Softball: Superior Biceps Pain and What to Do

Short head - Green    Long head - Red

Short head - Green

Long head - Red


Superior Biceps pain is one of the top instigators that cause pitchers to lose playing time. Often times this pain can be disguised as anterior shoulder pain. A 2009 study by Shanley, found a 45% incidence (11/24) of time-loss injuries in a single season among softball pitchers. Of the time-loss, injuries were to the shoulder and elbow. Including bicipital and rotator cuff tendinitis and strain—both examples of repetitive load and abrasive wear and tear. 

But first, A mini anatomy lesson.

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The biceps brachii breaks off into a two-headed muscle near the top of the shoulder. These two heads are known as the short and the long heads of the biceps tendon.

Short head originates on the coracoid process of the shoulder blade

Long head originates on the supraglenoid tubercle. In lay man’s terms, this tendon runs up through a shallow groove located in the front of the shoulder.

Note to the reader* This tendon is also very superficial. Meaning there is not a whole lot of muscle in front of it to protect the tendon from abrasive wear and tear.Here are 4 more than likely reasons you are experiencing superior biceps pain and what to do about it.

Poor Technique

When an athlete expresses an annoyance that she's been experiencing with her shoulder the first thing I do is ask her 2 questions.

1. What exercise bugs your shoulder the most?

Note to the reader* Don’t be surprised if this is an upper body push/pull movement like a push-up or a row variation.

2. Would you mind showing me a few reps?

 In many cases, the glaring cause of this pain is due to a flaw in technique that she’s been unknowingly doing for many months. 

Action Steps:

1)    If particular exercises is causing you pain, don’t do it.

2)    If you’re in pain while doing these exercises simply ask a coach to take a look at your technique. Here is a quick technique tutorial for the 1-arm cable row.



Improve Core Stability/Core Strength

Core stability is the ability of the muscles surrounding your trunk to “own” positions. Many of these movements involve your limbs moving around a fixed core.  

Here is a quick example:



Why do we need to improve this?

Rib cage position is often affected by the core. When the core lacks optimal stability the rib cage can become flexed forward. Now, the shoulder blades are fixed to your rib cage. When the rib cage is flexed forward this causes the shoulder blades to tilt anteriorly off the rib cage pushing the humerus forward in the shoulder joint. Over time, if athletes stay in the position the humerus will start rubbing against the long head of the biceps tendon that could lead to issues down the road.

Take a quick look at these two photos: What do you see? Which one is more likely to have anterior shoulder discomfort? 

In photo A, I am in a  good athletic position. I have my core braced and my lats engaged. As you can see there is no forward glide occurring.

In photo B, My core and lats are not engaged causing my shoulder blades to pop off my rib cage. This unstable position pushes the head of the humerus forward into the long head of the biceps. 



Actions Steps:

1)    Use core stability drills in your warm-up as well as in your training to enhance stability and get your shoulder blades moving along your rib cage.

2)    Learn what a good athletic position looks like and feels like. 


Little or Too Much Rotator Cuff Work

little or too much rotator cuff work before a competition can actually be a bad thing. We have to remember that the rotor cuff is a group of SMALL muscles. These little guys will fatigue much faster with high volume direct arm care work. In result, they won’t be able to help stabilize the humerus when you need it the most in the circle.

If you’re an overhead athlete it’s a pretty smart idea to perform some variation of a low-level arm care drills prior to competition, practice, or strength training sessions to activate the rotator cuff. For most athletes, I recommend picking 3-4 “cuff” exercises and performing one set of 8 reps.

*Note to the reader: Quality reps are a must! I find all too often people have good intentions when performing arm care but many athletes are just grinding away at the anterior aspect of their shoulder. Check out this video to see common J-Band mistakes.


Trigger Points

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A trigger point is an area of connective tissue or muscle that becomes painful when compressed. These trigger points also have referral pain patterns. For example, if you have a trigger point located in the pec major the pain could radiate up to the front of your shoulder. 

Action Steps:

1. Perform soft tissue on the muscles surrounding the shoulder (avoid the neck). Many of these muscles have referral pain patterns that go directly to the front of the shoulder.

2. See a certified manual therapist. They will be able to help located the trigger points faster and show you how to correctly perform soft tissue work on sensitive areas.