Welcome to the gun show!

February 11, 2019

You guessed it!  The guns we are referring to are the biceps.  In this article, we will discuss proper motion, common injuries, exercises and things not to do at the gym! 

The biceps brachii have two muscle bellies and attach the shoulder to the elbow.  For those that would like to know more specific anatomy, the short head, attaches to the coracoid process of the scapula and the long head attaches to the supra glenoid tubercle of the scapula.  Together, both muscle bellies come together to form a single tendon at the elbow which inserts at the radial tuberosity on the radius.

The action of the biceps brachii is to flex the elbow, flex the shoulder and also, often forgotten, is supination of the forearm, or the motion of turning your palm up.

Some of the common injuries we see with the biceps include strains, tendonitis, ruptures of the biceps tendon or the transverse humeral ligament. Less common injuries are lesions to the tendon at their insertion points (SLAP injuries). Strains are probably the most common biceps injury.  This typically involves an overuse injury while lifting a heavy object, either at home or the gym.  Most of us often get biceps strains to a mild extent when we overdo it at that gym.  This is the pain we experience that lasts more than 1 or 2 days post workout.  Another mode of onset that often occurs that results in a strain is a quick deceleration of the muscle ending with a contraction while the muscle is in its lengthened position.  For example reaching forward to catch something of weight, often too heavy for you.

Strains are cared for with your P.R.I.C.E protocol, Protect, Rest, Ice, Compress and Elevate.  After 72 hours, soft tissue techniques like massage, myofascial release, cupping, etc… can be used to assist with the healing process.  The main goal with these soft tissue treatments is to align the muscle fibers and help break apart any scar tissue that has already formed or is in the process of forming.

Tendonopathy is a term used to describe the collection of different tendon injuries (tendonitis, tenosynovitis, tendonosis, or paratendonitis).  The difference in the terminology is the anatomical structure that is involved and/or if there is inflammation or degeneration.  Depending on the structure that is involved, the treatment will vary slightly.  If there is an inflammatory process involved, the obvious treatment is to reduce the inflammation.  Ice, laser, ultrasound treatment or anti-inflammatories will help with inflammation.  Some more severe cases will require steroid injections to control or eliminate the inflammation.  When degeneration is the problem with the tendon, treatment will focus more on strengthening the muscle under closely monitored rehab program.

Tendon or ligament ruptures can occur at any age.  Generally, we will tend to see more biceps tendon ruptures in individuals over the age of 50 as a result of pre-existing degeneration.  The biceps can rupture at the elbow or at the upper at upper scapular attachment.  When the tendon ruptures at the elbow, the muscle belly of the biceps will recoil up the arm, giving the “Popeye“ look or a bulge towards the upper part of the arm.  The opposite will happen when the tendon ruptures from the other attachment site.  Another area of rupture, is at the transverse humeral ligament. This is a small ligament that holds the biceps tendon in the groove in the humerus.  With an excessive load, the transverse humeral ligament will rupture, causing the biceps tendon to pop in and out of the groove resulting in pain and over time, fraying of the tendon due to the repetitive tendon microtrauma or eventually rupturing the biceps tendon.  Surgery for any of these various ruptures will be dependent on the age of the patient and the impairment.  The majority of ruptures are left alone because biceps function is only diminished by 20-30%. 

Exercising your biceps. 

As we discussed, the action of the biceps is to flex the elbow, shoulder and supinate the forearm. 

https://www.youtube.com/watch?v=jGwGRmRS2xA

When we exercise the biceps, we want to incorporate all of these actions.  Biceps curls are a common exercise I’m sure we have all done in the past.  You can do all kinds of variations on the biceps curl based on your positioning, single arm vs two arms, timing (up 2, down 2) and constant vs variable resistance (weight or resistance band). 
Check out this video on different variations of biceps exercises to add to your workout routine. 

https://www.youtube.com/watch?v=bf0Ip4DW8y4

In addition, I like to add exercises for the whole shoulder exercising multiple muscles at once.  These types of exercises are considered functional motions, or motions that would be used in more everyday motions.  A functional exercise that would emphasize the whole motion of the biceps, elbow flexion, supination and shoulder flexion, would be a chin up with palms facing towards you.  Another functional exercise would be lifting a weight or resistance band from the ground up and over the head.

There are a lot of mistakes I see in the gym.  The most common mistakes when training the biceps in isolation, or any other muscle, would include recruiting other muscle groups unintentionally.  Often, individuals will go for the larger weight in the gym to do their bicep curls, only to sway at their spine and hips.  If form is compromised, then the work is not really effective.  Lift the weight that allows you to maintain proper and complete form.

When you are ready to work on developing your biceps, I hope you consider the information above.  Most importantly remember that the bicep muscles control essential movements, so don’t try strengthening them without proper technique.


 

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