Front Shoulder Pain Holding You Back in the Gym? Let’s Fix That
Derek Lam Physical Therapy and Performance | Oakland, CA
If you’ve been dealing with pain at the front of your shoulder during workouts — especially with movements like pressing, reaching overhead, or pulling — there’s a good chance your biceps tendon is involved.
This issue is often referred to as biceps tendinopathy (sometimes still called "tendonitis"), and while it’s common, it’s also very manageable with the right approach. Let’s walk through what it is, why it happens, and what steps you can take to start feeling better.
Anatomy of the right biceps muscle and associated tendons.
What’s the Biceps Tendon, and Why Does It Hurt?
Your biceps brachii muscle has two parts:
The short head attaches to the coracoid process of your shoulder blade
The long head attaches deep within the shoulder at the supraglenoid tubercle
These two parts merge and anchor into the radial tuberosity in your forearm, allowing the biceps to act at both the shoulder and elbow. At the elbow, it bends the arm and turns your palm upward (supination). At the shoulder, its role is less clear — though it may assist in shoulder flexion and help stabilize the joint due to the long head's location.
Tendinopathy, Not Tendonitis
Pain in the front of the shoulder is often attributed to the long head of the biceps tendon, especially during activities that stretch or overload it. While it’s commonly called "biceps tendonitis," newer research suggests inflammation isn’t the primary cause. A 2015 study by Sethi et al. found that inflammatory processes aren’t typically driving the symptoms.
Instead, the more accurate term is tendinopathy, which describes a painful, often overloaded tendon that has become irritated over time — not necessarily inflamed.
Another important point: biceps issues are rarely isolated. Imaging studies (like MRIs) often show coexisting shoulder problems, such as rotator cuff pathology. That’s why diagnosis can be tricky — even the best clinical tests aren’t always reliable for pinpointing the exact cause.
What Activities Aggravate It?
Biceps tendon-related pain often shows up during movements that stretch or heavily load the tendon. Some common triggers include:
Bench press (especially barbell)
Dips or deep triceps work
Cable or dumbbell flies
Overhead pressing
Reaching behind your back
Holding a barbell for back squats
If your symptoms aren’t caused by something like frozen shoulder or arthritis, and there’s no trauma involved, this blog (and the accompanying video) is designed to help.
Step 1: Modify Movements That Irritate Your Shoulder
Your first move should be reducing stress on the irritated tendon by adjusting key training variables:
Volume – Reduce sets, reps, or frequency
Range of Motion – Avoid extreme positions, like deep shoulder extension
Speed – Move slower to reduce tendon strain and improve control
Load – Use lighter weights to lower intensity
Here are specific ways to adjust your workouts:
Pressing:
Replace the barbell bench press with a floor press, or modify with spotter arms
Try push-ups with reduced range if benching is painful
For overhead pressing, opt for dumbbells and keep your arms slightly forward to reduce joint stress
Triceps dips may need to be avoided or modified early on
Pulling:
With dumbbell rows, stop when your elbow aligns with your torso
Switch to chin-ups or use a neutral grip bar if pull-ups are painful
Squatting:
For barbell back squats, try a wider grip or a thumbless grip
Consider swapping for front squats, goblet squats, or leg presses temporarily
You can also experiment with slower reps, especially during the eccentric (lowering) phase, and use pauses at the bottom of movements to ease strain and improve muscle engagement.
Step 2: Gradually Rebuild Strength and Function
Once pain levels have settled, the goal becomes progressive reloading — slowly and strategically reintroducing the movements and intensities that once caused discomfort.
Start with Nearby Muscle Groups:
Because biceps tendinopathy rarely occurs on its own, strengthening nearby stabilizers — like the rotator cuff and scapular muscles — is a smart next step.
Rotator cuff / External rotation strengthening:
Side-lying or standing external rotations (with bands or cables)
Isometric band pulls (hold 30–45 seconds with arms at side or shoulder level)
Posterior shoulder exercises:
“T,” “Y,” and “A” raises (prone on a bench or isometric holds on the floor)
Perform 2–3 sets of 10–15 reps or timed holds 2–3x/week
These exercises provide important support and can usually be added early in the process.
Step 3: Load the Biceps (When You’re Ready)
Once symptoms are under control, you can begin directly loading the biceps tendon — but it must be done gradually and strategically.
Start in supported, lower-stress positions:
Elbow Flexion Progressions:
Preacher curls or incline bench curls (arm supported)
Spider curls (moderate stress, unsupported)
Standard curls with arms at sides
Extended shoulder curls (e.g., seated incline curls or cable curls behind body)
Shoulder Flexion Progressions:
Begin with light front raises, preferably seated on an incline
Use dumbbells or cables to target the long head with more control
Stick to 2–3 sets of 8–15 reps, 2–3x per week, and focus on slow, controlled movements with tolerable loads. Progress slowly and listen to your body — recovery isn’t linear, but consistency is key.
Final Takeaways
Front shoulder pain from biceps tendinopathy is often the result of overuse and mechanical overload, not inflammation
Managing load, modifying technique, and reducing provocative positions are crucial early steps
Progress slowly and rebuild strength in the biceps and surrounding areas for long-term success
Ready to Start Feeling Better?
At Derek Lam Physical Therapy and Performance, I help active individuals in Oakland, CA stay strong and pain-free — whether that means getting back to lifting, training, or daily life.
Ready to book your first visit with me? Visit www.derekorthopt.com or click here to schedule online. I’m here to help you get back to doing what you love—pain-free.
📍 Derek Lam Physical Therapy and Performance
🏢 399 Grand Ave, Oakland, California 94109
🌐 www.derekorthopt.com
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