Physiotherapy After Bicep Tenodesis: A Step-by-Step Guide to Recovery

Phase 1: Protection and Pain Management (0–4 Weeks Post-Surgery)

Goals:

• Protect the surgical site.

• Manage swelling and pain.

• Maintain hand, wrist, and scapular mobility.
   

What to Expect:

• The arm is typically immobilised in a sling for 3–4 weeks.

• You’ll be advised to avoid lifting, pushing, or pulling.

• Passive and assisted range of motion exercises may begin, as directed by your physiotherapist and surgeon.
   

Physiotherapy Focus:

• Pain management: Ice and gentle soft-tissue massage around the shoulder/elbow.

• Scapular re-education: Gentle scapular setting and activation exercises to maintain postural control.

• Elbow and wrist mobility: Active wrist and hand movement, with caution to avoid biceps activation.

• Posture awareness: Prevent compensation due to sling use.
   

Precautions:

• Avoid active biceps contraction.

• Do not lift anything heavier than a coffee cup.

• Avoid external rotation of the shoulder beyond surgical limits.

 

Phase 2: Range of Motion and Early Strength (4–8 Weeks Post-Surgery)

Goals:

• Regain gentle shoulder and elbow range of motion.

• Begin light strengthening without overloading the repair.

• Continue pain-free progression.
   

What to Expect:

• The sling is gradually weaned off as comfort improves.

• You may start active-assisted and active range of motion under guidance of your physiotherapist.
   

Physiotherapy Focus:

• Gentle mobility exercises: Pendulum swings, wall walks, and stick-assisted mobility exercises.

• Shoulder stabilisation: Isometric exercises for the rotator cuff and scapular muscles.

• Elbow mobility: Begin gentle active flexion and extension, avoiding resisted biceps curls.

• Core and posture training: Maintain good shoulder alignment and trunk control.
   

Precautions:

• Still avoid lifting or resisted biceps work.

• Respect pain and fatigue limits.

• Ensure smooth, controlled movement, avoid any sudden movements.

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Phase 3: Progressive Strength and Muscular Endurance (8–12 Weeks Post-Surgery)

Goals:

• Restore full range of motion of the shoulder and elbow.

• Gradually strengthen the biceps and supporting muscles.

• Build endurance for daily tasks.
   

What to Expect:

• The repaired tendon has gained sufficient strength to tolerate low-load strengthening.

• You can now start light resistance exercises for the biceps and shoulder.
   

Physiotherapy Focus:

• Biceps activation: Begin with low-resistance curls using bands or light weights.

• Shoulder strengthening: Add resistance bands or weights for deltoid, rotator cuff, and scapular stabilisers.

• Functional exercises: Introduce closed-chain exercises such as wall push-ups or supported planks.

• Proprioceptive training: Enhance control and coordination of shoulder movements.
   

Precautions:

• Increase loads gradually, avoid fatigue or pain.

• Avoid heavy lifting or high-speed activities.

 

Phase 4: Return to Full Function (12–24 Weeks Post-Surgery)

Goals:

• Achieve full, pain-free range of motion.

• Restore normal strength and endurance.

• Safely return to sport, work, or hobbies.
   

What to Expect:

• By this phase, the tendon is well-healed, and your physiotherapist will shift focus toward sport-specific or work-related movements.

• Strength training intensity increases, mimicking real-life demands.
   

Physiotherapy Focus:

• Advanced strengthening: Incorporate eccentric loading and dynamic resistance.

• Plyometric and functional drills: For athletes - throwing, catching, or overhead drills.

• Work conditioning: For manual labourers - lifting, pushing, and pulling drills.

• Movement correction: Address any lingering compensations or muscle imbalances.
   

Precautions:

• Return to high-load lifting or sport only when cleared by your surgeon and physiotherapist.

• Continue a regular home exercise programme to maintain gains.

 

Bicep Tendon Surgery Rehab: Common Challenges 

While recovery from bicep tendon surgery usually progresses smoothly, some patients experience challenges that physiotherapy can help address. Here’s what to watch out for:

1. Stiffness or Loss of Motion - Early immobilisation in a sling can lead to shoulder stiffness. Gentle guided exercises, manual therapy, and heat modalities help maintain flexibility.

2. Pain or Swelling - It’s normal to experience mild soreness, but persistent pain may signal overuse. Icing, taping, and gradual exercise progression can help manage symptoms.

3. Weakness or Fatigue - Muscle atrophy occurs after surgery and immobilisation. Gradual strengthening, especially of the rotator cuff and scapular stabilisers under guidance of a physiotherapist, is essential.

4. Fear of Reinjury - Confidence is key. Your physiotherapist will provide reassurance, education and a structured goal orientated rehabilitation programme to rebuild trust in your shoulder.

 

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Restoring Function After Bicep Surgery

The final phase of rehab is about restoring normal function and returning to the activities that matter most to you. Whether it’s throwing a ball, lifting weights or carrying groceries, physiotherapy ensures your movement patterns are strong and efficient.

Functional rehabilitation can include:

• Sport-specific drills: Overhead throwing, push-ups, or resistance band exercises mimicking athletic movements.

• Work conditioning: Simulated lifting or carrying tasks for trade professionals.

• Daily activity retraining: Techniques for reaching, lifting, or dressing without pain.
   

The key to long-term success is maintaining strength, flexibility, and postural control. Even after formal physiotherapy ends, continuing a tailored home exercise routine will help prevent reinjury.

 

Physiotherapy After Bicep Tenodesis: Key Takeaways

• Be patient - Healing takes time. Pushing too hard early can compromise the surgical repair.

• Follow your protocol -  Your surgeon and physiotherapist will guide you on your recovery and rehabilitation timeframe.

• Stay consistent - Regular physiotherapy sessions and home exercises yield the best outcomes.

• Communicate - Report any unusual pain, swelling, or stiffness to your physiotherapist promptly.

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Final Thoughts

Recovery after bicep tenodesis takes time, patience and the right support. Physiotherapy is the key to protecting your surgical repair, restoring movement, and rebuilding strength safely and effectively. Every person’s recovery journey is different, which is why a tailored rehabilitation plan guided by your physiotherapist is so important.

With consistent effort, clear communication, and expert guidance, you can steadily progress through each phase of recovery and regain full confidence in your shoulder. If you’re recovering from bicep tendon surgery, our physiotherapy team is here to support you every step of the way, from early protection and pain relief to full, functional strength and lasting recovery.

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