Biceps Tenodesis Protocol

If you are experiencing pain in your upper arm between your elbow and your shoulder you might be experiencing biceps tenodesis. Fortunately, there are steps medical professionals can take to improve your symptoms and give you a full range of motion back. Biceps tenodesis protocol is a surgery performed when you are experiencing intense symptoms involving the tendon in your bicep muscle, most commonly from inflammation or tears in the tendon.

Rehab Protocols


Simply put, biceps tenodesis surgery involves cutting a tendon in the bicep and reattaching it in a more optimal position. There are a variety of ways this can be done, and your surgeon will let you know the process that will work best for you.

Phase 1 – Passive Motion

Physical therapy begins a week or two after successful surgery. Passive motions goals include:

  • Limiting pain and inflammation 
  • Slowly regaining some range of motion
  • Monitoring the healing process

Monitor incisions and keep them clean as your surgeon suggests. Make sure not to do any lifting as this could damage the surgical site and repair. Also, do not massage the area, even if it feels itchy or irritated. If you are feeling abnormal pain or notice signs of infection, contact your surgeon immediately. 

During this phase, don’t try to force the range of motion beyond what is comfortable. If you are feeling discomfort stop exercises immediately. Make sure to continue wearing your sling at all times when you are not with your physical therapist. This keeps your bicep stationary. To deal with inflammation, cryotherapy is encouraged. 

Activities in this phase are designed to increase your passive motion of the shoulder and elbow including:

  • Simple shoulder hang exercises 
  • Clock exercises to extend the rotation of the scapula
  • Ball squeezing exercises

If you work in an office on a computer, you can return to work at this time.

Phase 2 – Active Motion

This phase begins approximately four weeks after your bicep surgery. The goals of the active motion phase include limiting pain and inflammation along with eliminating the need for wearing the sling. Keep in mind that during this period you should not engage in any heavy lifting or massaging the tissues of your upper arm and shoulder area.

With the sling off, you’ll begin exercises that extend your arm and elbow. Just keep in mind, you should not be using any resistance during this period. Other exercises should include:

  • Posterior capsular stretches
  • Cross body stretches
  • The sleeper stretch

To limit inflammation after performing these exercises continued use of cryotherapy is recommended.

Make sure you are taking the necessary steps to keep your surgery site clean and are adequately protecting your bicep, elbow, and shoulder areas. As long as your incision site is healing as expected and you can perform your exercises without pain, you’re ready to move on to phase 3.

Phase 3 – Strengthening

Phase 3 begins between six to eight weeks after your surgery. The focus during your therapy is now to regain the strength and endurance of your arm and shoulder. You will also work to regain the motion of your arm at chest level and above. During this portion of your therapy, you need to try to resist doing too much too quickly. You’ll be excited to regain motion, but pushing yourself and your muscles too hard could cause reinjury and setbacks. Even if you are feeling better do not lift heavy objects around the home or at work.  

By this point, your exercises will be a bit more extensive. Expect to perform:

  • Bicep curls with slight resistance
  • Arm extensions with resistance 
  • Stabilization exercises 
  • Shoulder rotations
  • Tube exercises (including cross body diagonals) 
  • Prone rowing
  • Modified push-ups
  • Forward punch

The point of these exercises is to gain both strength and endurance in your affected arm. This is done with light resistance (1-3 lbs) and high repetitions, usually between 30-50 per exercise. Repetitions and resistance can be added as your arm gains more strength and endurance. If you feel any pain, lower resistance and repetitions to a level where you feel comfortable. Like with the previous phases, utilize Cryotherapy to reduce pain and inflammation when needed.

Phase 4 – Advanced Strengthening

The goal of phase 4 of therapy is to get you back to feeling like you did before surgery when your bicep and arm was healthy. After you complete phase 4 you will be able to get back to work with no restrictions and go back to your normal recreational activities. Phase 4 usually begins about 10 weeks after your surgery. 

At this point, it is fine to go back to some of your normal exercise routines such as weight lifting, but continue to avoid activities that put too much pressure on your shoulder area such as military press and wide grip bench press. Your physical therapy routine should include:

  • All the exercises from the previous phases
  • Shoulder specific stretching and exercises at least four times a week
  • Upper body weight lifting program (moderate weight with 15-25 repetitions)


Going forward, as long as there is no lingering pain, you can return to sports and higher impact activities. Make sure you get clearance from your doctor or surgeon before you officially return.

If you’re looking for expert orthopedic shoulder surgeons in the Austin area, contact Dr. Benjamin Szerlip today. We support you before, during, and after your biceps tenodesis protocol.