What are examples of eccentric exercises for biceps tendinosis rehabilitation?

Eccentric Biceps Exercises for Tendinosis Rehabilitation

Direct Answer

For biceps tendinosis rehabilitation, perform slow lowering (eccentric) biceps curls with a dumbbell or resistance band, taking 3 seconds to lower the weight from full elbow flexion to full extension, starting with 1 set of 10-15 repetitions and progressing to 3 sets performed 2-3 times per week on non-consecutive days. 1

Specific Exercise Technique

Primary Exercise: Eccentric Biceps Curl

• Starting position: Hold a dumbbell or resistance band with elbow fully flexed (biceps contracted) 2
• Eccentric phase: Lower the weight slowly over 3 seconds to full elbow extension 1
• Return phase: Use the opposite arm to assist lifting the weight back to starting position, or perform a normal concentric curl 2
• Maintain full range of motion throughout the movement 1

Exercise Variations by Position

• Standard position: Elbow at side, forearm supinated (palm up) 2
• Alternative position: Perform in different degrees of elbow flexion to target the distal biceps tendon specifically 2
• Both positions should be incorporated into the rehabilitation program 2

Dosage and Progression Protocol

Initial Phase (Weeks 1-2)

• Frequency: 2-3 non-consecutive days per week 1
• Sets/Reps: Start with 1 set of 10-15 repetitions 1
• Speed: 3-second eccentric (lowering) phase 1
• Resistance: Begin with minimal weight that allows proper form 1

Progression Criteria

• Advance to 3 sets once initial volume is tolerated with minimal pain 1
• Increase resistance gradually only when exercises can be performed with minimal pain 1
• Mild discomfort during exercise is acceptable, but pain should not persist after exercise 1

Critical Implementation Guidelines

Pain Monitoring

• Acceptable: Mild discomfort during the exercise itself 1
• Unacceptable: Pain that persists after completing the exercise session 1
• Warning sign: Increased pain indicates progression is too rapid 1

Breathing Technique

• Exhale during the eccentric (lowering) phase of the movement 1
• This helps maintain proper form and prevents Valsalva maneuver 1

Speed Control

• Perform at moderate to slow controlled speed throughout 1
• The 3-second eccentric phase is non-negotiable for therapeutic effect 1

Complementary Interventions

Adjunctive Treatments to Combine with Eccentric Exercise

• Stretching: Perform wrist extensor and biceps muscle stretching 1
• Cryotherapy: Apply ice through a wet towel for 10 minutes after exercise for pain relief 1
• Relative rest: Avoid activities that reproduce pain, but do not completely immobilize 1
• Deep transverse friction massage: May provide additional pain relief 3

Evidence from Clinical Cases

A case series of 10 patients with chronic biceps tendinopathy treated with eccentric-concentric exercise combined with dry needling and stretching showed mean pain reduction of 3.9 points and functional improvement of 19% on QuickDASH scores 4. A single case report of distal biceps tendinosis treated primarily with eccentric training in two elbow positions over 4 weeks demonstrated decreased pain, increased strength, and clinically significant QuickDASH improvement 2.

Mechanism of Action

Why Eccentric Exercise Works

• Stimulates collagen production in the tendon 1
• Guides normal alignment of newly formed collagen fibers 1
• Tensile loading promotes tendon healing and remodeling 1
• Reduces symptoms while simultaneously increasing strength 3, 1

Common Pitfalls to Avoid

Do Not:

• Completely immobilize the arm, as this leads to muscle atrophy and deconditioning 1
• Progress resistance too quickly, which can worsen symptoms and delay healing 1
• Continue if pain persists after exercise sessions 1
• Skip the slow eccentric phase, as speed is critical to therapeutic effect 1

Do:

• Maintain activities that do not reproduce pain to prevent deconditioning 1
• Monitor pain levels closely and adjust accordingly 1
• Progress gradually based on symptom response, not arbitrary timelines 1

Expected Timeline

Most patients with tendinosis respond to eccentric training within 3-6 months when performed consistently with appropriate progression 5. The key is patient comprehension, motivation, and adherence to the specific loading parameters outlined above 6, 7.