Distal biceps tendon repair
Post-operative protocol following distal biceps tendon repair, covering range-of-motion progression and strengthening.
Typical timeframe: Light upper-extremity weight training from ~12 – 14 weeks
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Phase 01 · Weeks 0 – 2
ROM programme – Weeks 0 – 2
- Keep immobilised in the sling / plaster to allow for wound healing.
Phase 02 · Weeks 2 – 3
ROM programme – Weeks 2 – 3
- Passive ROM for elbow flexion and supination (with elbow at 90°).
- Assisted ROM for elbow extension and pronation (with elbow at 90°).
- Shoulder ROM as needed based on evaluation, avoiding excessive extension.
Phase 03 · Weeks 3 – 4
ROM programme – Weeks 3 – 4
- Initiate active-assisted ROM elbow flexion.
- Continue assisted extension and progress to passive extension ROM.
- Week 4: active ROM elbow flexion and extension.
Phase 04 · Weeks 6 – 8
ROM programme – Weeks 6 – 8
- Continue program as above.
- May begin combined/composite motions (i.e. extension with pronation).
- If at 8 weeks post-op the patient has significant ROM deficits, the therapist may consider more aggressive management — after consultation with the referring surgeon — to regain ROM.
Phase 05
Strengthening programme
- Week 1: sub-maximal pain-free isometrics for triceps and shoulder musculature.
- Week 2: sub-maximal pain-free biceps isometrics with forearm in neutral.
- Weeks 3 – 4: single-plane active ROM elbow flexion, extension, supination and pronation.
- Week 8: progressive resisted exercise program is initiated for elbow flexion, extension, supination and pronation. Progress shoulder strengthening program.
- Weeks 12 – 14: may initiate light upper-extremity weight training. Non-athletes initiate endurance program that simulates desired work activities/requirements.
Last reviewed: 2025-10-15.
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Have questions about your recovery?
Every patient is different. If you would like a tailored plan or need to clarify any of these instructions, book an appointment with the East Coast Orthopaedic Physiotherapy team.
General guide only. These resources are intended as a general guide. Please follow the instructions of your treating surgeon and physiotherapist — your individual recovery plan may differ.