Bicep Tendon Clicking: Causes, Concerns, and Strategies for Management

How do I stop my bicep tendon from clicking?

Bicep tendon clicking, often referred to as crepitus, can stem from various causes ranging from benign joint sounds to indicators of underlying structural issues like tendon subluxation or inflammation; addressing it involves a multi-faceted approach focusing on anatomical understanding, movement pattern correction, and targeted strengthening.

Understanding Bicep Tendon Clicking

The clicking sensation in your bicep tendon, particularly around the shoulder, is a common concern for fitness enthusiasts and athletes. To understand how to stop it, we must first delve into the anatomy and potential causes.

Anatomy Refresher: The biceps brachii muscle has two heads: a short head and a long head. The long head of the biceps tendon (LHBT) is particularly relevant here as it originates from the supraglenoid tubercle of the scapula, passes over the humeral head, and runs through a bony groove on the humerus called the bicipital groove. This tendon is held in place by the transverse humeral ligament and other surrounding tissues.

Common Causes of Clicking: Clicking can be categorized into two main types: non-painful (benign crepitus) and painful (indicative of pathology).

• Tendon Subluxation or Instability: This is one of the most common causes. The LHBT can momentarily slip out of its bicipital groove during certain movements, especially those involving external rotation and abduction of the shoulder. This often produces a distinct, sometimes audible, click or pop. It can be due to laxity or damage to the transverse humeral ligament or a shallow bicipital groove.
• Bicipital Tendinopathy/Tendinitis: Inflammation or degeneration of the LHBT can cause it to rub abnormally within the groove, leading to clicking, grinding, and often pain. This is usually an overuse injury.
• Shoulder Impingement Syndrome: Compression of the LHBT (and/or rotator cuff tendons) under the acromion can lead to irritation and clicking, especially during overhead movements.
• Scapular Dyskinesis: Abnormal movement or positioning of the scapula (shoulder blade) can alter the mechanics of the shoulder joint, placing undue stress on the LHBT and contributing to its instability or friction.
• Osteoarthritis: Degenerative changes in the shoulder joint can lead to bone spurs or irregular surfaces that cause clicking as the tendon moves over them.
• Gas Bubbles (Cavitation): Similar to knuckle cracking, nitrogen gas bubbles can form and collapse within the joint fluid, causing a benign clicking sound. This is usually painless and not a cause for concern.

When to Be Concerned

While some clicking can be harmless, certain signs warrant professional evaluation.

• Pain: If the clicking is accompanied by sharp, dull, or aching pain, especially during or after activity, it's a red flag.
• Swelling or Bruising: Visible signs of inflammation around the shoulder or upper arm.
• Weakness: A noticeable decrease in strength, particularly during bicep curls or shoulder movements.
• Instability: A feeling that your shoulder is "giving out" or feels loose.
• Post-Injury: Clicking that begins immediately after a fall, direct impact, or sudden forceful movement.
• Persistent Symptoms: If the clicking persists despite rest and activity modification, or worsens over time.

If you experience any of these accompanying symptoms, consult with a physical therapist, orthopedic surgeon, or sports medicine physician for an accurate diagnosis and personalized treatment plan.

Strategies to Address Bicep Tendon Clicking

Addressing bicep tendon clicking requires a systematic approach that targets the underlying cause, improves shoulder mechanics, and strengthens supporting musculature.

• Rest and Activity Modification:

  • Identify Aggravating Activities: Pay attention to which specific movements or exercises trigger the clicking.
  • Reduce or Eliminate: Temporarily decrease the intensity, volume, or entirely cease these activities. For example, if bicep curls cause clicking, reduce the weight or switch to a different curl variation that minimizes the click.
  • Modify Form: Often, improper form or excessive range of motion can contribute. Focus on controlled, deliberate movements.

• Improving Shoulder Stability and Mobility:

  • Rotator Cuff Strengthening: The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis) are crucial for stabilizing the humeral head within the glenoid fossa and keeping the LHBT centered in its groove.
    • External Rotations: With resistance bands or light dumbbells.
    • Internal Rotations: Against resistance.
    • Scapular Plane Abduction (Scaption): Raising arms to 30 degrees in front of the body, thumbs up.
  • Scapular Stabilization Exercises: Strong and mobile scapular stabilizers (rhomboids, serratus anterior, trapezius) are essential for a stable base from which the humerus moves.
    • Scapular Retractions/Depressions: Squeezing shoulder blades together and down.
    • Wall Slides: To improve upward rotation and serratus anterior activation.
    • Band Pull-Aparts: To strengthen posterior shoulder muscles.
  • Thoracic Mobility: A stiff thoracic spine can force the shoulder into compensatory, often problematic, movement patterns.
    • Thoracic Extensions: Over a foam roller.
    • Cat-Cow Stretches: To improve spinal segmentation.

• Optimizing Movement Patterns:

  • Proper Lifting Mechanics: Ensure your form for exercises like bicep curls, overhead presses, and rows is impeccable. Avoid excessive anterior humeral head glide during pressing movements or excessive internal rotation during pulling.
  • Elbow Position in Curls: When performing bicep curls, keep your elbows relatively stable and tucked close to your sides. Excessive elbow flare or anterior movement can place undue stress on the LHBT.
  • Controlled Eccentric Phase: Focus on a slow, controlled lowering (eccentric) phase for all exercises, as this helps build tendon resilience and control.

• Addressing Muscle Imbalances:

  • Pectoralis Minor Tightness: A tight pectoralis minor can pull the shoulder forward, leading to anterior humeral head glide and impingement of the LHBT. Incorporate pec minor stretches.
  • Upper Trapezius Dominance: Over-reliance on the upper traps can lead to poor scapular mechanics. Focus on activating lower and middle trapezius and serratus anterior.

• Soft Tissue Work:

  • Foam Rolling/Massage: Gentle self-massage around the shoulder, upper back, and even the bicep belly can help release tension, but avoid direct, forceful pressure on the tendon itself, especially if inflamed.

• Gradual Return to Activity: Once symptoms subside, gradually reintroduce activities. Do not rush back to previous loads or intensities. Progressive overload is key to long-term success.

Preventative Measures

Preventing bicep tendon clicking, especially if you're prone to it, involves consistent attention to your training practices.

• Thorough Warm-up: Prepare your shoulder joint and surrounding muscles for activity with dynamic stretches and light resistance exercises.
• Progressive Overload: Increase weight, reps, or intensity gradually. Avoid sudden jumps in training volume.
• Listen to Your Body: Pay attention to any discomfort or new clicking sounds. Pushing through pain can exacerbate issues.
• Balanced Training Program: Ensure your workout routine includes exercises that strengthen all planes of motion around the shoulder, not just the "mirror muscles." Prioritize posterior chain and rotator cuff strength.
• Cross-Training: Incorporate diverse activities to avoid repetitive stress on the same structures.

Conclusion

Bicep tendon clicking is a signal from your body that something in your shoulder mechanics or training regimen may need adjustment. While often benign, persistent or painful clicking warrants professional evaluation. By understanding the underlying anatomy, diligently addressing potential causes through targeted strengthening, mobility work, and meticulous attention to exercise form, you can effectively manage and often eliminate this common issue, ensuring the longevity and health of your shoulder complex.