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Before surgery, the patient is scheduled for physical therapy the day after their procedure.  Patient education is critical to the success of the rehabilitation of a bicep tenodesis.  Emphasis is placed on teaching patient daily self-care.  Any negative changes need to be reported to Dr. Talkington at (850) 763-0346.

I.             Phase I (Protective Phase) (week 1 -4)

Goals:   Allow healing of soft tissue, early-protected ROM, retard muscle atrophy, decrease pain/inflammation.

Sling:   for 4 weeks (removed 2-3 times per day in order to perform the exercises that follow.  Sling must be worn during sleep for the first 4 weeks.

Week 1

  • Pendulums
  • Wrist and hand AROM and gripping
  • Modalities prn for pain and inflammation

Week 2-4

  • Continue previous exercises
  • Initiate gentle pain-free PROM for shoulder forward elevation and external rotation; may progress to AAROM
  • Initiate gentle elbow ROM; may progress to AA elbow flexion

Any strengthening activities related to elbow flexion, supination, or forward elevation of the arm with the elbow extended should be restricted until 9 weeks following biceps tenodesis.

II.            Phase II (Intermediate Phase) (week 5-8)

Goals:  Gradual increase in ROM, improve strength, decrease pain/inflammation

Criteria:  Minimal pain and inflammation, stable shoulder

Sling:  Discontinue sling during day and night

Week 5-8

  • Continue previous exercises
  • Initiate scapular strengthening with scapular retractions
  • Initiate AROM of elbow – pronation, supination, flexion, and extension
  • Gentle passive stretching at tend of elbow ranges to maintain or increase flexibility
  • Initiate AROM of forward elevation in scapular plane beginning with gravity-eliminated positions (supine and side-lying) and progressing according to quality of motion (semi-recumbent, standing).  Begin with elbow flexed and progress to elbow extended.
  • Isometrics with the arm at the side for rotator cuff or deltoid strengthening; may be advanced to elastic band with least resistance at week 7.


Any strengthening activities related to elbow flexion, supination, or forward elevation of the arm with the elbow extended should be restricted until 12 weeks following biceps tenodesis.

III            Phase III (Strengthening Phase)(week 12-16)

Goals:   Improve strength and neuromuscular control, normalize arthrokinematics

Criteria:  Normal ROM, minimal pain

Week 12-16

  • Continue previous exercises
  • Initiate biceps isometrics; may advance to LIGHT (less than 1 lb) resisted biceps at week 10
  • Strengthening of triceps, rotator cuff, deltoid, and scapular stabilizers should be performed 3 times per week


Stay high rep and low resistance with above exercises or any that affect the glenohumeral joint and may fire the biceps.

IV            Phase IV:  (Return to activity phase) (4 months)

Criteria:  Full painless ROM, satisfactory clinical exam, muscle strength that fulfills work/sports requirements.

Month 4

  • Continue previous exercises
  • Advance biceps strengthening to 2 lb or greater
  • Progress previous strengthening program; continue to increase weight resistance with isotonics
  • Focus exercises on eccentric strengthening of post, rotator cuff and scapular muscles
  • Add total body conditioning, including strength and endurance training if appropriate
  • Initiate sport/work specific drills or activities


Initiate appropriate interval throwing, pitching, tennis, and golf program as appropriate at 16 weeks.


Return to sport/work or prior activity level unrestricted based on Dr. Talkington’s approval.

All times and exercises are to serve as guidelines.  Actual progress may be faster or slower, depending on each individual patient, as agreed upon by the patient and his/her therapy and Dr. Talkington.

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