This summer saw the Worlds Strongest Man competition in the USA, and our very own sponsored athletes Tom and Luke Stoltman taking 5th and 7th respectively. More recently Tom regained his title of Scotland’s Strongest Man with a great performance, narrowly defeating his brother to make it two titles in a row. In a similar vein, ESP provided the physiotherapy cover for the finals and the world deadlift championship at the SFN Expo for the second year in a row and we were kept busy with several injuries.
Understandably, the sport of strongman can be brutal with heavy lifting, awkward lifts, and lung busting medleys that push the body to its absolute limit. This month’s blog is inspired by strongman and the king of the strongman injury, the bicep tear. From the dawn of the sport in the late 1970’s we have consistently seen strongmen rupture either the long head of biceps or the insertion of the bicep into the forearm.
So why and how does this injury happen; what can you do to prevent it; and finally what should you do if you suffer this injury? To cover this topic we will specifically split the blog it into two parts: Part 1 – The Bicep muscle/tendon injury and how to manage it. Part 2 – The Bicep tendon rupture, how to identify it and what to do next.
The bicep muscle crosses over two joints, attaching below the elbow and upwards at two points around the shoulder. This means that the motion at one joint increases the passive tension to the muscle and tendon at the other end. Unfortunately this can lead to an overstretching injury of the tendon.The bicep muscle has several jobs: to supinate (palm up) the forearm; bend the elbow; and raise the shoulder upward. Therefore when you load the elbow into supination/flexion and the shoulder into flexion at the same time you put the muscle and its tendon attachment under considerable strain. The main two movements that most often result in bicep injuries in strongman are picking/loading the atlas stones and cleaning the axle with a mixed grip on the supinated arm.
Healthy tendons do not rupture! This may seem a bold statement, but with the exception of physically cutting the tendon they are very strong structures and transfer force incredibly well between the muscle and the bone attachment: So the answer to this question is keep the tendon and muscle strong but also flexible. See the video below for soft tissue release on the bicep muscle, using a Pulseroll Peanut Ball. This is a great tool to help release tension in the muscle and keep the tissue pliable.
A tear in the bicep muscle is similar to any other muscle injury, in that if you subject the muscle to more load than it can cope with, or lift with poor technique then the muscle can tear. There are 3 grades of muscle injury, ranging from Grade 1, where there is a slight strain of the tissue, to a grade 3 which is a full thickness rupture of the muscle. For an accurate classification of the grade you are best to be assessed by a registered health care professional.
Injury to the bicep tendon can occur at either the shoulder or in the elbow joint, and is usually referred to as a tendinopathy (a mixture of swelling and degenerative changes in tendon). In general the presentation of a tendon injury will be the same as the muscle, but the pain will be felt mainly around the tendon at either end of the biceps.
The athlete will generally complain of a gradual onset of discomfort around the involved tendon. They will also notice pain when contracting the muscle or experience their symptoms worse first thing in the morning after sleep. Tendon symptoms of pain and stiffness often develop 24-48 hours after injury. Recent research has identified that you are more likely to sustain an injury to the bicep tendon at the shoulder if you have any of the following;
Whether the tendon or the muscle is involved the management is the same. At ESP we like to follow the POLICE guidelines, specifically Protect, Optimal Loading, Ice, Compression and Elevation. We will discuss this in more detail in a future blog where we will specifically look at what to do when you get injured.
Physiotherapy intervention can significantly speed up the recovery of these types of injuries. At ESP we typically perform the following to rehabilitate the injury.
Coinciding with these passive physiotherapy treatments we provide you with a bespoke graded rehab training program. The aim of the program is to ultimately restore strength, endurance, power, control and function to the muscle and the structures above at the shoulder girdle and below with the hand and grip. Following this program you will soon begin to build some confidence in the bicep and make a gradual return to training and competition.
Next month we will look at the bicep tendon rupture, how to spot if you have detached the tendon, and finally what to do next after it is ruptured.
Meanwhile if you are needing any help with you bicep problem then why don’t you book in for an appointment. At ESP Physio, we can undertake a full shoulder/elbow assessment, provide a diagnosis, help you understand what is going on, treat and help heal the injury before supporting you with a bespoke rehabilitation plan which would also help reduce the chance of future injuries.