sharp pain in overhead position

Phase 2 — Rotator Cuff & Tendon Control (3–6 weeks)

Goal: restore rotation control and tendon glide.

Exercises:

  • external rotation eccentrics (slow lowering)
  • internal rotation eccentrics (very light)
  • YTWL patterns
  • serratus wall slides
  • prone shoulder raises

Protocol:

  • 3× per week
  • slow tempo (3–5 sec eccentrics)
  • pain <3/10

Criteria to progress:
→ no pinching during underclings

Phase 3 — Progressive Loading (6–12 weeks)

Goal: return to full pulling strength without irritation.

Exercises:

  • controlled sidepulls
  • controlled gastons
  • overhead isometrics
  • lock-off progressions
  • 2–5% weekly progression

Criteria for full return:

  • no pain in bicipital groove
  • strong overhead pulling
  • stable swings
  • no morning soreness

8. Return-to-Climbing Protocol

Step 1

Vertical climbing → neutral shoulder angles.

Step 2

Open-hand climbing with scapula-first focus.

Step 3

Underclings + overhead moves (light).

Step 4

Sidepulls and gastons (controlled).

Step 5

Light dynamic moves with “scapula set before catch”.

Step 6

Steeper terrain + overhead loading.

Step 7

Full load, dynamic climbing, compression.

If pain returns → regress 1 stage.

9. Long-Term Prehab (5 minutes)

  • 10 external rotation eccentrics
  • 10 scapular depressions
  • 10 serratus wall slides
  • 10 YTWL reps
  • 5 controlled underclings (technique drill)

This keeps the long head of the biceps tendon happy — for life.

10. When to Seek Professional Help

  • sharp pain during underclings
  • weakness lifting arm
  • constant front-of-shoulder pain
  • swelling
  • pain radiating down arm
  • symptoms lasting >6 weeks

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