Distal biceps tendonitis

[tcul1972]

Tourniquet

Ok, I know how crazy this appears. That was my initial response when I read the research on it in 2008.

You want to MODERATELY tie a tourniquet around the distal part of the arm (up by the arm pit).

The distal part of the arm


Is down by the hand


(up by the arm pit)

is the proximal part of the arm

[Mizypt]

So, a status update.

- Pull-ups didn't work since they were too heavy.
- Light curls and resting works.

The pain was all gone, and I started squatting, the first session worked out fine, but the next heavier session brought back the tendon pain. I'm not sure exactly what I do wrong, I was very careful about having my hands on top of the bar and without squeezing the bar. It happens when the weight gets heavy, and at that point the arms are probably the least thing I have proper control of.
I'm going to try recording and see what my arms look like.

Is it even possible to do heavy squats without any biceps activity whatsoever?

[Red Finn]

I've been dealing with ye olde wrist flexor tendinitis (the same as medial epicondylitis I think) for many weeks now. It seems to be going away now. I would suggest you look into heavy eccentric loadings for the affected tendon. Perhaps three sets of fifteen, heavy enough so you can't go on after the third set of 15. Pay attention to your form so that you a) eliminate the concentric portion and b) do it as an isolation exercise, i.e. make that tendon work as hard as you can make it.

Also, no offense Kenny, but your posts are hilarious.

[veryhrm]

I've been dealing with ye olde wrist flexor tendinitis (the same as medial epicondylitis I think) for many weeks now. It seems to be going away now. I would suggest you look into heavy eccentric loadings for the affected tendon. Perhaps three sets of fifteen, heavy enough so you can't go on after the third set of 15. Pay attention to your form so that you a) eliminate the concentric portion and b) do it as an isolation exercise, i.e. make that tendon work as hard as you can make it.

Also, no offense Kenny, but your posts are hilarious.

Hmm... this sounds crazy-ish to me but the web says otherwise. What exercises are you using? I can only think of wrist curl negatives. (the web says something about an isokinetic programmable dynanomometer ... but i don't have one of those. )

[Red Finn]

That's right, eccentric wrist curls. I hold the weight in my hand, and I use a desk nearby to do the concentric portion for me. I do them with my arm vertical. I contract the triceps to keep the elbow straight (seems to keep more tension on the wrist flexors) and make sure I contract the wrist flexors hard at the top to ensure maximum range of motion on the way down. The eccentric portion is slow, maybe five seconds.

[Mizypt]

Today was a good day.

I lowered the weight from 130 kg to 80 kg in the Squat, with one goal in mind: Not using the biceps at all. As it turns out, thinking about the biceps during a squat was exactly what I needed, and there was no pain at all. This squat session also forced my back angle to change a bit as it was probably too vertical to begin with, and this also made the bounce feel a bit better.

I also tried doing some heavier (3x15) 90 degree dumbbell curls, it wasn't possible to remove the concentric part altogether, but using both arms during the concentric part made it pretty much non-existent. I'll keep doing curls for a while.

[JHG]

Hi all,

Hoping someone can offer some advice/insight with respect to my particular complaint. As per the customary template:

40 year old male, new to training after a long lay off. Running Novice LP.

Chief complaint: Deep aching localized pain in the right distal biceps and brachioradialis region with squats and bench press, especially during the eccentric phase of the bench press.

Pain is 7/10 when it arises. It does not radiate anywhere. It is at its worst during work sets of squats and the eccentric phase of the bench press. The pain subsides about 30-60 minutes following a training session but I am aware of it throughout the day.

Provocative: This started when my work sets on squats approached 290lbs and I have been varying my grip on the bar to try and alleviate this pain.

Palliative: I am taking an exceptionally wider grip on the bar now, which has significantly relieved my right biceps pain but I know that it’s too wide as per Rip’s videos on bar placement and grip width, but adhering to grip width causes excessive strain on my wrists and causes the right biceps pain to be very distracting. I completed 3 sets of 5 reps at 310lbs today without too much pain with the wider grip but it was very painful during the eccentric phase of bench press. I was able to complete 3 sets of 5 reps with 230lbs. My grip with the bench press is just outside of shoulder width and I am able to maintain vertical forearms throughout the lift. This pain does not bother me with the press.

Pertinent past medical history includes a distal partial tear of the right biceps at the musculotendinous junction, multiple bilateral glenohumeral joint dislocations (no, I don’t have Ehlers-Danlos, this is from a history of collision and combat sports). Bilateral shoulder external rotation ROM is within normal limits but internal rotation bilaterally is markedly restricted.

On inspection, there is no evidence of discolouration, soft tissue swelling or muscle contour deformity. ROM about the right elbow joint is full and I am otherwise functional, but the pain is significant enough to cause a distraction. I am enjoying my progress thus far and do not wish to suspend my training.

Note: I do not expect a virtual assessment with a bonafide diagnosis and/or prognosis. Just wondering if others with more experience have dealt with this problem and whether I may obtain some helpful tips/advice to apply. I have read on here that doing chin ups or high rep hammer curls may help. Could someone explain whether these should be performed before or after training and more importantly why this would help?

Thanks

[JHG]

Seems like everyone is busy or disinterested in this topic, so I figured I would contribute with the information I have gathered since my last post in a concise fashion.

Assuming the condition is bicipital tendinitis given the presentation and symptoms, it has been established that hypoxia is a key regulator of tendinopathy (see a couple of papers here: https://www.researchgate.net/publica...n_tendinopathy, Tendinopathy and tears of the rotator cuff are associated with hypoxia and apoptosis) . While these papers discuss the role of hypoxia in regard to rotator cuff tendinopathy, it is safe to infer that this mechanism also applies to bicipital tendinopathy.

So in an effort to correct this with movement therapy (i.e. barbell/weight training), it appears the strategy is to create an acute inflammatory response great enough to correct this hypoxic condition by flushing more blood, and in turn oxygen, to the affected region, which would explain the recommendation for performing chin ups and/or hammer curls.

In this video, Rip explains the old practice of pin firing among veterinarians for the treatment of bowed tendons in horses and how he applied this idea to treat his lateral epicondylitis by way of chin ups. Starting Strength: Golfer's Elbow | The Art of Manliness - YouTube

This is in keeping with the strategy of eccentric training for treatment of tendinopathies, although the mechanism of tendon adaptability and why this modality seems to work is not well understood. https://www.ncbi.nlm.nih.gov/pmc/art...rticle_260.pdf Quantification of Internal Stress-Strain Fields in Human Tendon: Unraveling the Mechanisms that Underlie Regional Tendon Adaptations and Mal-Adaptations to Mechanical Loading and the Effectiveness of Therapeutic Eccentric Exercise