The list of committed weightlifters who haven’t had their close calls with injury is short. Lifting too much weight, using improper form, and focusing too much on a single muscle group are recipes for pain. The easiest injuries to avoid, however, are also some of the most common. 

Biceps tendinopathy, commonly called biceps tendinitis, is one of those injuries. Biceps tendinopathy refers to any injury to the biceps long head tendon, which connects the biceps muscle to the top of the shoulder socket. This is what your buddy who won’t stop adding weight to the bench press—even when it hurts—might have, and if you don’t want to develop it, consider taking preventative steps.

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Biceps tendinopathy is common to any activity during which repetitive overhead motion is demanded: this includes tennis and swimming, and especially weightlifting. The foremost thing to keep in mind, according to Susan Carrigg, a physical therapist at the Providence St. Vincent Medical Center in Portland, OR, is that “weightlifters tend to get biceps tendinopathy by overusing the biceps, which may be due to sheer volume or due to improper technique, or both.” She noted that the barbell bench press, when done incorrectly, is a major factor in the development of biceps tendinopathy. Here’s her recommended form: “Avoid flaring the arms out to the sides, as this technique does not maximize the use of the pectorals and instead puts more stress on the shoulder and biceps long head tendon. Keep the upper arms angled a bit down (toward the horse 20°-30° or so), and aim the bar to hit below the nipple line. Dumbbell bench press allows you to perform at this angle a bit more easily, so if bench press is causing pain, try the dumbbells.”

Keeping the area around the biceps tendon strong is crucial to avoiding tendinopathy. This means doing exercises that target the rotator cuff, but nothing too heavy. Carrigg states that “the rotator cuff muscles are very small so they don’t need a lot of resistance or volume to keep them strong. Include external and internal rotation strengthening with pulleys, resistance bands, or dumbbells in side-lying position.” 

You might think those endless barbell curls look impressive, but they can lead to injury. Same goes for overhead shoulder presses. Carrigg recommends giving your biceps and your shoulders a break, stressing that back and chest exercises are usually sufficient to keep these smaller, more vulnerable areas strong.

How can you tell if you’ve got biceps tendinopathy? If you feel pain in the front of your shoulders after a lift, especially sharp pain that radiates down your arm or up your neck, you may have a problem. The good news is that many developing cases can be turned around with a regimen of rest and flexibility exercises. Chest-opening stretches will help your biceps tendon heal, as will strengthening your rotator cuff. Adjusting your form in certain weighted exercises can play a big role, too, says Carrigg: “For instance, if the barbell bench press is aggravating, try a dumbbell flat bench press with shortened range.” Because dumbbell lifts strengthen the supporting muscles around a major muscle, they are a safer bet for shoulders workouts than barbells, which isolate specific muscles.

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In addition to these active remedies, you should be taking care of your shoulders outside the gym with 20-minute ice pack applications every 3-4 hours and plenty of sleep.

However, if your shoulder pain has been persistent for more than two weeks, you should hold off on dosing yourself with NSAID pain relievers (like ibuprofen and aspirin) before getting a doctor’s evaluation. The reason for this exposes a simple but critical part of treating biceps tendinopathy: NSAIDs are good for an inflamed tendon (tendinitis) but bad when the tendon is deteriorating (tendinosis). Many cases treated as tendinitis are actually tendinosis, according to a 2002 article in the British Medicine Journal, and treating tendinosis with NSAID pain relievers can weaken the shoulder further. Having tendinosis means your tendon’s fibers are weakened and soft, and sometimes even microscopically torn, increasing your risk of a major tear. The healing time for tendinosis is months rather than weeks, as the tendon needs to be allowed time to replace its deteriorated tissues. If you suspect tendinitis, you shouldn’t rule out tendinosis. A visit to the doctor will be important in learning how to proceed.

Catch biceps tendinopathy early enough and you can probably nurse your shoulder back to health with no serious treatment needed. But if you ignore the pain and keep slamming your shoulder with heavy lifts, you’re signing up for a long recovery path and possible surgery.