I received a message from a Jags’ season ticker holder with a simple medical question related to a not so simple shoulder injury. This loyal Jacksonville fan completely tore the proximal long head of the biceps brachii muscle in his dominant arm and he was looking for some direction on how to manage this injury.
As you can imagine, I get many calls from individuals, coaches and parents seeking my opinion for sports medicine issues.
A complete tear of either of the proximal bicep heads or tendons (long head and short head) is not a common injury compared to the more often torn belly of the biceps muscle or the distal insertion of the muscle. Is there much of a difference in the long head tendon tear compared to “just a biceps tear”? A Google search for “torn long head of biceps” produces 84,400 results. A Google search for a much simpler term “torn biceps” generates 938,000 or 11 times as many results! The bottom line: a biceps tear is not just another biceps tear.
“Do you think I need surgery?”
Answer: Not likely.
“Will torn biceps limit my ability to throw and participate in martial arts?”
Answer: For about 8 weeks, it will limit you considerably. After that, overhead activities need to be limited as tolerable and his rotator cuff (R/C) activities need to be consistent to maintain his rotator cuff (R/C) strength.
As a 50+ year old athlete with an injured shoulder, the healing time for this gentleman may be longer and the tendon itself will not be as elastic and strong as it was when he was in his 20’s. Does he need to sit on the coach, take a couple of bottles of medicine, rest the arm, let all the muscle of the shoulder and arm get weak for 8 weeks when he revisits his doctor? No way!!
After extensive listening (a valuable skill for smart physical therapists), asking him to move/assess his arm via detailed instructions over the phone, a thorough medical history and asking him very specific questions, here is what I suggested to him:
1. Go see an orthopedic surgeon to have your shoulder injury thoroughly examined.
2. If no surgery is required, start physical therapy to focus on restoring shoulder joint range of motion (ROM).
3. Get after your R/C aggressively. A weak R/C with a missing long head of the biceps is predisposed to shoulder impingement syndromes and bursitis injuries.
4. Re-evaluate your athletic activities. Overhead strength work, high-intensity bicep strengthening drills and throwing activities are risky and may need to be minimized for the remainder of his life to avoid complications.
5. Your overall bicep strength will be reduced by 15 to 40%, depending upon any secondary injuries and the strength of your short head of the biceps.
6. Don’t underestimate the little things that create big results at your injured shoulder: Posture, upper back strength and hand grip strength.
He was so happy and appreciative for my phone call and advice. As I always tell those that I give medical advice to: “I’m not a doctor” but I’ve seen many injuries now that I’ve literally spent the last 1/2 of my life (24 years) working in the NFL.
I’m proud of that fact and I feel privileged to represent the Jacksonville Jaguars. To make it even better, I’m able to share sports medicine knowledge every day to help improve the lives of both professional and amateur athletes!