Cleveland Cavaliers point guard Kyrie Irving was recently sidelined by a biceps injury. This type of injury is problematic in basketball because it makes dribbling painful, limits upper-body strength and makes full extension on a jump shot nearly impossible.
The biceps brachii is a two-headed muscle with a common tendon attachment at the elbow, which is strong and helps bend the elbow. The upper end of the muscle near the shoulder has two tendons. One of these attaches at the top of the upper arm bone. The other, called the long-head tendon, crosses into the shoulder joint and attaches at the top of the scapula (shoulder blade) onto the labrum.
Types of biceps injuries, with unique characteristics and treatment variables
Distal tendon rupture
This tendon can be ruptured—either torn in two or ripped off the bone—near the elbow. This can happen to the recreational weightlifter when deadlifting heavy with a bent elbow or when trying to curl too much.
This injury causes a sudden deformity in the upper part of the muscle. Bleeding/bruising happens quickly, as does swelling. It requires surgery and about six months or more to recover. The initial challenges are to diminish pain and swelling, improve range of motion while healing, and restore strength.
A muscle strain to the biceps happens in the middle of the muscle. It can be caused by many things. It may swell, bruise and cause pain. It will definitely weaken the muscle and increase stiffness. Treatment is similar to tendinitis.
This common biceps injury can happen with repetitive work like carrying shingles for a roofer, performing too many curls in the gym, or engaging in any activity in which you repeatedly use the muscle.
Tendinitis can occur at the elbow, but more common tendinitis for a basketball player is at the "proximal" end of the joint, or near the shoulder, which feels more like a shoulder problem. Basketball players can suffer this type of injury due to their training regimen (improper technique or overuse), an awkward fall, or simply from shooting mechanics and the number of shots they put up in a week.
Tendinitis generally requires some rest, anti-inflammatory treatment, icing and bracing. Plasma-rich protein injections can help. To continue playing, it may be beneficial to use Kinesio Tape to help the muscles function more appropriately. A sleeve for the elbow or shoulder can be helpful as well.
The biceps have long and short heads. The tendon to the long head continues across the shoulder joint and attaches to the labrum. The labrum is a major stabilizer of the shoulder. When the long head of the biceps tendon is overused or acutely injured, it can cause a tear of the labrum. This seems like a shoulder instability injury, but it's also a biceps injury. A labral injury can range from pain-free to season-ending surgery. The key is to work on shoulder stability.
Progressive training and post-rehabilitation plan for a biceps injury
Biceps and Shoulder-Focused Warm-Up
- Squat while performing Band Curls - 1x20
- Lunges - 1x20
- Push-Ups- 1x20
- Prone Press Fingers Facing Toward Feet - 1x10 with no hold
- Quadruped Thoracic Rotation - 1x10 each side
- Body Blade x 30 seconds
- Band Pull-Aparts - 1x10
- External Rotation and Internal Rotation (90 degrees of shoulder abduction) - 1x10 each
- T, Y, I Series - 1x10 each
Band Curls - Palms up is specific to the biceps; thumbs up is supportive; palm down is also supportive.
Curls with elbow at shoulder height - Works the deltoids to support the shoulder.
Ball Squeezes - One hand on top, injured arm under. Squeeze the ball as hard as you can. This is an isometric exercise for the biceps.
This stretch to the biceps will hit the upper end near the shoulder.
This stretches the middle of the muscle.
Unstable Training for the Upper Body
Training on an unstable surface encourages the use of the small stabilizers that protect the joint.
- TRX strap - Push-Ups and Inverted Rows
- Slosh pipe - Overhead Press
- BOSU - Push-Ups and Planks
Multi-Joint Upper-Body Strength
- Band Presses with a block. Allows for more weight, but limits the distance traveled.
- Floor Presses
- Incline Dumbbell Presses. Take some stress off the shoulder by placing the forearms in neutral.
- Flat Bench Press: Allows for the most resistance and progression of strength, but also the most challenging to the shoulder joint.
Biceps and Pulling Variations/Progression
- Lat Pull-Downs, palms facing you
- Inverted Rows, palms facing you
- Band-Assisted Pull-Ups
- Strict Pull-Ups (but avoid dead hanging; keep the shoulder stabilizers active prior to the pull)
Biceps and Cable Column Resistance
- Seated Cable Rows with palms up
- Cable Face Pulls with external rotation
- Bent-Over Barbell Rows with palms facing up
- Single-Arm Horizontal Abduction
Long head biceps injury rehab and shoulder stabilization programs are similar. Strengthening the biceps is not difficult and does not necessarily need to be done outside of a rehab setting. A good multi-joint warm-up, foam rolling, stretching and strengthening program can keep the biceps in shape from top to bottom.
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