In this installment of our “injury of the week” series we’re going to be talking about bicep strains. We’re going to keep the same format we’ve had all along. First we’re going to start off with a review of what the injury is and talk about if this is what you have and when you need to worry/consult your doctor. From there we’re going to take you through the steps of the A-T-A self treatment system so that you’ll have a “sample treatment session”.
In my experience bicep strains, either at the origin in the front of the shoulder, the middle, or the insertion down below the elbow, are a result of muscle imbalances in the shoulder itself. That means posture is a factor! Remember- the bicep moves two joints: 1) the elbow and 2) the shoulder.
Joint wise, the elbow is a very stable joint thanks to its bony structure. It bends and it straightens. The shoulder on the other hand is an unstable joint that relies on muscles to hold it in good alignment versus bones. That means that it relies on us having good postural strength to hold our shoulders back versus letting them slouch forward. With good posture, there is plenty of space within the shoulder joint and all of the tendons and bones are able to move through their full range of motion without a problem. However, when they do not, this space is decreased. This can result in the smaller tendons in the front of the shoulder ( aka the bicep tendon and rotator cuff tendons) getting repeatedly pinched and inflamed.
The upper bicep tendon is a common victim in shoulder impingement injuries (click here to read more about impingement). That being said, it can also be injured down at it’s insertion point. Typically this happens when the bicep is either overloaded by trying to lift to much or it’s being worked at both the shoulder at elbow at the same time.
Bottom line- fix the postural issues upstream to keep the bicep muscle healthy! We all like to focus on bicep curls and tricep curls in the gym, but we tend to ignore the back of the shoulder!
My bicep hurts? Now what?
- Scary purple/black bruising where the pain is.
- Numbness/tingling anywhere in the shoulder/arm.
- You can’t pick your arm up or hold it up above shoulder height.
- If this a traumatic injury, meaning you fell on it or felt a pop/tear when the injury happened.
- If you aren’t making any progress on your own.
Be smart when self treating at home. If you aren’t getting better, get some help. I can’t tell you how many patients I get who wait weeks and even months before coming in for treatment. The longer you wait, the harder it is to get rid of. Here are some tips for finding the right health care professional:
- Find someone certified in soft tissue mobilization, whether it’s instrument assisted like Graston Technique or hands on like Active Release (ART). This is where you need to do your homework to see who’s near you. Follow the links to those sites to search their provider lists and read up on what each is all about. An injured bicep will definitely benefit from some hands on/massage work. If the provider lists don’t have anyone close by. Google who’s in your town and check their websites! Not everyone advertises on those lists.
- Not every PT and chiropractor are created equally. Some do very little soft tissue work and rely mostly on exercise and manipulations. Others do not. We all specialize in our own little areas. Frustrating right? Not really. Most of us have websites to tell you what we are certified in. If we don’t? Pick up the phone and call us. There’s nothing worse than wasting 8 insurance visits not getting better only to switch places and have them fix it in two.
How to treat it.
Step 1- Traditional R.I.C.E. treatment:
When a new muscle injury occurs, the first and most important goal is always to decrease pain and any swelling that may be present. In other words, we want to decrease inflammation. Don’t short cut this stuff. It’s boring but it works, especially if your symptoms worsen as the day goes. For example, it’s now easier than ever to smuggle an ice pack into the office fridge and wear compression gear under your dress clothes. Use that to your advantage when working to heal an injury!
Rest: This may sound obvious, but I’m going to say it anyway. An injured muscle will require a decreased activity level to fully heal. The severity of the injury will determine if this is a full rest or more of an active recovery. For the bicep my advice is typically to avoid overhead activities and heavy lifts. If you can’t pick it up with your elbow tucked tight against your side, it’s too heavy.
Ice: while heat may feel better on stiff and sore muscles, ice only during the first 7 days following injury. This will help to decrease swelling, inflammation and pain. 10-15 minutes is sufficient and you can perform every hour as needed. Avoid direct ice to skin contact.
Compression: thanks to the recent explosion of compression sleeves, tights, shorts, etc, you have several options in this department. Ideally you want something that is snug without being uncomfortably tight. Think tight under armor or CWX shirt or a compression sleeve. If it reinforces posture by pulling your shoulders back? Even better.
Step 2- Kinesiology taping:
1) The taping application for bicep strain is designed to protect the muscle from extension. Click here to see a video for application.
If the above tape doesn’t help and your injury is at the upper insertion at the front of the shoulder, try this application to help pull the shoulder back into better alignment and give the injured structures space to heal.
2) Impingement taping application. Click here.
Follow the directions for skin prep and care. This can stay on 3-5 days easy. Any signs of skin irritation? Take it off.
Step 3- Getting mobility back:
The second goal of treatment is going to be to loosen up the injured area. Below I have the treatment techniques set up in levels. As a rule, you must be able to complete #1 without pain to progress to the next level. Be smart! Healing a muscle sprain/strain isn’t about no pain, no gain. The muscle needs to heal! Don’t overdo it in an attempt to speed up your recovery.
1) R.I.C.E. + gentle stretching. There should be no pain with stretching. With this type of injury, we will need to stretch out the muscles in the back of the shoulder as well as the front and upper arm.
2) Begin using the foam roller AROUND the injured area. The goal here is to start getting slack into the muscle without aggravating the injury itself. No tennis ball work or mobilizations. The order should be foam roll around injury -> stretch -> RICE.
3) Begin using the foam roller over the injured area to tolerance. The order should be foam roll around injury-> over injury -> stretch -> RICE.
4) Begin using the tennis ball for mobilizations. The order should be foam roll around injury -> over injury -> active mobilization with the tennis ball -> stretch -> RICE.
5) Begin using the tennis ball for cross friction + trigger point. These are the deepest of the soft tissue techniques so you want to save them for last to target specific adhesions and restrictions. Consider this your fine tuning step.
How long do you need to R.I.C.E for??? Until it’s 100% gone.
Here’s what it looks like. Use the guidelines above.
Step 4: Strengthening
We’ve broken the exercises down into three levels based on pain levels. This stuff should NOT hurt. If it does, go back a level or ease up on the resistance. Only progress as pain free.
What you’ll need: 1) resistance band/tubing. This is easy to find in any sporting good store these days. You can probably even get it in walmart or target.
Optional equipment: 1) a stability ball. Same guideline as above. Very easy to find and cheap these days.
Video’s for each level are here. Please note, in the PDF download (above) you will find details for reps and difficulty progression, as well as, benchmarks you should meet before progressing to the next level. The video’s show you the basics for each exercise and what they look like.
Note: You won’t see any bicep curls in this treatment plan for a reason. The bicep is typically a victim. Strengthen the bigger muscles in the back of the shoulder/upper back and restore the balance.
The number one thing to remember is that these exercises should be pain free. If you’re getting discomfort, go back a level. You can’t force this injury to heal, but you certainly can make it worse if you over do it.
Hope that helps, and fire away with any questions in the comments section!
1) Capobianco, Dr. Steven and van den Dries, Greg. (2009). Power Taping, 2nd Edition, Rock Tape Inc, Los Gatos, CA.
2) Hammer, Warren. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.
3) Hyde, Thomas and Gengenbach, Marianne. (2007). Conservative Management of Sports Injuries, 2nd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.
4) Kase, Kenzo, Wallis, Jim, and Kase, Tsuyoshi. (2003). Clinical Therapeutic Applications of the Kinesio Taping Method.
5) Muscolino, Joseph. (2009). The Muscle and Bone Palpation Manual. Mosby, Inc, St. Louis, MO.