The bicep muscle could be imagined as two muscles side by side that ultimately separate into two “heads” that attach to tendons and connect into the shoulder complex. The short head of the bicep connects to the scapula and is rarely a pain generator. On the other hand, the long head of the bicep attaches to the glenoid, which is where the humerus connects to the shoulder blade, or the area we more often call the rotator cuff. If the tendon that connects the long head of the bicep to the glenoid becomes inflamed due to excessive friction or overloading of the muscle-tendon unit—more accurately described as long head of the biceps tendosynovitis or LHBT—it can be experienced as pain in the anterior (front) of the shoulder.

This tendinopathy often co-occurs with other shoulder conditions such as rotator cuff disease or subacromial impingement. As such, LHBT is typically addressed as part of a multimodal treatment approach starting with conservative care first before healthcare professionals consider more invasive options, like surgery. In a chiropractic setting, non-surgical LHBT management begins with a case history and careful examination of the shoulder and adjacent sites of the body to determine all potential causes of the patient’s pain and disability.

In-office treatment may involve both thrust and non-thrust manipulative therapy techniques applied to the shoulder joints, as well as the cervical and thoracic spinal regions. Soft tissue techniques may also be used to address issues found in the muscles surrounding the shoulder region. Treatment may also include modalities like ultrasound, electrotherapy, laser therapy, extracorporeal shockwave therapy, pulsed magnetic field, and iontophoresis.

Patients will also be advised to remain active within pain tolerances and be provided with assurance that their condition will improve. These instructions are very important because it’s natural for people with a painful condition to modify or even cease activities to avoid pain, but these practices are more likely to prolong pain and disability and lead to additional problems. In addition to diet and supplement recommendations to reduce inflammation, patients may also be asked to perform exercises at home to facilitate the treatment process. This can include resistance training and/or stretches, depending on the patient’s unique case.

As with many musculoskeletal conditions, the earlier in the course of the disease you seek treatment, the more likely you’ll receive a satisfactory outcome with conservative approaches. However, if the condition does not improve, the patient’s chiropractor may co-manage the case with a medical physician or specialist if pharmaceuticals, injections, or surgery may be required.