How to Fix Distal Biceps Pain for Climbers (Biceps Tendinitis)
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- čas přidán 25. 08. 2024
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This video talks about the etiology of distal bicep tendinopathy, signs and symptoms, mechanisms of injury and risk factors, differential diagnosis, and finally treatment.
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WARNING (00:32): Before we delve in, I need to mention something important: If you have a distal biceps tendinopathy, you may have an increased risk of a distal biceps rupture, which will likely require surgical intervention. If you have had immediate and acute pain with a pop, please seek professional help before you develop a more significant injury. If you have been dealing with this chronically, take this seriously, because you may be increasing your risk for a distal biceps tear.
Etiology & Signs/Symptoms (01:55): Distal bicep tendinopathy is typically an overuse or degenerative disorder of the biceps tendon as it attaches at the elbow. The pain will present at the anterior (front) portion of the elbow near the crease of the elbow. It may be slightly more medial than lateral but should not be felt on the inside of the elbow. Pain may be reproduced with active and/or resisted flexion of the elbow, and may be more severe with the forearm in the supinated (palm-up) position.
Mechanism of injury and risk factors (01:19): The more common activities associated with this are lifting, pulling, or overhead activities… So…. climbing. OK we get it, climbing puts us at risk, but what particular type of climbing?
Climbing preference/style: side pulls and underclings will place additional stress on the biceps. So, check your preference. Are you always in the cave and love pulling on underclings? Maybe your project has a sweet side pull move that you have tried over and over again.
Climbing technique: climbing with your arms always bent or with your legs always straight and/or not using your feet well will lead to increased strain/stress on the bicep tendon and can over time lead to this pathology..
Training style: lots of campus boarding, weighted pull-ups, loads of lock offs, etc. Basically, you need to look at it all. If your climbing preference and training style is leading to a lot of load on your biceps, you may need to re-evaluate and see if you need to change your training or if your just not getting enough rest.
(02:30) Differentiating this from another pathology is much simpler. The two main things to be careful of are bony issues (which will typically present with significantly decreased elbow range of motion) and median nerve issues.
As we mention in the video, climbing can cause an over development of the pronator teres muscle. This can lead to entrapment of the median nerve, causing pain in that area, misleading someone to believe they have biceps tendinopathy when really they have a nerve entrapment issue. Differentiating a true bicep tendinopathy from a median nerve entrapment can be important as it will have a drastically different treatment approach. See the video to learn how to do a median nerve test.
Note on median nerve testing: this test is positive on a majority of people, so a TRUE positive is only going to be if it 1) replicates your normal symptoms and/or 2) is more significant on the affected arm compared to the unaffected arm. If both arms are affected, you can only go off of if it replicates your normal symptoms.
Treatment (04:06): treatment will be multimodal and will involve activity modification (look at your climbing style, technique, and your training), gentle stretching, soft tissue mobilization to help with remodeling tissue, and eccentric training.
Eccentric training (05:26) should involve using a theraband or free weight to apply a load to elongating tissue. This training should initiate with the forearm in a neutral or thumb up position and will progress to a supinated position. If you are able to get through both positions without pain or discomfort then you will be able to progress to eccentric elbow flexion with 90 degrees of shoulder flexion. This will isolate the long head of the biceps more and will place your arm into a more functional position that would relate to climbing.
Reminder, exercises shown in this video are to be performed at the user's own risk. This information is not meant to replace direct medical intervention and if you have serious concerns you should seek professional help immediately.
Outro & bloopers (06:57)
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Written and Presented by Jason Hooper, PT, DPT, OCS, CAFS
IG: @hoopersbetaofficial
Filming and Editing by Emile Modesitt
www.emilemodesitt.com
IG: @emile166
This is a big topic so if you feel like we rushed through certain parts, don't worry! More detailed videos about it are in the works!
Great video. Looking forward to future videos. It would be neat if you reference some literature for those who want to go deeper
This has been a recurring injury for me, usually triggered from general over use as you described. What makes it difficult is that the pain is not acute, but sets in over time making it hard to know what is ‘too much’.
Same man, and it sucks haha
I'm in the same boat.
Psyched for this topic! I’ve had problems with both my distal tendons for about 4 years now. I’m 28, and have been climbing 10 years. For me, the issue is totally manageable with rest, ice, compression, and avoiding ~15% of boulder problems entirely (and close to 40% of indoor boulders... setters love their biceps). I have to avoid any climb with a hard undercling move, or any move that requires you to shock-load your arm in a locked-off position (usually narrower compression problems, especially those that are steep and/or have poor feet). I’m from Vegas (A+ on the thumbnail by the way), so for reference, the first move on Timmy’s Problem absolutely destroys my bicep. Luckily it’s kind of a terrible rock climb, so I have no problem with never being able to even try it again. BUT I can only try The Fountainhead once or twice a session before my biceps start bothering me. I use the same beta as everyone else, my tendons just can’t handle the sudden compression.
Anyway, I’m very exited you are covering this-the quality of content and production on this channel is always great! In the next video, could you go into a bit of the reasoning/science behind the bicep exercises? I mean, exercises that specifically target the bicep and the distal tendon seem like the #1 thing to avoid if your bicep and distal tendon are injured, so knowing the science behind the exercise would help me understand when/how/why I should do it.
I’ve tried doing the ones in this video many times, but I’m always terrified to use too much weight and make the issue worse rather than better. So I use very little weight and then feel like I’m not really doing anything productive. What amount (maybe as a % of what one would have used pre-injury) is best to use? Thanks for all the work you guys do to put these videos together!
Awesome question. Really appreciate the time and detail of the response. I think that is a great idea. We will work on producing a video and will have links discussing the reasoning behind it. I always think people should understand why they do something rather than just blindly doing it. Makes us all smarter, more aware, and more responsible for our injuries. To answer the second part about repetition. The "scientific" answer is that you need to be doing a percentage of your 1 rep max.... which I wouldn't really want you to find out if you have had issues before! lol. So a better way is basically to look at 'Do you get muscle fatigue between reps 8-12?' If not, you probably aren't doing enough weight to trigger hypertophy. The hold is to help with the tendinopathy, the eccentric is to help gain strength in the tendon. Combining the two can be effective to strengthen the tissue so it can hold more strenuous loads in the future, essentially increasing it's work capacity. I'll go more in depth in a video soon but I hope that makes sense!
"Viewer Question answered in detail!"
You really did answer my Question O.o. Thank you very, very much for your work. Keep up the awesome Content!
I had that! Was about my fourth month climbing.
I solved it warming properly and lowering de pull-ups for a while (and probably improving my technique). Great content!!!
After maybe 7 years of issues with what I thought was elbow issues, starting at the point I was close to bouldering 7c (in a cave), causing 4 periods of stop/start, I've finally found this....... and it all makes sense.
Thanks!!!
and after 1 year you still have issues XD
I know this channel is centered around climbing injuries/rehab but do you have any plans on making a video about hangboarding? Would love to hear your approach on misconceptions/mistakes, beginner-advanced routines, favorite hangboards and how to use a hangboard for rehab! Appreciate the content as always Jason!!!
Thanks for the support! Great question. Hangboarding can be such a polarizing topic, with varying opinions from different camps. It can be an amazing tool if used correctly, or can be an injury machine if not. We have put out an intermediate training program but you're right, further content is needed! That means more research and more sources to bring you awesome, evidence based information.
Fantastic video! This helped a lot! Thank you!
Great info my dude! Thank you!
An advanced progression of biceps curl: Perform supinating bicep curls using an adjustable dumbbell with WEIGHT LOADED ONLY ON THE PINKY SIDE. This will strongly bias the biceps over other elbow flexors as it challenges the biceps as a forearm supinator as well as an elbow flexor.
Informative but at a beginner level to the issue. Look forward to move complexity hopefully in further videos
Hello Hooper thank you very much to share this video,
I have been suffering from this injury for more than six months, and I do my climbing in this injury. while climbing it doesn't hurt much, but it hurts a lot when relaxing and in deep sleep. Are there any other exercises to heal this injury?
Apologies if I missed it in the video, but how many days a week should we perform the eccentric exercises?
Wow thank youuuu
is the eccentric curls video available?
I would love more detail on this topic! Also, I've heard people say that doing tricep exercises may help with this as well. Is there any evidence for that?
Hey! Thanks for all the amazing content you are putting out! Just a question about the timescale of symptoms with this: I generally get this type of discomfort coming on quite gradually during bouldering sessions (less so when route climbing), and the pain can become quite intense, accompanied by a sensation of weakness in the whole arm, shaky hand etc. The discomfort then generally goes away over the next day or 2. Is that duration consistent with bicep tendinopathy? I get it generally on the right side but also occasionally left side, and I've also had it from swimming before, and even once from throwing loads of snow balls one afternoon haha! Just curious if these activities and timescale fit the diagnosis. Thanks!!!
Actually, to be honest, as I was reading that I was thinking "It's probably actually his infraspinatus and/or teres minor". Then you mentioned swimming and even throwing. Throwing places loads of stress on the external rotators (infraspinatus and teres minor) as you slow the arm down after throwing. Bouldering also places loads of stress on those due to the stabilization required and may be more intense than the route climbing you're doing which may be more endurance focused. I would check out some strengthening for your external rotators and see if that helps!
@@HoopersBeta did you get better @timothy??? I have the exam same symptom from climbing (mainly from lockoff, dyno start or catching dyno), weigthed pull up and also from throwing
Thanks for the vid. How often should i do it per week?
so....no stretches to target distal bicep tendinopathy?
I feel like he's talking directly to me
👀
What does it mean if thumbs up hurts more than palms up when doing eccentrics? Palms down zero pain btw.
Jason can you please do a video on the Median Nerve Entrapment?
I have been climbing for a long time and have had on and off forearm problems. I’m a strong, enthusiastic kid and like to do a lot of gymnastics/calisthenics (like full ups and handstands, arm balances etc.) to supplement my training, which does lead me to tend to use my arms/upper body a lot. This combined with the fact that when I Boulder I like to do heavy upper body / lock off / cave style climbing (while crimping or not) leads me to believe that the biceps are actually more affected than where my tendons attached at the elbow (medial epicondylitis), especially because I have done a lot of rehab work (and rest) with respect to medial epicondylitis round and it has had little results for me this time around (i had this in the past and figured out how to recover from it.)
This time around something new is a-brewing. I have been doing suplination and pronation exercises along with forearm antagonist work and some eccentric bicep loading with little luck so far (been two months and I am skeptical I’m hitting exactly what I need to do).
This time around, the problem was directly correlated with an increase in volume and intensity of my muscle up (full up) training (which I have since stopped) specifically being bad not during the pull up phase but rather the transition phase at the top of the pull up right when I try to activate the wrist and forearms to engage the push muscles. It has been a few months and now I am even starting to feel pain in areas that I had never before (forearm muscle below Ulna when hand standing, especially when I lose a bit of balance and correct to a straight form when I start to fall into a “scorpion Planck”).
Anyway, as for the median nerve test, the more affected arm felt a lot more tension than the less affected arm at the neck bend stage, but both arms are affected. To reiterate this tension was specifically at the crease of the elbow area and when i dig in there and palpitate Thats the only real time I feel pain. Otherwise i notice I weaken (with maybe some very dull pain) and light throbbing when it is overworked. Perhaps the worst motion for my arm is down climbing with an emphasis on my arms (going from high hand straight, low hand bent 90, to let go of straight hand, loading the bent hand and straightening that one). That and full ups really screw me up.
Sorry this ended up being an essay but I feel like I have been combing the internet, talking to friends and PTs I know and have had little luck. The median nerve seems more niche and could be what is affecting me.
Hope to hear back soon!
Thanks so much for this video I can tell you do great work, keep it up!!
Hey sorry I can’t give you any PT advice but did you try the treatments in our neural tension video (czcams.com/video/aUj5fwLJ5-s/video.html)? If those aren’t working you may want to schedule a consult with a PT (Jason does e-consults if you want to see him specifically), as your issue is too complex to respond to via a CZcams comment. :)
-Emile
Think my issue is Distal but I didn't have any of the cracking or Popeye muscle people talk of. Flares up are at the lower Bicep and inside Elbow. I don't have money for a doc yet. So in Covid times I am doing all the research I can.
Hey Morris, did you manage to sort this out? I have pain like hell just below the elbow and they say its tendinosis. If I massage the sore part a-lot with tiger balm it helps. Do you have loss of sensation or weakness in your fingers at all?
@@msbutterflyz I went to sports therapist when the Stimulus money was being handed out. He suggested stretching. I held my elbows behind my head for a few seconds a couple of times a day for a couple of times a week. I used resistant bands and light lifting until it worked itself out. Good luck
Thought this would be helpful for an issue I've been having but was not. I've been having a lot of pain after climbing recently in my upper bicep below the shoulder. It's been fairly intense and takes up to a week to feel healed. I've been climbing hard for a few years now and have just recently had this issue. I broke my humerus 5 years back and had surgery for it and am curious if that may part of the problem.
Hi Jacob, how close is the pain to your shoulder? That will actually be a subject we are planning on talking about soon so if your bicep pain is closer to the shoulder, stay tuned! It may not be your bicep issue at all, it may be all mechanics!
What about pain in the middle of the biceps?
And you’re right. It’s definitely a form issue, combined with too much bouldering and not enough rope time.
Pain in the middle of the biceps, if I am guessing what you mean by middle (from a top down perspective) it may be the Brachialis. If you have a chance look up the anatomy. The Brachialis is a prime elbow flexor and based upon it's location it may account for your discomfort.
You’re right. It’s definitely brachialis. It actually doesn’t hurt much, but it occasionally feels like a sharp, yet not very painful pull in the middle of my biceps. Other times it’s a minor, dull ache. Trying to be proactive here in hopes that it never gets worse.
It would be great if you make a video on brachialis care! Thanks for the insight.
@@bodysmithperformance3741 thanks for sharing. Yeah now is a great time to rest and rehab. I'll put it on the list 👍
@@bodysmithperformance3741 I have the same injury, I got it 3 days ago but managed to finish my workout, it felt much worse after climbing today, what did you do to repair it?
Hey, thank you so much for the information.
So while I do suffer with some discomfort in the area described (usually during my 2nd climbing day on before rest) it’s only when de loading a particularly intense position rather quickly, that I feel a deep pain that persists for a minute or so.
I wondered whether you’ve encountered similar complaints, and if what I’m describing is related to the topics of this video.
Sorry if my description was too vague, cheers!
Tough one! The key word in this is "intense", while this can be a number of things, the pain we have sometimes after sustaining an intense load can be due to a few physiological issues. Sometimes it's a neurovascular response to the compression of our vascular structures, sometimes it's due to a form of cramping where you are burning through energy stores in the muscle and finally give out but a brief moment of cramping occurs because there is no ATP left to break the bonds of the contraction, and other times it is simply a protective response: you're super engaged, and then all of the sudden you let go / fall off and the tension is no longer on the tissue/tendons so the body responds to that sudden change in a manner to protect itself from shortening or lengthening too quickly.
Much needed video. I developed this issue as a newer climber that increased load very quickly in about period (of course with bad techique). Now I have to go really easy or climb with a "handicap". Do you recommend no climbing at all until the exercises prove effective at strengthening tbe tendon with no pain? Or is very mild climbing okay? The injury has been helpful for me to improve my footwork as I try to reduce the pull on my arms.
How is it going now?
Hi, I had a long term issue similar to how you describe, almost certainly from not resting and trying things I wasn't strong enough
Can't really do any fully extended straight arm moves on that side and although I can load it and it feels strong, a sudden unload will be painful like if my hand unexpectedly pops off a hold.
I've had longs periods off climbing and it doesn't bother me but as soon as I climb again it returns.
Who should I speak to to get this looked at. I feel like a doctor would just dismiss it as it happened so long ago and doesn't really cause an issue in day to day life.
Cheers, great video
I'm not sure if this is available to you but a physiotherapist/physical therapist with either a Sports or Orthopedic Clinical Specialist certification (SCS and/or OCS) would be a good resource for you!
@@HoopersBeta thank you!
Lots of cave climbing and kilter board at 50 degrees
I always get it from doing pullups
Sorry to hear that!
6:04 @ da band
Great video!
When talking about the eccentric exercises you say "once you've _cleared_ yourself" a couple times
Could you clear up (ha!) what you mean by "cleared"? Is it just if doing the 3x15 sets doesn't cause any significant pain?
Great question! Yeah, you're on the right track. If you can perform the activity without issue (pain, reproduction of symptoms, weakness, etc) then you can move on to the next test/activty.
I couldn't be grateful enough for this.
I have something but not sure this is a match. I wonder if you can help me. I developed this after 2nd time ever climbing. So it’s not something that developed slowly over time. I don’t remember any kind of pop. I have no pain when climbing but after climbing it starts to throb hitting a climax around 5 minutes later and then cooling down. It is happening on both arms somewhat equally.
This doesn’t seem consistent to me with either a rupture or tendinitis (which I understand is usually from repetitive over use). Though I am a very fit 200 lb 40 year old man and do about 100 pull ups a week in various different positions. So my suspicion is just that my biceps are maybe too strong for my relatively weak aging tendons? My bad technique was just doing extremely high force dynamic arm pulling? The thing is pull ups don’t bother me at all. Not before and not even after hurting myself climbing. I only get the pain climbing.
Did you ever figure out what the issue was? I am experiencing similar symptoms.
@@andrewandrus3296 no unfortunately. Still looking lol. I am working with some knee people though so I will try and remember to get back to you if they figure it out.
@@colwem This sounds like what I would get sometimes if I tried a big bicep move before warming up properly. I personally found doing an isometric hang with hands in a neutral position on a bar and elbows at 90 degrees would help warm them up in a controlled way. You can easily limit the duration to what feels safe - for me 10s was the max I could manage at first, now its between 45s and 60s depending on the day and I haven’t had this problem in a long time.
@@simonrogers1898 thank you. I will try this.
people have short attention spans, save the bloopers till the end of the video
checked out both your elbow videos and they're really good, keep up the good work!
@@paulusul appreciate it! Will do 👍 or at least we will keep trying to 😎
So true! But what about the people that come just for the bloopers ... 😅
haha 😅 they're a certain breed they'll stick to the end