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The Physiotherapist assesses the muscle and joint flexibility of the affected arm and recommends exercises to achieve normal range of motion. The goals of management include; � Decrease joint swelling, inflammation, or restriction � Reduction of pain � Improving shoulder joint integrity and mobility � Reduce functional limitations � Increase the active range of motion in the arm � Improve strength and muscle power of the affected arm � Posture education In the initial phase the individual may be unable to fully lift the arm or sleep comfortably hence the focus of management is to offer rest from pain-provoking postures and movements. This implies that the individual puts a halt to movement or activity that provoked the shoulder pain in the first place and avoids doing anything that causes pain in the affected arm. Biceps tendonitis; its treatment may include stretches, strengthening exercises, rest or activity modification and cold therapy. Rest and Cold therapy Before any rehabilitation exercises can be started, inflammation must be decreased to a manageable level. This is best accomplished through rest and ice application. Rest prevents further aggravation of the tendon. Ice ensures limitation of flow of blood to the area, reducing swelling and pain. It is also best to keep the area elevated above the heart to reduce inflammation. Stretching Exercises Stretching exercises permits the individual with bicep tendonitis to gradually work through any lingering pain. Stretching also promotes blood flow to foster the healing process. Once swelling is under control, stretching exercises can be executed to re-introduce the tendon to motion. Affected individuals usually start out slowly and gently stretch the biceps tendon in various directions and this helps to ascertain how much pain is still present. One stretching exercise may involve holding the affected arm against a doorway and gradually turning the body away from the arm to stretch the top of the biceps tendon. Another exercise may necessitate the individual to reach behind his back and pull a rolled-up towel upward to stretch the biceps tendon at another angle. Strengthening Exercises When the bicep tendon has been stretched and loosened up over a period of time, resistance exercise is then initiated. Exercises may include dumbbell biceps curls, front dumbbell raises for the shoulder joint, one-arm rows for upper back and a variety of other exercises. Resistance exercises assist to obtain mobility and strength in the tendon. At the same time, adjacent muscles are strengthened to offer support for the healing tendon. Strengthening exercises usually promotes amount of blood flow to the tendon and progressively, the biceps tendon will get stronger and a person can eventually return to normal activity. Other exercises include; Pendulum stretch The pendulum stretch may be carried out for about five minutes a day during the first few weeks of recovery. Range of motion/flexibility exercises should not cause more than a mild level of discomfort. While standing or sitting, keep the arm close to your body. Allow your arm to swing forwards and backwards, from side to side, then in small circles in each direction. Only minimal pain should be felt. The exercise will be supplemented or replaced by other exercises to target specific areas of tightness/restriction as the movement of the arm improves. The pendulum stretch may also be used as a warm up for more localised flexibility exercises and strengthening exercises. Wall walks / climbs Face a wall, standing close enough in order for you to touch the wall with your fingertips. Starting with the arms outstretched, parallel to the floor, move the fingers up and down the wall. Keep your shoulders level (do not shrug the shoulders during the climb with your fingertips). You should walk your fingers high enough that you begin to feel just a mild discomfort, not a sharp or severe pain. Perform the exercise up to five minutes, at least twice a day. To raise the difficulty, try to walk the fingers above the shoulder joint. Once more, you may feel mild discomfort but you should not feel sharp or severe pain. � The writer is a Senior Physiotherapist at the 37 Military Hospital