LH Bicep tendon injury, please help me :(

Hello everyone! 

I'll try to keep this brief. In summer last year I got severe tendonitis in my long head bicep tendon. It started out from overdoing pull ups.

I have gone to two doctors and also 3 physiotherapist's, and one of these was able to actually help me somewhat (in the sense that he told me to do negative hammercurls) Along with rest, deep tissue massage and a combination of negative hammercurls with different intensity it finally went away. I also did rotator strengthening, stretching, mobility and you name it.

During rehab time I only did pulling exercises supinated, this is key. No pain or anything here. Pronated pulling, though, problems arise very fast. I started doing BW pull ups and pendlay rows pronated about 2 months ago and now my tendonisis has flared up again, I first felt it yesterday. It instantly made me very depressed, and now I am in the thought process of walking away from training altogether since it seems I am maybe injured for life 

I am tired of incompetence guys, most of the people I talked to about my injury couldn't help me at all (and mind you these are educated people) and just said oh your are tight just stretch, or oh just rest you have trained too hard. The thing is they know basically nothing of tendon injuries. I knew more after a couple of hours on google. I tried to convince them to x ray me but they refused several times, stating you don't do that for these kind of injuries since you can't see anything either way. I tried to argue and convince them to think outside the box but.. no. 

I have educated myself as much as I possibly can but it isn't enough. I'm lost. I know there are knowledgeable people on this forum so I thought just maybe someone here could help me. I possess adequate strength and mobility in my rotators. My shoulder mobility is very good compared to normal standards, my scapular control and mobility is decent. My forearms and upper arms are not tight, my back is not tight. All of the above of course is as far as I know, which maybe isn't that much.

I can perform all pulling movements supinated, so we know that pronation has something to do with the problem. If I pronate my forearm, flex my elbow to 90degrees and abduct my shoulder so my upper arm is horisontal, and do small circles with my shoulder I aggrevate the tendon big time. After I come out of this position I can feel tension relieving from the tendon and also elevated pain. These circles are also "difficult" for me to do, I feel weakness in the shoulder when I do it and I get fatigued fast. I discovered this movement today, none of the therapists could aggrevate my tendon by moving my arm and shoulder when i met them. So maybe this could be some sort of key to the root of my problem, since the bicep tendon usually is injured because of problems elsewhere.

Anyone have any ideas? It would really mean the world to me.

Hi Andreas there is not too much to say because the diagnosis from the web is the last solution why:

-because i do not know you;

- i do not know your previous training;

- i cannot test you.

I can only make an assumption which has zero validity from a professional point of view.

What I can understand is that the problem is the long head bicep tendon, so a shoulder problem. when this problem occurs is because the shoulders are imbalanced, too much tension in the front and too less strength in the upper back. basically poor shoulder mobility. your opinion is that you have a good shoulder mobility, for GB and my standards a good shoulder mobility for bulletproof injury is:

-dislocate approximately at shoulder width;

-perfect bridge;

-shoulder extension up to 150 degrees (hands together).

If you can match all of them your mobility is ok, if not the mobility is the crucial part.

I would like to repeat that these are assumptions and they do not constitute the solution. long head bicep tendon is strictly connected to rotator cuff problem, no matter how strong they are, a problem still exists.

for the rest, GB forum is not the place where you can find the solution because nobody can give you a reasonable solution without seeing you face to face.

+1 to Alessandro's comment. I used to treat shoulders a lot when I was a massage therapist, so here's my $0.02 worth.

Read anything/everything by Craig Purdham, Jill Cook, Ebonie Rio. They're all tendon researchers, and there is a LOT of information out there.

Mobility has to be good mobility: it's easy to extend the shoulders (arms behind the back) up to 90 degrees by internally rotating and protracting the scaps, so unless we see a video, it's hard to tell what's going on.

What kind of "deep tissue" massage did you get? Where? How often? What was the the massage therapist's intent?

You said "none of the therapists could aggravate my tendon by moving my arm and shoulder when i met them."

This is common: passively moving your arm/shoulder isn't going to tell anyone anything.

Have you ever injured your shoulder before?

Have you had an MRI of the shoulder?

9 hours ago, Alessandro Mainente said:

Hi Andreas there is not too much to say because the diagnosis from the web is the last solution why:

-because i do not know you;

- i do not know your previous training;

- i cannot test you.

I can only make an assumption which has zero validity from a professional point of view.

What I can understand is that the problem is the long head bicep tendon, so a shoulder problem. when this problem occurs is because the shoulders are imbalanced, too much tension in the front and too less strength in the upper back. basically poor shoulder mobility. your opinion is that you have a good shoulder mobility, for GB and my standards a good shoulder mobility for bulletproof injury is:

-dislocate approximately at shoulder width;

-perfect bridge;

-shoulder extension up to 150 degrees (hands together).

If you can match all of them your mobility is ok, if not the mobility is the crucial part.

I would like to repeat that these are assumptions and they do not constitute the solution. long head bicep tendon is strictly connected to rotator cuff problem, no matter how strong they are, a problem still exists.

for the rest, GB forum is not the place where you can find the solution because nobody can give you a reasonable solution without seeing you face to face.

8 hours ago, Nick Murray said:

+1 to Alessandro's comment. I used to treat shoulders a lot when I was a massage therapist, so here's my $0.02 worth.

Read anything/everything by Craig Purdham, Jill Cook, Ebonie Rio. They're all tendon researchers, and there is a LOT of information out there.

Mobility has to be good mobility: it's easy to extend the shoulders (arms behind the back) up to 90 degrees by internally rotating and protracting the scaps, so unless we see a video, it's hard to tell what's going on.

What kind of "deep tissue" massage did you get? Where? How often? What was the the massage therapist's intent?

You said "none of the therapists could aggravate my tendon by moving my arm and shoulder when i met them."

This is common: passively moving your arm/shoulder isn't going to tell anyone anything.

Have you ever injured your shoulder before?

Have you had an MRI of the shoulder?

 

Thank your for the advice, I will look into their writings. 

As for mobility, no, I do not have mobility up to this standard. But, when injury happened I worked hard on mobility and while still not up to that standard, I had a nice bridge and a decent dislocate at least. I could be wrong but I dont think poor mobility is the reason. However it of course wouldnt hurt to improve it. 

Deep tissue intent was to increase blood flow from what I understand. They also treated with laser at insertion point elbow and shoulder. 

I have dislocated my shoulder as a child, but that was long ago and this is my only injury. 

I have not gotten MRI, they refuse to do it. You dont do that with problems like this they say, they also say no surgery, no ultra sound, no nothing. 

I assume it is LHBT because my tendon is tender at insertion point in humerus. However I do not feel pain in my shoulder at all, instead I feel it like between brachialis and biceps brachii. I think it is around the upper arm bone. The pain is felt the most near the elbow and also a little higher up, I feel it clearly If I do pull ups or military press or something similar. Chin ups, curls, etc nothing. I can show with pictures IF that would help. 

I understand the point of some doctors, BUT look of a private clinic and go for it. I talk about my experience. when I tore my ACL 13 years ago I wasn't able to take the MRI and my doctors said it was only a distortion with a little strain. then the MRI said completely torn ACL.

You have previously said that you do not have this level of mobility. then I want to say you again that when I began GB 10 years ago I had many problems but lack of mobility for sure. in the last 6 years I've developed the mobility I said to you and I have ZERO injuries.

lack of mobility is the first cause of shoulder injury plus a weak upper back.
also, you had a dislocate when you were a child so you are more predisposed to have a problem in that shoulder.

take an MRI and give it to a shoulder specialist.

Yep, this needs MRI or ultrasound (imaging) at the least.

Here is something you could try:

Do you know the exercise "inverted row"? You could try this standing almost vertical, (so not really inverted)  but still holding on to a bar, in pronated grip (both hands). Find a position where you arm is just beginning to feel sore - only the smallest amount. Stay in this position for a minute, let the arms relax, one minute of "hanging", rest, another minute, rest.

By "stay in this position" I mean you just "hang". No pulling, no movement.

This "isometric loading protocol" works for by loading the muscle/tendon/? a little, to try to provoke a healing reaction, but not to load it so much that it hurts or makes the injury worse.

But you have to be patient. 

Once a particular position no longer causes any pain, increase the load; in this case, become more inverted. No movement, all isometric. It might take a month to get into a "normal" inverted row position.

I suggest this because you said this started after you "overdid pullups". So, read about "tendon dysrepair". And no pullups for a long time

On reflection, I think this may not be LHBT near the elbow (as Alessandro said, it's hard to figure out over the internet), but the common extensor tendon.

Usually, the extensors straighten the fingers and move the back of the hand towards the wrist. However, in a pullup (pronated grip), the wrist and fingers are fixed, and the extensors then help to bend the elbow as you pull up.

This is an approximate test (Mill's test)

With a straight arm, flex your wrist, then push the back of your hand into your other hand (or a wall or something). If there is any pain near the elbow, the common extensor tendon is likely to be involved.

The same isometric protocol can be used (there are variations, some do it twice a day, others once) :

Load it (45s-60s), rest x 3-4.

Next day, if it feels better, load it a little more. If it feels worse, load it less for a few days, then increase the load again.

By load it, I mean reps x force x time. So 4 reps x 4 kg of force x 120 seconds total gives a "dose" of 1920.

You can put the back of your hand on bathroom scales to more accurately measure the force.

It does amaze me that none of your physiotherapists have mentioned this. Probably ultrasound around the elbow might reveal more.

Anyway, let me know if you have any questions.