Various things can cause pain in the middle of the bicep, which is the muscle at the front of the upper arm. Muscle strains and bruises, for example, are common causes of bicep pain.

The bicep bends the elbow and twists the forearm, allowing the palm to face upward.

Pain at the top of the bicep, near the shoulder, or at the bottom, near the elbow, may result from tendonitis. But pain in the middle of the bicep is likely caused by a muscle strain or bruise. Either can happen during sports or other strenuous activities, such as heavy lifting.

In this article, we explore the possible causes of pain in the middle of the bicep and the treatment options.

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People sometimes refer to muscle strain as a “pulled” muscle. It happens when a muscle bears too much pressure and the fibers inside it tear.

Lifting an object that is too heavy or doing too many repetitions of an exercise, for example, can lead to muscle strain.

Other symptoms

The symptoms of muscle strain depend on the severity of the injury:

  • Grade 1: A mild strain causes pain and tenderness in the muscle, often the day after the injury.
  • Grade 2: A moderate strain causes significant pain, moderate swelling, and some loss of muscle strength.
  • Grade 3: A severe strain causes severe pain and swelling and a complete loss of muscle function.

Treatment options

For grade 1 and 2 muscle strains, doctors recommend following the RICE principle:

  • Rest: Resting until the pain dies down will help the muscle heal.
  • Ice: Using an ice pack several times a day for no more than 20 minutes at a time will reduce the swelling.
  • Compression: Wrapping the muscle firmly in a bandage will also help ease the swelling.
  • Elevation: Keeping the bicep raised as close to heart-level as possible will help speed healing.

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and naproxen (Aleve), can help with the pain.

As the pain gets better, start using the muscle again gradually, rather than returning to previous levels of activity right away.

For someone with severe muscle strain, there is a risk of the muscle tearing away from the tendon. When this happens, the only treatment is surgery.

After the operation, the person usually needs to wear a sling for a few weeks. In most cases, doctors also recommend physical therapy. Most people make a full recovery.

Bruising is another possible cause of pain in the middle of the bicep.

It happens when a blunt force crushes the small blood vessels inside the muscle. The blood leaks out of the broken vessels and becomes trapped within the muscle.

Many things, including sports injuries, falls, and other accidents, can cause a bicep bruise.

Other symptoms

A bruised muscle might be tender to the touch.

Treatment options

The best approach is to follow the RICE protocol described above. It can take 2 weeks to several months for a bruise to heal.

Learn what the color of a bruise means here.

Delayed onset muscle soreness (DOMS) happens when someone overworks their muscles, usually during exercise. It tends to happen when starting a new activity or increasing the intensity of a workout.

DOMS can affect any muscle in the body, including the biceps.

Other symptoms

Symptoms include pain and soreness in the bicep. It may hurt to straighten the arm or carry things.

The pain usually starts 6–8 hours after exercising, and it may last up to 48 hours.

Treatment options

People can use over-the-counter NSAIDs, such as Advil or Aleve, to help with the symptoms. Massage and rest can also help ease the pain and soreness.

Sometimes, pain in the left arm can signal a heart attack. This happens when part of the heart does not get the blood it needs to function properly.

A heart attack is a medical emergency. The Centers for Disease Control and Prevention (CDC) explain that the more time that passes without treatment to restore the flow of blood to the heart, the greater the damage.

Other symptoms

The pain can be different for everyone, but it might radiate from the shoulder down into the bicep area. Usually, the pain comes on suddenly. Other heart attack symptoms include:

  • pain or discomfort in the left or center of the chest
  • feeling weak, faint, or lightheaded
  • a cold sweat
  • pain or discomfort in the jaw, neck, or back
  • shortness of breath
  • unexplained tiredness
  • nausea and vomiting

The pain or discomfort in the chest might last for more than a few minutes or keep going away and returning. People have described it as a feeling of pressure, squeezing, or fullness in the chest.

Treatment options

If someone may be having a heart attack, call 911 or the local emergency number right away. The sooner the person receives medical attention, the more likely they are to recover.

Learn about spotting the signs of a heart attack here.

Anyone who may be having a heart attack should receive emergency medical care.

Mild to moderate muscle strains, bruises, and DOMS usually get better on their own. If muscle pain is severe or does not go away, speak with a doctor.

Muscle injuries often happen when people suddenly increase the duration, intensity, or frequency of activities, the American Academy of Orthopaedic Surgeons reports.

The association offers this advice:

  • Start or add new activities slowly and build up their intensity gradually.
  • Always warm up before exercise or other strenuous activities.
  • Drink plenty of water during these activities.
  • Always cool down afterward.
  • Have regular rest days to allow the muscles to recover.

Having a healthy lifestyle is the best way to prevent a heart attack. Top tips from the CDC include:

  • having a balanced diet
  • maintaining a moderate weight
  • exercising regularly
  • not smoking

Common causes of pain in the middle of the bicep include muscle strain, bruises, and DOMS after exercise. Mild injuries usually get better on their own, while more severe ones may require medical treatment and physical therapy.

Sometimes, pain in the left arm can indicate a heart attack. Anyone who may be having a heart attack should receive emergency medical care.