# Distal right bicep tendonopathy **URL:** \ **Category:** Medical Q&A \[Moderated\]\ **Created:** [July 19, 2018, 9:19am UTC](https://forum.barbellmedicine.com/t/distal-right-bicep-tendonopathy/2699 "2018-07-19T09:19:19Z")\ **Posts on this page:** 4\ **Page:** 1
**Author:** ![bohemian](https://avatars.discourse-cdn.com/v4/letter/b/e5b9ba/32.png) [@bohemian](https://forum.barbellmedicine.com/u/bohemian)\ **Post date:** [July 19, 2018, 9:19am UTC](https://forum.barbellmedicine.com/t/distal-right-bicep-tendonopathy/2699/1 "2018-07-19T09:19:19Z")
Hello docs, I have been having pain on my right distal bicep tendon, on the inside of the elbow, for the past 1-1.5 years, especially when I flex the bicep with my arm externally rotated, i.e. palm up and when I squat. It started during my SSLP, when I started to add chin-ups to my routine. I always had trouble with chinups, being weak and overweight, and although I did get up to two reps, I soon stopped because it was only making the tendon pain worse. I am not sure if the chin-ups created the problem or exasperated something that was created by squatting. The pain after a hard set was too much and my right arm would tremble. I found I could not do another squat set and bench pressing was also out of the question. After reading a bit I experimented with the position of my elbows on the squat and making sure I was not pulling on the bar when grinding and it seems to have reduced the stress, but the problem has not gone away. I still feel it when I squat, it flares up on some days when the intensity is higher than usual and I find that my bench press is underdeveloped compared to my other lifts (104kg 1erm vs 200kg for the squat, 220 for the deadlift). I tried some lat pull downs with moderate weights the other day and sure enough the pain increased a bit. I know it might have been nocebo, but there is definitely something there, because the effect is consistent every time I put some stress on it. I recently read Jason’s article on the mixed grip and higher incidences of distal bicep tendon tears using the mixed grip and I thought I had an aha moment, because I have been doing all my deadlifts like this, with my right hand in an underhand grip. I bought some straps and have been using them for a couple of weeks now, but I have seen no improvement and the tendon still hurts when I squat or directly apply stress to it (e.g. curls). How would you suggest I attack this? Different hand grip on the squat? Isometric bicep curls? ---
**Author:** ![Austin\_Baraki](https://sea1.discourse-cdn.com/flex001/user_avatar/forum.barbellmedicine.com/austin_baraki/32/1095_2.png) [@Austin\_Baraki](https://forum.barbellmedicine.com/u/Austin_Baraki)\ **Post date:** [July 19, 2018, 3:02pm UTC](https://forum.barbellmedicine.com/t/distal-right-bicep-tendonopathy/2699/2 "2018-07-19T15:02:36Z")
Are you sure it’s a bicep tendon? Or could it be flexor tendinopathy (i.e., golfer’s elbow)? It may be a bit too sensitized to train “through”, and you may need more substantial training adjustments in the short term - for example, high bar squatting, deadlifting w/ straps, and taking a break from the chins/pulldowns. ---
**Author:** ![bohemian](https://avatars.discourse-cdn.com/v4/letter/b/e5b9ba/32.png) [@bohemian](https://forum.barbellmedicine.com/u/bohemian)\ **Post date:** [July 20, 2018, 8:47am UTC](https://forum.barbellmedicine.com/t/distal-right-bicep-tendonopathy/2699/3 "2018-07-20T08:47:34Z")
Hi Austin, thanks for the answer. I am relatively sure it is the distal bicep tendon. I feel the pain exactly in the middle of the inside area, right between median cubital and cephalic veins. Could be wrong though, I am not a doctor. 🙂 The pain definitely becomes worse when I flex the bicep and release after a few seconds. I have started deadlifting with straps since a couple of weeks ago, but no substantial improvement yet, though I realise it is still early. Chinups have been out of the pictures for a few months now, the load is just too much. I will try some high bar squatting to see if it helps. I read that eccentric exercises with low loads help the tendon heal, is that true and if so, would it apply in this case? ---
**Author:** ![Austin\_Baraki](https://sea1.discourse-cdn.com/flex001/user_avatar/forum.barbellmedicine.com/austin_baraki/32/1095_2.png) [@Austin\_Baraki](https://forum.barbellmedicine.com/u/Austin_Baraki)\ **Post date:** [July 25, 2018, 3:03pm UTC](https://forum.barbellmedicine.com/t/distal-right-bicep-tendonopathy/2699/4 "2018-07-25T15:03:14Z")
We’ve historically used eccentric-focused / tempo-work for tendinopathy, although some of the unique benefits of this approach have come into question more recently. However, _low_ loads (depending on how low we’re talking, of course), are generally not ideal for tendons, which require a bit higher loading compared to skeletal muscle in order to generate a response. I still frequently use tempo work as an inherently load- and fatigue-limiting condition, to prevent people from going crazy and doing too much too soon.