Q: I have a very painful biceps tendonitis which I’ve been told the remedy for is rest and ice. Is it possible for me to continue a yoga practice?

A: Biceps tendonitis is the inflammation of tendon sheaths (tissues connecting muscle to bone), typically as a result of overuse. Symptoms of tendonitis can include localized pain (often made worse by joint movement), redness and swelling. Treatment for tendonitis involves rest of the affected joint and muscle region, systematic application of cooling packs to reduce inflammation, and in severe cases, the use of anti-inflammatory agents or drugs.

When applying ice/cooling packs, never apply the packs directly to the skin. Have a thin cloth separating the pack from skin to prevent irritation and over-cooling of the skin. It is important to reduce the inflammation to prevent worse tissue damage from forming as well as to reduce the formation of scar tissue. Rest and ice application will help the recovery of the tendon sheaths more readily. As the tendon is recovering, you may feel comfortable to slowly and mindfully lengthen and bend the elbow to maintain joint/muscle mobility (I am assuming the tendonitis is located in the tendons crossing over the elbow into the forearm bone).

After the inflammation and localized pain has subsided, a therapist may prescribe specific exercises to re-strengthen the bicep muscle and tendon to help prevent reoccurrence of the tendonitis.

In regards to practicing Yoga, Yoga typically does not actively engage the bicep muscles. If you analyze the more vigorous Yoga poses and Yoga flows (as in Power Yoga or vinyasa Yoga), the upper body muscles that are most energetically loaded are the “push-phase” muscles: Pectoral muscles (chest), Anterior Deltoid muscles (front shoulder), Triceps muscles (rear upper arm). Due to the lines of gravity and force generation, the bicep muscles and tendons typically are not be heavily loaded in Yoga.

However, when recovering from tendonitis in the biceps, you should avoid vigorous motions and heating of the arms and elbows. Even though the biceps may not be overloaded directly, the heat and motion in the elbow joint can worsen the tendon inflammation. Also, unmindful extension (straightening) of the elbow can over-expand the tendon when it is not ready to be stretched.

So, can you do Yoga with bicep tendonitis? Absolutely. But you should not perform flows and poses that directly load or deeply extend the arms/elbows: for example- Chaturanga and Pushup style poses, Upward Facing Dog, Downward Facing Dog, Side Plank, Plank on the elbows, Yoga Mudra arm variations, Dancing and Balancing Cat pose, Crow pose and other arm balances.

Take this time during recovery to explore lower body Yoga postures or enjoy more restorative style practices. This is also a great time to deepen your meditation and pranayama (breath exercises) practices. If you require more physicality to maintain body weight and to control calorie expenditure, then enjoy some brisk walking in addition to your Yoga practice. Again, any non-Yoga exercise programs should not heavily involve the biceps and vigorous motions of the elbow joint.

Embrace patience during your recovery from tendonitis. Seek out proper advise from trained therapists to aid in the renewal and conditioning of your biceps. Address what was the cause of the tendonitis so you may modify activities and behavior patterns to prevent the injury from returning. Utilize this time to venture into other areas of your Yoga practice finding connection with aspects you may have drifted away from or require greater attention.

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