PHYSICAL THERAPY PROTOCOL
Biceps Tenodesis
Physical Therapy Protocol
Rehabilitation following biceps tenodesis is designed to protect tendon healing while restoring shoulder motion, strength, and normal upper extremity function. Progression may vary depending on associated procedures such as rotator cuff repair or labral repair.
Protect Tendon
Restore Motion
Begin Strengthening
Pain-Free Function
Important Note
This protocol serves as a general guideline. If biceps tenodesis was performed together with another procedure, such as rotator cuff repair, shoulder stabilization, or shoulder replacement, the rehabilitation protocol for the larger procedure takes precedence.
Rehabilitation Philosophy
The biceps tendon requires time to heal securely to the humerus. Early rehabilitation focuses on protecting the tenodesis while maintaining shoulder mobility. Strengthening of the biceps is intentionally delayed until tendon healing has occurred.
Phase I: Protection Phase
Timeframe: 0–6 Weeks
Goals
- Protect the tenodesis
- Control pain and swelling
- Restore gentle shoulder motion
- Maintain elbow, wrist, and hand mobility
- Prevent stiffness
Restrictions
- Sling for comfort
- No resisted elbow flexion
- No resisted forearm supination
- No heavy lifting
- Avoid sudden pulling activities
Exercises
- Pendulum exercises
- Passive shoulder motion
- Active-assisted shoulder motion
- Elbow and wrist range of motion without resistance
- Grip strengthening
- Scapular stabilization exercises
Phase II: Motion Phase
Timeframe: 6–10 Weeks
Goals
- Restore full shoulder motion
- Normalize shoulder mechanics
- Begin light functional use
- Maintain flexibility
Exercises
- Active shoulder motion
- Pulleys
- Wall walks
- Posterior capsule stretching
- Scapular strengthening
- Gentle rotator cuff exercises if appropriate
Avoid During This Phase
- Heavy lifting
- Resisted biceps strengthening
- Forceful pulling
- Maximal curls
Phase III: Strengthening
Timeframe: 10–16 Weeks
Goals
- Restore strength
- Improve endurance
- Return to unrestricted daily function
- Gradually load the biceps tendon
Exercises
- Light resisted elbow flexion
- Light resisted supination
- Theraband strengthening
- Progressive dumbbell strengthening
- Rotator cuff strengthening
- Scapular stabilization
Phase IV: Return To Activity
Timeframe: 16+ Weeks
Strength
Gradually return to unrestricted strengthening as tolerated.
Sports
Progress sport-specific activities after strength and endurance have returned.
Work
Return to heavier occupational demands as tolerated and approved.
Return To Activity Guidelines
Desk Work
Often within several days to 2 weeks.
Driving
When no longer taking narcotic medication and safely controlling the vehicle.
Daily Activities
Gradually increase after sling discontinuation while respecting lifting restrictions.
Golf
Putting around 6 weeks, full swing typically 3–4 months.
Weight Training
Progressive strengthening begins after healing; heavy curls delayed until adequate tendon healing.
Throwing Sports
Usually resume around 4–6 months depending on associated pathology.
Therapist Notes
- Protect the tenodesis during the first 6 weeks.
- Do not begin resisted elbow flexion or supination prematurely.
- Restore full shoulder motion before aggressive strengthening.
- Progress strengthening gradually.
- If another shoulder procedure was performed simultaneously, follow the more restrictive protocol.
- Contact the office if recovery deviates from expectations.
Red Flags
Contact The Office For
- Increasing redness
- Drainage
- Increasing pain
- Loss of shoulder function
- Sudden "pop" with loss of biceps contour
Seek Urgent Care For
- Chest pain
- Shortness of breath
- Calf pain or swelling
- Severe uncontrolled pain
Related Resources
Questions About Biceps Tenodesis Rehabilitation?
Successful rehabilitation depends on protecting the healing tendon during the early postoperative period while progressively restoring shoulder function and safely reintroducing strengthening.
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