(Also known as Biceps Injury, Torn Bicep, Bicep Strain, Bicep Muscle Strain, Strained Bicep Muscle, Bicep Tear, Pulled Bicep)
What is a bicep strain?
A bicep strain is a relatively uncommon condition characterised by partial or complete tearing of the biceps muscle and typically causes pain in the front of the upper arm (figure 1).
The biceps muscle is situated at the front of the upper arm (figure 1) and is comprised of two (‘bi’) muscle bellies (‘ceps’). These muscle bellies are known as the long and short head of biceps. The biceps muscle originates from the front of the shoulder blade (scapular) and attaches to the radius (outer forearm bone) (figure 2) via the biceps tendon.
At the elbow, the biceps muscle is responsible for bending the elbow (flexion) and rotating the forearm away from the body (supination). At the shoulder the biceps muscle assists forward elevation (flexion) movements of the shoulder particularly when the shoulder is positioned in external rotation (palm facing forwards). The biceps muscle commonly assists movements such as lifting or carrying (e.g. shopping), turning a screw driver or performing exercises such as chin ups or bicep curls at the gym.
During contraction or stretch of the biceps, tensile force is placed through the biceps muscle and tendons. When this tension is excessive and greater than the biceps can withstand (due to too much repetition, prolonged or high force), one or more of the biceps muscle bellies can tear. When this occurs, the condition is known as a bicep strain.
Bicep strains can range from a small partial tear whereby there is minimal pain and loss of function, to a complete rupture. The severity of injury ranges from a grade 1 to a grade 3 tear and are classified as follows:
- Grade 1: a small percentage of fibres are torn resulting in some pain, but allowing full function.
- Grade 2: a significant percentage of fibres are torn with moderate loss of function.
- Grade 3: all muscle fibres are ruptured resulting in major loss of function.
The majority of bicep strains are grade 2.
Causes of a bicep strain
A bicep strain most frequently occurs due to a sudden, forceful contraction of the biceps muscle. This typically occurs during heavy lifting or weight training (especially when performing explosive chin ups with palms facing upwards or biceps curls e.g. preacher curl, standing biceps curl etc). At the gym, the use of heavy free weights, quick movements and eccentric training (i.e. negatives) may increase the likelihood of the condition occurring.
Occasionally a bicep strain may develop over time due to repetitive or prolonged activities placing strain on the biceps muscle. This may result in microscopic tearing, degeneration and weakening of the biceps increasing the likelihood of further injury. Bicep strains tend to occur more commonly in the older deconditioned athlete, especially following a sub-optimal warm-up.
Signs and symptoms of a bicep strain
Patients with this condition typically experience a sudden pain or tearing / pulling sensation in the front of the upper arm at the time of injury. In minor cases, symptoms may be minimal and patients may be able to continue the provocative activity only to experience an increase in pain and stiffness after activity with rest (often at night or upon waking the following morning). In patients with more severe injuries, the pain may be disabling, preventing the patient from performing further activity.
Symptoms are usually localized to the front of the upper arm (biceps region). Occasionally, pain may radiate into the shoulder, elbow or forearm. Bicep muscle tightness or spasm is often present. The pain associated with this condition is often experienced as an ache that increases to a sharper pain with activity.
Some patients with a minor biceps tear experience little or no symptoms. In these cases, minor discomfort or tightness may be the only complaint. In severe or chronic cases, muscle wasting and a noticeable deformity (or palpable hole) in the muscle may be detected corresponding to the location of the injury. In patients with a grade 3 tear, bunching of the biceps may also be noticed when contracting the muscle.
Patients typically experience discomfort when firmly touching the affected biceps muscle at the injured region. Pain may also increase when stretching the biceps muscle or performing activities requiring prolonged, repetitive or forceful contraction of the biceps muscle. These activities may include heavy lifting or carrying (e.g. shopping, a small child) or performing exercises such as chin ups or bicep curls (with free weight, machine weights, resistance band or cables). Bruising, swelling and weakness (of variable severity) may also be experienced.
Diagnosis of a bicep strain
A thorough examination from a physiotherapist is usually sufficient to diagnose a bicep strain. Further investigations such as an Ultrasound, X-Ray, CT scan or MRI scan may be required to confirm diagnosis, rule out other pathology and assess the severity of injury.
Treatment for a bicep strain
Prognosis of a bicep strain
With appropriate physiotherapy treatment, management and rehabilitation, most patients with a minor to moderate bicep strain that has not been present for long can typically recover within a number of weeks. In more severe or chronic cases recovery may take many weeks to months to achieve an optimal outcome. Those patients with a complete biceps rupture that need surgical intervention, usually require a rehabilitation period of 3 – 9 months or longer before returning to full activity or sport.
Contributing factors to the development of a bicep strain
There are numerous factors which may predispose patients to developing a bicep strain. These factors should be assessed and corrected, where possible, with direction from a physiotherapist. Some of these include:
- poor weight lifting / bicep curl or chin up technique
- muscle weakness (especially the biceps muscle or other elbow flexors)
- elbow, shoulder, neck or upper back stiffness
- muscle imbalances
- inadequate conditioning of the biceps muscles
- muscle tightness (especially the biceps or triceps)
- neural tightness
- inadequate rehabilitation following a previous bicep injury
- poor posture, biomechanics or core stability
- excessive or inappropriate training or activity
- inadequate recovery periods from sport or activity
- sudden increase in activity using the biceps (such as lifting, carrying, weight training)
- inadequate warm up
- age (more common in an older population)
Physiotherapy for a bicep strain
Physiotherapy treatment for patients with a bicep strain is vital to hasten the healing process, reduce the likelihood of recurrence and ensure an optimal outcome. Treatment may comprise:
- soft tissue massage (including trigger point release techniques)
- electrotherapy (e.g. ultrasound)
- dry needling
- joint mobilization or manipulation
- anti-inflammatory advice
- ice or heat treatment
- protective taping
- the use of a sling or collar and cuff
- the use of an elbow brace
- progressive exercises to improve flexibility, strength, posture and function
- technique correction (e.g. lifting technique)
- training and activity modification advice
- postural correction
- establishing and monitoring an appropriate return to sport or activity plan
Other intervention for a bicep strain
Despite appropriate physiotherapy treatment and management, some patients with a bicep strain do not improve adequately. When this occurs the treating physiotherapist or doctor can advise on the best course of management. This may include further investigations such as X-rays, ultrasound, MRI or CT scan, pharmaceutical intervention, injection therapy (such as autologous blood injection or cortisone injection) or referral to appropriate medical authorities (such as an orthopaedic specialist or sports doctor) who can advise on any intervention that may be appropriate to improve the condition. In rare cases involving a complete rupture of the biceps muscle, surgical intervention may be indicated.
Exercises for a bicep strain
The following exercises are commonly prescribed to patients with a bicep strain. You should discuss the suitability of these exercises with your physiotherapist prior to commencing them. Generally, they should be performed 2 – 3 times daily and only provided they do not cause or increase symptoms.
Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place gradually and provided there is no increase in symptoms.
Static Biceps Contraction
Begin this biceps exercise with your elbow at your side and bent to 90 degrees, palm up as demonstrated (figure 3). Slowly push up against your other hand tightening your biceps. Hold for 5 seconds and repeat 10 times as hard as possible provided the exercise does not cause or increase symptoms.
Elbow Bend to Straighten
Begin this exercises standing in good posture with your palm facing your body. Slowly bend and straighten your elbow as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 4). Repeat 10 – 20 times provided the exercise is pain free.
Begin with your elbow at your side and bent to 90 degrees (figure 5). Slowly turn your palm up and down as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10 – 20 times provided the exercise is pain free.
Rehabilitation Protocol for a bicep strain
Physiotherapy products for a bicep strain
Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:
To purchase physiotherapy products for a bicep strain, click on one of the above links or visit the PhysioAdvisor Shop.
Find a Physio for a bicep strain
Find a physiotherapist in your local area who can treat a bicep strain.
- Bicep Strengthening Exercises.
- Bicep Stretches
- Upper Body Foam Roller Exercises
- Massage Ball Exercises (Upper Body)
- Upper Body Resistance Band Exercises
- Gym Exercises (Upper Body)
- Arm Stretches
- Arm Strengthening Exercises
- Ice or Heat
- R.I.C.E. Regime.
- Warming Up & Cooling Down.
- Returning to Sport.
- Mechanical Pain.
- Understanding Pain.
- Shoulder Diagnosis Guide.
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