Taping for Biceps Tendinitis
A CASE STUDY
Often, fear of pain with movement prevents patients from completing exercise programs
By Deborah Sherry, PT, and Javier Acosta, PTA
A patient's compliance with recommended rehabilitative exercises is often compromised by pain or the fear of pain with movement. This case study presents a taping technique that proved effective in reducing the painful symptoms associated with chronic biceps tendinitis. By eliminating pain, patient compliance with recommended rehabilitative exercises and functional activity tolerance was significantly improved.
Biceps tendinitis is a painful inflammatory process arising from a combination of overuse, repetitive microtrauma and degenerative changes in the tendon and/or tendon sheath. The biceps tendon, much like the supraspinatus tendon, is poorly vascularized. This makes it susceptible to the types of degenerative changes seen more often in the rotator cuff. The long head of the biceps rests in the narrow bicipital groove on the anterior humerus between the greater and lesser tubercles. It attaches to the supraglenoid tubercle of the scapula and is anchored within the groove by the transverse humeral ligament. When the arm elevates, the tendon must be able to slide smoothly within the groove. If the gliding mechanism is compromised, pain is produced.1
Restoration of normal strength, function and pain-free range of motion are the primary therapy goals for any musculotendinous dysfunction. To achieve these goals, the therapist must be able to progress the patient through a series of passive, active and active-resistive exercises. The patient must be willing to perform these exercises consistently and independently, but, too often, pain or the fear of pain with arm movement limits compliance. In many cases, taping has become a commonly accepted treatment tool for reducing pain and providing patients feedback to aid in correction of faulty postures and joint biomechanics. However, a review of the literature indicates the majority of research studies have focused on the effects of taping for treatment of patellofemoral pain syndrome.2-8
While the authors were unable to find any literature specific to the use of taping in the treatment of biceps tendinitis, two clinical case studies were of note. In 1995, Host described the use of scapular taping as one component of a successful rehabilitation program for an active 40-year-old male with an eight-month history of right shoulder pain secondary to anterior shoulder impingement.9 It is significant that scapular taping to correct excessive abduction and winging and to promote upward rotation immediately decreased the patient's pain from 4 to 0 on a standard visual analog scale of 0 to 10 (4/10 to 0/10).
In 1997, Shamus and Shamus successfully treated a 47-year-old and a 25-year-old male who had both sustained trauma-induced Grade III ancromioclavicular joint sprains.10 Both patients were taped on the initial visit and kept the tape on overnight. At the second clinic appointment, each reported a significant reduction of pain (10/10 to 1/10 and 8/10 to 1/10 respectively) and the ability to sleep through the night. Full pain-free range of motion was achieved by the first patient in six visits and by the second patient within three visits.
Based on these studies, it appeared reasonable to assume that taping to create more space for the biceps tendon to move within the biceptal groove could reduce tissue irritation and pain. The taping technique illustrated here was used to provide the level of pain relief needed for the patient described in the following case study to comply with an active rehabilitation program.
Palpate the biceps tendon. Apply two overlapping strips of 2-inch width dressing-retention tape approximately 6 inches in length from coracoid process laterally to mid-deltoid. Apply one 6-inch long strip of high-adhesive tape from coracoid process laterally to medial aspect of bicipital groove. Fold tape back on itself so adhesive side is visible. Apply one 4-inch long strip of high-adhesive tape from mid-deltoid medially to the lateral aspect of bicipital groove. Fold tape back on itself so adhesive side is visible.
Press strips together, then pull anteriorly to create a trough over the bicipital groove. Pull tape laterally and secure to posterior deltoid.
Retest for pain by resisting supination with elbow flexed to 90 degrees. If the patient experiences no pain, begin the exercise program.
The patient was a 20-year-old machinist who was referred to physical therapy with a diagnosis of right subacrominal bursitis and biceps tendinitis. He incurred the initial shoulder injury two years prior to seeking treatment. He received five cortisone injections, which provided only short-term relief. He has been off work now for four months.
Upon initial evaluation, the patient described intermittent pain localized at the right anterior shoulder capsule ranging in intensity from 2/10 to 9/10 on a standard pain rating scale. The pain was aggravated by movement and eased with rest. He stated that any time he tried to exercise his arm it aggravated his shoulder pain. He denied associated neck pain or right upper extremity radiculopathy. Prior to injury, the patient played basketball and golf.
Objective findings revealed active shoulder flexion pain limited to 125 degrees and abduction to 75 degrees. Functional testing of shoulder external rotation showed that the patient could reach with difficulty to C1 but was unable to internally rotate enough to reach any portion of his back. Elbow flexion and extension were within functional ranges.
Shoulder and elbow muscle strength was 5/5 but the patient experienced pain with resistance to flexion and abduction. The drop arm test for supraspinatus pathology was negative but both Yergason's and impingement tests provoked pain. The patient also experienced point tenderness at the bicipital groove.
Biceps tendon taping was initiated during the second treatment session prior to exercise. The patient was able to actively move through full flexion and abduction without pain. Resisted supination with elbow flexion did not produce pain.
The patient lived two-and-one-half hours away from the clinic. Due to the distance, he could only attend one session per week. This made compliance with a home program even more crucial. His wife was taught the taping procedure for home use. At the third session, the patient reported feeling "no pain, just mild soreness" with the tape in place when using his arm. By the fourth session, he reported feeling "80 percent to 90 percent" better, experiencing no pain at the bicipital groove, just point tenderness over the lateral aspect of the glenohumeral joint.
Unfortunately, plans to progress to more work and sports-related functional activities and to wean the patient from taping could not be completed when the patient moved away from the clinic's service area.
To date, existing research has not proved that taping significantly alters muscle length-tension relationships or joint biomechanics. Research is also inconclusive regardless of whether taping provides an improved level of pain reduction.5,7 However, the anecdotal experiences of practitioners and few existing published case studies suggest taping may speed pain reduction. This, in turn, can break the pain-guarding-spasm cycle that inhibits the return of normal range of motion, strength and function. Although therapeutic interventions should not be based solely on anecdotal evidence, the significant reduction in pain experienced by one patient with a two-year history of symptoms and improvement in exercise compliance may make biceps tendon taping a useful tool to consider using in any comprehensive rehabilitation program for the treatment of patients with chronic biceps tendinitis. It would also be of benefit to undertake more controlled studies of the effects of taping in the conservative treatment of shoulder dysfunctions. *
1. Norkin, C., & Levangie, P. (1992). Joint structure and function: A comprehensive analysis (2nd ed.). Philadelphia: FA Davis Co.
2. Bockrath, K., Wooden, C., Worrell, T., Ingersoll, C.D., & Farr, J. (1993). Effects of patellar taping on patella position and perceived pain. Med Sci Sports Exerc, 25(9), 989-992.
3. Gilleard, W., McConnell, J., & Parsons, D. (1998). The effect of patellar taping on the onset of vastus medialis obliques and vastus lateralis muscle activity in persons with patellofemoral pain. Phys Ther, 78, 25-31.
4. Hunter, L.Y. (1985). Braces and taping. Clin Sports Med, 4, 439-454.
5. Kowall, M.G., Kolk, G., Nuber, G.W., Cassisi, J.E., & Stern, S.H. (1996). Patellar taping in the treatment of patellofemoral pain. Am J Sports Med, 24(1), 61-66.
6. Larsen, B., Andreasen, E., Urfer, A., Mickelson, M.R., & Newhouse, K.E. (1995). Patellar taping: A radiographic examination of the medial glide technique. Am J Sports Med, 23, 465-471.
7. McConnell, J. (1986). The management of chondromalacia patellae: A long-term solution. Australian Journal of Physiotherapy, 32, 215-223.
8. Powers, C.M., Landel, R., Sosnich, T., Mengel, K., & Perry, J. (1997). The effects of patellar taping on stride characteristics in subjects with patellofemoral pain. J Orthop Sports Phys Ther, 26, 286-291.
9. Host, H. (1995). Scapular taping in the treatment of anterior shoulder impingement. Phys Ther, 75, 803-812.
10. Shamus, J., & Shamus, E. (1997). A taping technique for the treatment of acromiolavicular joint spasms: A case study. J Orthop Sports Phys Ther, 28, 6: 390-394.
Deborah Sherry is a staff physical therapist at the Community Outpatient Rehabilitation Center in Fresno, CA. Javier Acosta was a staff physical therapist assistant at the same facility at the time this article was written.