Biceps Trigger Points and Referred Pain Pattern

Before you read about biceps trigger points and their pain referral patterns, you may want to find out more about the biceps brachii muscle.

The biceps brachii is the most well-known muscle of the arm due to its prominence. It is the muscle we think of when we imagine someone with ‘big arms.’ Its chief role is elbow flexion, and, while it is not the only elbow flexor, its role makes it prone to overload problems which can lead to trigger points.

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Barbell or dumbbell curling, pullups, lat pulldowns and any climbing movements all work the biceps brachii. During the curling movement, the origin is fixed, so that the muscle moves the forearm toward the humerus. During the pullup, the insertion is fixed, so that the muscle moves the humerus toward the forearm. The biceps is an important stabilizer while carrying any heavy object at waist level, such as a suitcase, and without it, the shoulder would be pulled apart.

It is also active in the throwing action, both as an elbow flexor during late cocking and a forearm decelerator during follow-through. As well, it is thought to be an important stabilizer during throwing motions. During shoulder abduction in the scapular plane, the long head of the biceps may act as a stabilizer, although its precise role as a stabilizer is a subject of controversy. ¹Hammer, Warren I. Functional Soft Tissue Examination and Treatment by Manual Methods. N.p.: Jones & Bartlett Pub, 2006. 49.,²Kendall, Florence Peterson. Muscles, Testing and Function with Posture and Pain. Baltimore, MD: Lippincott Williams & Wilkins, 2005.

Biceps Brachii Trigger Points Causes and Symptoms

Various daily lifting activities can overload the biceps brachii muscle, leading to trigger points. These include lifting heavy objects with the palm up, and weight lifting or other exercises that utilize the biceps. Repeated supination under load, such as turning a screwdriver, can also aggravate the muscle. Violin playing may cause a strain, due to the biceps of the arm supporting the instrument needed to be continuously contracted, usually the left. The biceps can also be overloaded during hard tennis serves or throwing activities. Over-exertion from shoveling snow may also aggravate the muscle.

Trigger points in the biceps may also start because of pain referred from TrP’s in the infraspinatus or subclavius muscles. The TrP’s themselves tend to occur in the middle portion of the muscle and pain is projected primarily upwards.

The chief pain symptom of biceps brachii trigger points is pain or aching in the front of the shoulder, which is superficial and not deep to joint itself. The tenderness in these areas may be mistaken for bicipital tendinitis or subdeltoid bursitis. Additional pain may be felt in the crook of the elbow.

Sometimes pain may skip to the suprascapular region. There does not tend to be pain referred to the biceps muscle itself. ³Davies, Clair. The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief. Oakland, CA: New Harbinger Publications, 2004. 100-101.

Biceps Trigger Points Self Treatment

Focus massage on the area of trigger points in the mid portion of the muscle, which can be found in either head. Use the knuckles or thumb of the opposite hand and rake deeply. A knobble massage tool may also be used. A roller massage ball may also be effective. See the Trigger Point Therapy Workbook for information on other muscles that cause pain in these areas. Secondary trigger points may develop in the brachialis and supinator muscles as well as the triceps. Later, the anterior deltoid, supraspinatus, and upper trapezius muscles may develop TrP’s.

During periods of active biceps brachii trigger points, remember to carry heavy objects with the hand pronated to take some of the stress off the muscle, and avoid prolonged heavy carrying and other aggravating activities. ⁴Simons, David G., Travell, Janet G.,Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore: Williams & Wilkins, 1999. 447-455.

Self Stretch of the Biceps Brachii using Doorway

After you have successfully treated the biceps trigger points, use a passive stretch on a daily basis. To stretch the biceps, the arm must be extended behind the back and the thumb facing down. Stand in a doorway and reach your hand up to your side and grab onto the doorjamb with your thumb facing the floor. Lean forward slightly and slowly rotate your body away from the doorjamb so that a stretch is felt in the biceps muscle. Stretch the muscle gently and slowly, without jerking for a few seconds, then relax for a few moments before repeating the stretch for a total of six repetitions. ⁵Davies, Clair. The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief. Oakland, CA: New Harbinger Publications, 2004. 100-101.