Biceps muscular strain is a common occurrence in sports enthusiasts. It is a complete or partial tear of muscle fibers or tendons of the bicep muscle. As a result, the affected arm loses strength and flexibility.

Biceps strain may occur due to overuse or excessive stress on the shoulder due to injury. The condition presents itself as pain in the upper arm. In addition, the pain may sometimes be associated with apparent bruising.

The strain causes muscle spasms and loss of mobility. The condition is typically relieved with conservative therapies.

The anatomy of the biceps muscle

The biceps are one of the muscles of the forearm, lying in the anterior compartment.

Biceps is a two-head muscle that arises from its attachment on the scapula, the shoulder bone. The muscle goes over the head of the humerus, the upper arm bone, and stabilizes the shoulder joint while passing it.

Though most of the biceps lie in front of the humerus, it has no bony attachment on this bone.

The long head of the biceps originates from the supraglenoid tubercle of the scapula at the back.

While the short head originates from the coracoid process of the scapula.

Both heads insert distally into the radial tuberosity of the radius bone, one of the bones of the forearm.

The tendons connect the biceps muscle to the shoulder joint at two places. These two tendons are called the proximal biceps tendons. The two heads of the biceps merge as it descends towards the forearm.

The tendon attaches the biceps muscle to the forearm bone; the radius is called the distal biceps tendon.

When the biceps muscle contracts, it pulls the forearm up and rotates it outwards.

Causes of a biceps strain

Biceps strain can be caused by;

• Overuse of the muscle
• Repetitive movements like swimming, tennis, or football
• Acute injury in which the elbow gets twisted

Any history of shoulder or upper arm injury makes one prone to biceps strain. Besides, improper warming and cooldown techniques and playing in improper form also increase the risk of a bicep strain.

Signs and symptoms of a biceps strain

The signs and symptoms vary according to the severity of the injury. Usually, the biceps injury falls under one of the following three grades;

• Grade 1

A minor injury to the biceps in which the muscle or tendons are overstretched. However, there is no loss of strength or any effects on mobility range.

• Grade 2

A moderate intensity of strain or injury resulting in some loss of strength as well as mobility.

• Grade 3

Severe injury resulting in complete rip or rupture of the bicep muscle or tendons.

The symptoms of a bicep tear or strain include:

• A characteristic pop sound at the time of injury
• Muscle spasms
• Physical deformity or the Popeye look of the upper arm
• Loss of mobility
• Bruising
• Weakness in the shoulder

Treatment of the biceps strain

Most of the time, a strain in the biceps muscle is relieved by conservative therapy.

1. Immediately after the injury to the first week
   1. RICER

Upon hearing any popping sound from your upper arm during physical activity, immediately resort to RICE. RICE helps in preventing an injury from getting worse and aids recovery.

Rest your arm if you feel any strain in your arm muscles. Stop lifting heavier objects and weight training.

In case of severe pain, apply a cold compress or ice the area. Such measures will help relieve the pain and resolve swelling.

If the pain is too much to bear, apply compression to ease away pain and swelling. Make sure not to use the reduction too tight to prevent any obstruction to the blood circulation.

If keeping your arm by your side increases the pain, elevate your arm with a sling. It should help ease off the burden on the strained muscles.

If nothing helps and the symptoms worsen, get referral to a specialist and get your arm checked.

• Medications

Over-the-counter pain relievers and anti-inflammatory medicines help to relieve the pain in the initial days. They also work to ease away associated inflammation, if any, with the injury.

In case of unbearable pain that results in sleep disturbances, the doctor may prescribe muscle relaxants.

• TENS

TENS therapy is prescribed if there is no associated injury or open wound, or bruising with the muscle strain.

If your doctor suggests, TENS can be employed after the first two weeks. It helps relieve post-injury pain and speeds up recovery.

• Platelet-rich plasma (PRP)

Injecting platelets separated from the patients' blood into the affected shoulder helps speed up the recovery process.

• Surgery

If the tear is severe, surgical treatment may be needed. Candidates for surgery include:

• People who have jobs requiring a full range of motion in the shoulder
• Athletes who require a full range of motion as a professional baseball player of those playing golf
• debilitating chronic pain conditions after the initial injury that may start affecting the shoulder

• After the first week
  • Massage

Arm massage helps release stress, pain, and muscle tightness after initial recovery and treatment.

Deep tissue massage is done by applying deep strokes to increase the local temperature, which results in increased circulation. As a result, muscle elasticity and flexibility are improved.

Deep strokes are applied using the fingers and palms of the hand. It helps break the collagen fibers. Collagen fibers, when produced in the muscle, exert a restrictive effect causing pain and tightness.

Kneading is another technique used for an arm massage. It is usually performed on areas containing soft tissues. Pulling and squeezing actions of kneading help relieve tightness by increasing the lymphatic exchange. This enhances the removal of waste products from the muscles in exchange for nutrients and oxygen.

Arm massage moves are made in an upward direction along the length of muscle fibers. The improved circulation and lymphatic drainage reduces the swelling and speeds up the recovery process.

Massage for the upper arm improves the delayed onset muscle soreness that often occurs post-exercise due to improper cooldown. It also helps to relieve tension and prepare the muscles for athletic performance. For example, in the case of biceps strain, there might be small tears in the muscle. These tears cause swelling, which impedes circulation, thereby hampering recovery. Massage helps to ease away the swelling.

Similarly, after an injury or a sports or exercise activity, the muscle becomes fatigued with waste collection. Massage gets rid of the waste from the muscle and enhances recovery and healing.

• Therapeutic ultrasound

Therapeutic ultrasound helps repair the torn muscles and strengthens the ligaments and tendons of the biceps at the point of attachment.

• Active rehabilitation

Active rehabilitative exercises help to restore muscle strength. It is essential to go for rehabilitative therapy after the initial injury has healed to prevent a recurrence. Such treatments help keep degenerative processes at bay, which plays a significant role in maintaining the health and vigor of people involved in active sports.

Some of the exercises for strengthening biceps muscular strain include;

Flexion and Extension

• Stand comfortably with your arms by your side.
• With your elbow bent, flex your affected arm and extend the elbow bringing the palm of your hand up to the shoulder.
• Bend the elbow as much as possible, remaining in your comfort point.
• Straighten your arm and elbow.
• Repeat at least 15 times.

Single Shoulder Flexion

• Stand and keep your feet shoulder-width apart. Keep your arms at your side.
• Keeping the injured arm straight.
• Raise it forward and slowly bring it up so that it points to the ceiling.
• Keep your comfort levels and stop if the pain is bothersome.
• Hold the raise for about five seconds before bringing the arm to the starting position.
• Complete eight to twelve sets.

Biceps Stretch

• Face a wall and stand at a distance of at least six inches away from it.
• Move your palm of the affected side to face the floor, slowly raise the arm and touch the wall with the thumb side of your hand.
• Make sure to keep your arm straight.
• Slowly turn your body away from the wall until you feel a stretch in the biceps.
• Hold the stretch for about 15 seconds.
• Rest. Complete the exercise by doing two more reps.

Reclining External Rotation

• Lie down on your healthy side with the injured arm side facing upwards.
• Rest your head on the extended healthy arm and bend your knees for support.
• Rest your injured upper arm on your side while bending the elbow to 90 degrees.
• Your palm of the wounded side should face in toward your body and your forearm arm down toward the floor.
• Keep your elbow tucked against your body for support. Raise your forearm until it comes parallel to the ground.
• Slowly lower it back down.
• Repeat for 15 times.
• Try this exercise with a light dumbbell as the condition improves.

Prevention of biceps muscle strain

There are some preventive measures to safeguard against biceps muscle strain.

• Build up your strength gradually.
• If you are an athlete, do not do deadlifts.
• Make sure your form and posture are correct while playing sports or doing exercise.
• While training, work on your abs, shoulders, and back.
• Do take rests between sets of exercise. Do not overtrain.
• Properly stretch while warming up and cool down.
• Avoid moves that may put pressure on outstretched arms.
• Look out for overuse injury if engaged in the shoulder and upper arm (baseball pitching, swimming laps, or serving in tennis or volleyball).
• Try to take help while lifting heavy objects.
• Quit smoking as it hampers healing and recovery by impeding blood circulation.