Articles: Physical Therapist's Corner

Greetings NAS members:

By Mike Johnston, PT, CSCS

Welcome to the Physical Therapy Corner. I hope that I will be able to provide helpful insight and narrative regarding injuries and rehabilitation in the coming months. For my first column I would like to discuss an injury that is very close to me; the topic is the distal biceps tendon rupture. According to several authors the biceps rupture at the elbow is relatively rare, however anecdotally appears common in the strongman and powerlifting communities. According to Morrey, the injury is most commonly a single traumatic event with the elbow flexed against a force of often 40 kg or greater. Anabolic steroid abuse and pre-existing degenerative changes in the biceps tendon are also implicated in the literature.

There are two different surgical interventions with the possibility of complications such as transient radial nerve palsy or ectopic bone formation (which often requires a second surgery to remove the boney growth.) Complications notwithstanding, current literature supports surgical intervention as the best choice for a functional outcome. The rehabilitation process starts with a 4-6 week period of immobility followed by passive and active range of motion for 2 weeks. At the 6- 8 week mark, easy strengthening begins and progresses accordingly. By 8-10 weeks, full motion is expected with a return to light weight training. Exercise continues slowly for 3 to 4 months with focus on the shoulder, elbow and wrist until the formal rehabilitation process comes to an end at which time the patient is cautioned to continue slowly toward normal activity with pain as the guide.

Now, all of that being said, here is the skinny. This injury sucks and you don’t want it! If you start having pain in the biceps or forearms, LAY-OFF! Rest, ice and compression works. Stop the exercises in your routine that hurt until the pain is gone (i.e. stones, heavy curls, high pulls, cleans, etc.) It might also be time to consider a double over hand hook grip on that deadlift. Once the pain is gone don’t stop icing and return to normal activity slowly. Remember, pre-existing degenerative changes in the biceps tendon can lead to rupture so; you may have to eliminate some activity that you know will cause the problem to reoccur.

None of the preceding suggestions are a guarantee that you won’t be injured; (it’s funny when mine ruptured I was feeling good and had been pain free for awhile. That underhand grip on the deadlift got me!) If you have a rupture and opt for surgery find a surgeon that has done the procedure, works with athletes and make sure he knows that you plan to continue to compete! (I was fortunate that my surgeon, Dr. Ekman, is my boss!) Once the procedure is done, follow the surgeon’s instructions to the letter. For rehabilitation, find a physical therapist that has rehabbed a distal biceps repair, deals with athletes and make sure he knows that you plan to continue to compete! You can survive this injury and do well. Ask around, there are a lot of professional and amateur strongman and powerlifting athletes that have had surgery and are back in the game.

Keep lifting heavy stuff,

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