Expert: Dr. J. Shawn Leatherman - 12/10/2006

Question
One year ago I was diagnosed with an acute partial tear to my lower bicep muscle on my right arm.  At 48 years old, I've weight trained and cardio trained each an average of 3+ days per week for the past 26 years, maintaining a lean, strong body (6'3" and 210# to 215#'s - but not a competitive bodybuilder type body). I heard the muscle tear/pop as I was lifting maximum weight with very poor form (my "bad" and I know better, but it was one of those days when my mind was preoccupied with work and I wasn't focused on my workout). The acute partial tear was diagnosed after having an MRI performed.  The orthopedic surgeon said that surgery was not recommended to repair the muscle and to stop all weight training for 8 weeks to allow the muscle to heal.  After 8 weeks of focusing on lower body weight lifting, cardio training and stretching for my upper body, I returned to upper body lifting.  Starting out with very light weights, after about 2 months I was back to about 80% of my normal lifting weights when during a bicep workout I felt the muscle "pop" again and knew that I had probably created a new tear.  Repeating the cycle of progressing from stretching to light weight to heavier weight, I am now on my 4th "new tear".  Each tear seems to be different than the prior because the location of sensitivity/pain radiates from a different area of my arm/bicep each time.  (The pain is never intensive, and I stop the motion/action as soon as I begin to feel it.) Visually comparing my right bicep to my left, the bottom of my right bicep "head" is about 3" shorter than my left and this appearance hasn't changed much during the past year.  Obviously, my "guessing" at how to rehab my arm is not working.  I feel as though the initial tear to a major bicep muscle never truly healed or is not rehabilitating properly and that smaller, supporting muscles compensate by growing as I progressively increase weight but reach a point of exceeding their capacity and then "blow out".  I've focused on slowing the progression of adding weight, and can train completely pain free with light weights with no indication of straining/stressing, and then all of a sudden I have a muscle "pop" and the resulting pain and sensitivity is felt for a week or two afterwards, during which time I go back to stretching and no upper body workout.  Is there a rehab program that I can implement on my own or should I seek professional help, and if I use professional guidance, what do you recommend as my first step to finding the proper professional?  Also, would a surgical repair to the original partial tear make rehab easier?

Answer
Dear Bill,

Wow, you really have had a tough one with this bicep. The original decision not to perform surgery was a sound one, most orthopedic info I have read states that a bicep tear does not need to be surgically repaired unless the tear is full thickness and causing strength problems, or it interferes with your daily activities/profession.  It is obvious that if you were a pro ball player that you would have had surgery for a better resolution and then an intense physical rehabilitation program.  

You are not a pro athlete, but you are a really active guy, and I think it is safe to say that you are not going to stop hitting the gym on a regular basis.  I can teach you rehab exercise for the bicep, but with the continual stress you place on that muscle comes continual problems.

I think you should talk to your orthopedist and let him/her know how this is affecting your performance in the gym as well as the pain/problems you are having.  You may need to find an orthopedist who specializes in sport injuries rather than blunt traumas, or pathologies, but I would speak to your orthopedist first.  In my opinion, this is going to continue to be a problem unless there is a surgical correction of the initial injury, and you may need other small repairs due to the repeated tears.  You also have to appreciate that the healing is in the form of granulation tissue (scars) which will always be weaker.

Concerning rehab...yes this does need to be conducted by a professional. Physical therapists do a great job, but after that I would suggest that you find a certified strength and conditioning specialist to train with.  CSCS is the credential and you can look for one at www.nsca-lift.org.  Surgery will not necessarily make rehab easier, but I think it will be more productive in your case.  I am the last person to want to send a patient to surgery, but when appropriate, that is what should happen.  

You may also want to follow up with another chiropractor here on Allexperts.  His name is Dr. Gillman and he has more specialized training with sports injuries than I do.  He may have something valuable to add.

Good Luck Bill.
Respectfully,
Dr. J. Shawn Leatherman