Ryan Boylen

Tricep and Bicep pain

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Ryan Boylen

Recently, I started having sharp pains in my tricep (at least it's on the underside of my arm) near my armpit whenever I do a pulling movement. This includes pull ups, weighted rows, etc. The pain happens when I flex my bicep, so I'm assuming it is stretching my tricep out beyond a comfortable range of motion. I've never had issues with pull ups or rows before (I've considered myself quite competent - RC/PE7 until now). All of the sudden this pain has come on.

 

In addition, when I flex my bicep and internally rotate it, I get a dull pain in my forearm near what I'm assuming is the bicep tendon (flexion and rotation...?).

 

To top it all off, my left shoulder has an impingement, which I am currently doing rehab for.

 

My questions are: does the impingement have anything to do with the pain I'm feeling in my arm (I wouldn't think it should), and does anyone have an idea of what's going on with the muscles in my arm? I don't have a lot of knowledge of anatomy, other than I know this isn't normal and it's preventing me from continuing with any RC progression (I can't even scale back to any of the earlier progressions).

 

If anybody has an idea of what's going on, and some ideas of rehab and stretching to fix it, I would be very appreciative.

 

Thanks,

 

Ryan

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Wesley Tan

Hi Ryan,

For clarity, are all these problems left sided? You never did say which arm is affected.

What do you mean by impingement? Did a professional diagnose your shoulder issue? Do you get the pain just flexing your elbow without load?

If you have a left shoulder issue and now a left arm issue then of course they are related, they are both yours! The hand, wrist, forerm, elbow, arm and shoulder are really a single functional unit. We divide things up anatomically for labelling purposes, learning and communication but in reality they function as one. If there is a problem in one it will affect the whole, and you tend to find it's the relationships between parts that are just as important as the indivdual parts themselves.

Firstly, stop performing pulling movements if there is a sharp pain! That statement must be one of the most frequent on this forum. You could be making a small issue greater and you don't want that to happen.

It sounds like you have strained something up near the axilla (armpit) and it could be a triceps insertion/tendon but could also be teres major (heavily used during pulling action alongside latssimus dorsi) or even one of the rotator cuff muscles like teres minor. There are other possible diagnoses as well but best to get it checked by a local professional. It could be that your rehab protocol for the 'impingement' is unbalancing???

There are many nerves that pass through the armpit on their way into the arm and some extend all the way into the forearam and hand. It is possible to impinge nerves in the axilla that could cause pain in the forearm. Less likely but not impossible, but again best to see a professional.

You got to understand what is wrong before you can correct it. Otherwise attempting stuff could be making it worse.

There are protocols to follow for muscle strains, tears, shoulder impingement but first get it seen and diagnosed properly. I wouldn't have one of my patients performing pull ups as rehab for a shoulder impingement issue, but would rather focus on scapulae position first, rotator cuff work second in conjunction with scapulo-humeral rhythm assessment work.

Personally, I always work from the foundation upwards, or outwards in the case of a shoulder issue. Make sure your scapulo-thoracic (shoulder blade/body wall) articulation is balanced and solid. Scapular shrugs vs retraction (can you retract in a ring row position with straight arms without pain?), scapulae depression vs elevation. I find there is often wewkness in scapulae depression in people with shoulder issues (parallel bar support shrugs) for example. If you can perform these without pain go ahead.

One last point. During pull ups, if one does not pay attention to depressing the scapulae early in the pull phase then latssimus dorsi is under utilised. This will mean too much emphasis on the long head of triceps, teres major and the biceps.

I hope this helps,

Wes

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Ryan Boylen

Thanks for the response, Wes!

 

Yes, they are all left-sided. The reason I was wondering if they were all related was because I've had a shoulder impingement in my right shoulder before, but never experienced any of these accompanying pains.

 

I haven't been performing pulling movements since I started to feel the pain...it hurts too much. I have seen a chiropractor who took an X-ray and the impingement is clearly visible. I just started the rehab this week, so I can't tell if it's "imbalanced" or not.

 

Scapular shrugs aren't an issue. I can do them both on the floor and on the rings without pain. Depression and elevation do not hurt either - I can do the support shrugs without issue.

 

I am aware of the importance of the engagement of the lats prior to the pulls...and I "try" to do that "every time" ;^) But I am wondering about the pinched nerves that run from the armpit down the entire arm. Possibly (maybe even more likely) the strain of the Teres Major that you mentioned above. Here's why:

 

Doing the Gymnastics Body workouts has never led to an issue. However, one month ago I took a break to train for an RKC certification. While doing so, and swinging heavy kettlebells mind you, I'm wondering if while focusing on lat engagement led me to strain a tendon up near the armpit area? Does that sound plausible? Perhaps swinging a weight I wasn't prepared to swing yet? That's about when I started noticing the pain.

 

Not all bent arm exercises trigger pain. I seem to be able to continue my planche progressions (SE2) without issue. I feel like it's the "rowing" movement - pulling my arm (both bent and straight) behind the frontal plane.

 

So, to recap:

Left side from shoulder and downstream

I have gotten it diagnosed by a chiropractor who took an X-ray and saw the impingement.

I have just started my rehab for it.

No pain in the scapular region (depression, elevation, protraction, and retraction seem fine). So does that mean it must start up in the shoulder?

And, rowing hurts.

 

Thanks again for your time! Greatly appreciated! And helpful!

 

Ryan

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Wesley Tan

Thanks for the extra info Ryan.

 

I think from the history you have given it would be a reasonable assumption that something during your RKC training must have caused the onset. Swinging heavy kettle bells, something you hadn't worked upto, could definitely put enough strain through that region to cause a strain. 

 

Did you have symptoms from the impingement before the arm pain? Or was the impingement picked up coincidentally from the x-ray? Do you get shoulder pain abducting the arm normally?

 

I assume the chiropractor noted reduced space between the humeral head and acromial arch on the x-ray? Muscle tightness, as a reflex to injury could be enough to cause that. You'll have some rotator cuff issues if the humeral head is 'hitched up' in my terms, so teres minor may well be involved?

 

Performing the scapulae exercises without pain doesn't mean there isn't a scapulae issue. I have seen many rotator cuff strains with no pain on scapular depression in the support position, but a definite weakness on that side, an inability to fully depress the shoulder. So the supporting musculature of the shoulder is not tip top (lats/ lower traps/serratus) which then affects how forces are transferred from the shoulder to body and vice versa.

 

Check in a mirror and look for any asymmetries in those movements if you can.

 

The 'tissue casuing symptom' or 'pain generator' is definitely in the shoulder, but predisposing factors that can contribute to the seeding of the problem can be around the scapulae. Not always, but often.

 

It would be a good idea to slowly work the shoulder out, trying to relax and lengthen through the rotator cuff, deltoid, biceps, triceps and capsule. You can use a tennis ball to gently self massage the area. don't be too harsh, the aim is not to cause pain but relax the muscles. A little pain is okay but too much can have the opposite effect and tighten muscles. 

 

You can also try an inverted hang on the rings, if its not painful of course, 20-30 secs. This can really help to lengthen the shoulder muscles as you relax into it.

 

One other way I use to stretch out the capsule and rotator cuff is to use a fulcrum and 'distract the humeral head'. A term we use to describe a technique of pulling the humeral head laterally away form the glenoid fossa (scapula socket). Usually I would place my forearm high up in the armpit of a patient so it lies between their arm and body. Then slowly apply pressure to the elbow toward their body. You could do this with a small towel rolled up, experiment with size, and pull your own elbow across your body with your right hand. You can try it sitting or side lying on your left using your body weight to create the movement. Do it after the shoulder is warm form stretching or massage.

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Ryan Boylen

I think the impingement began prior to the the RKC training. I noticed hints of it while doing dislocates during handstand training, needed to widen my grip because of "clicks" I was hearing. I haven't noticed any pain from abduction.

 

I saw the X-ray myself. The humeral head was indeed touching the acromial arch. It's interesting about tight muscles due to injury being enough to cause it to "pull up" in there. Is laying off the pulling enough to let it heal - or fall back down into its normal position, or is there something more along the lines of rehab that I should be doing? Either way, I'll put all the ideas you recommended into practice.

 

Thanks again for all the time you spent helping me out. I'm very appreciative!

 

Ryan

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Wesley Tan

Laying off the pulling for now is needed so as to not aggravate the issue further. I would start the stretching immediately and practice daily.

 

I have had impingement issues myself with a definite loss of abduction, I found i could abduct freely, without pain immediately after an inverted hang on rings, but was otherwise limited to 90 degrees with sharp pain. It would last about 2-3mins before the pain returned, so in this instance the retraction of the humeral head was being 'driven' by contraction of tissues within a definite time frame. After a few weeks I had no issues and could carry on with my training. Of course every case is different, depending on exactly what tissues are involved and the severity. 

 

The body always try's to restore normal function, but also try's to be as economical as it can. Just leaving injuries to heal, in my experience is often not enough. Some neurological changes don't seem to always unwind. I have seen many 'frozen shoulders' (adhesive capsulitis) diagnosed by GP's (General Practice MD's) resulting from falls that often occurred over 12 months previously. Weekly treatments for the first month incorporating massage, stretching, distraction and general manipulations of the joint in all planes and the beginnings of controlled exercises is enough to reverse in most cases. Some cases have taken 6 months to achieve full ranges of motion but the point here is even chronic issues can unwind, so best to not let them become long term issues in the beginning.

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Ryan Boylen

Well thank you for all the information! I will indeed do the stretching and distracting. I started the inverted hangs from the rings yesterday as well as just holding onto a heavy weight to let it "pull" the humorous down out of the arch. Both have felt good afterward. I'll just have to hold myself back from not doing too much (that's hard for me). I'll continue the rehab as well as the other bits of info you've given me.

 

Thanks again! Hopefully I'll be back to my RC progressions in no time!

 

Ryan

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