Persistent Bicep Injury (9 months)Looking for advice

[Mtrsy]

Background:
20 year old male
184 lb
7-8 hours of sleep per night
200g protein, 400g carbs, 150g fats + veggies daily.

Last September, during a set of chinups, I felt a sharp pain in the middle of the left bicep. My arm was weak for the next two days (I could barely hold my phone up to my ear), however no swelling or bruising occurred, and the appearance of the bicep did not change. I quickly saw a GP to rule out a tendon tear, and got an ultrasound, which came back fine (no damage to the muscle belly or the tendon was visible). The pain and weakness subsided after 2 days.

Assuming the problem was a strain, I took a week off and returned to the gym. However, the pain came right back after a set of chinups. This time the pain was mild and there was no accompanying weakness, so I attempted to train through it (in retrospect, I should have taken things slowly). I trained with the pain for 2 months, and it began to get worse.

Frustrated, I saw another doctor, who couldn’t make a diagnosis but suggested I take some time off. On the advice of my doctor, I took 5 weeks off all lifts but squats. This did not fix the problem—the pain was still there when I resumed upper body work.

At this point, I got an MRI to make sure no tears were missed by the ultrasound, and this also came back fine. The doctor said that there was “evidence of recent damage to the muscle belly”, but didn’t elaborate on what this meant. I’ve seen 3 different physicians, and despite the imaging there is no definitive diagnosis on what is wrong with the arm.

Now it’s been 9 months without improvement to the bicep. I’ve tried doing high rep chins/curls (as recommended here How to deal with first injury while adding weight?), rolling out the bicep (here Dealing With Bicep Tendonitis: A Multi-Step Approach | The Art of Manliness), and rest. The one thing I’ve read in the forums, and have yet to try, is a sports massage, which I plan to get sometime this week. I’ve also been to physiotherapy, where I was diagnosed with “scar tissue formation”, and scheduled for dry needling. I’ve read mixed opinions on needling in these forums, and refrained from trying it.

Current Problem:
Chinups, pull-ups, and cleans cause minor pain. The pain is not sharp but cramp-like. It is most apparent after a set, and I feel as if the bicep seizes up or spasms. This pain goes away several hours after lifting. In addition, when deadlifting above 185, or even when hanging from a pull-up bar, there is an intense stretch on the left bicep that I do not feel on the right—it feels almost as if it will snap. The feeling is not present in my right arm, although both have atrophied the same amount. The problem is minor enough that I can still train through it. My primary concern is rupturing the tendon or causing further damage to the muscle belly if I continue training as I do.

Questions:
Any ideas on what the problem is? Is it safe to deadlift and clean with the pain and “stretch” on the bicep? And does anyone have further suggestions for how to fix it? I understand the difficulty of providing injury advice over the web, but any input would be greatly appreciated.

TL;DR
Problem: bicep pain has persisted for 9 months, no definite diagnosis from 3 different physicians. MRI and Ultrasound show no problem. Physio suggests scar tissue formation. Bicep feels weak, as if it may tear when pulling even light weight.
Attempts to fix: 1 month off, high-rep chins/curls, physiotherapy. Will try: sports massage.
Questions: 1) Any idea what the problem may be? 2) Is it safe to deadlift and clean with the pain and “stretch” on the bicep? 3) Any suggestions for fixing the problem (would you suggest dry needling)?

[Mark Rippetoe]

It may be Thoracic Outlet Syndrome, or a cervical rib. Did any of these genius physicians you consulted suggest this as a possibility?

[Mtrsy]

Thank you for your quick response,

None of them suggested anything like this. I’ve looked up the condition, and it sounds dissimilar to my situation for the following reasons:

• The initial injury was sharp and felt like a strain or tear.
• There is no weakness anywhere else on the arm. Grip strength is 100%.
• I’ve dealt with a trapped nerve before, and the pain was different. I’d describe that pain as similar to a toothache, whereas the pain in the arm is similar to a muscle cramp.

That being said, there is occasional pain in front of the shoulder that I've been ignoring for some time. I assumed this was an irritation of the biceps short head (due to whatever is wrong with the arm), but it does seem to occur with tos. Would you suggest getting another opinion?

[Mark Rippetoe]

Sounds like a shoulder injury -- bicep tendon or supraspinatus. Need a diagnosis.

[Mtrsy]

In that case, I will get an ultrasound of the shoulder and push again for a proper diagnosis. In the meantime, do you believe there is any risk in cleaning and deadlifting as programmed? Of course, you cannot say for certain without a diagnosis, but would you recommend reducing the weight or maintaining linear progression on these lifts?

[Mark Rippetoe]

Pain is the indicator here. Try it. How much weight have you gained on your 3750 calories?

[Mtrsy]

I drink 2L of milk on top of the macros I track. Daily intake is around 4500-4750 calories if I remember correct.

Start: ~150lb. 15-16% bodyfat.
20 May: 184lb. Likely 17-18% bodyfat.

Lifts:
Bench: 182.5 lb
Press: 115.5lb
Squat: 270lb (stalled twice)
Deadlift: 305lb
Clean: 125lb

As I mentioned in the first post, there is mild pain with cleans (2-3/10). Deadlifts don’t cause pain, but a strong “stretch” sensation in the left arm that wasn’t there prior to injury.

[Mark Rippetoe]

At this bodyweight on this diet, your squat and deadlift numbers are pretty bad. I suggest that you train though this, since there is no alternative. I'm sorry your arm hurts. Mine does too. What are you going to do about it? Sit down, or train?

The First Three Questions | Mark Rippetoe

[Mtrsy]

My only concern was worsening the injury in a way that would require more time off. From your response, I understand this is unlikely or a necessary risk in this situation. Thank you for your help!