- (Music singing intro) Bob and Brad
the two most famous physical therapists on the internet.
- Hi folks.
I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together we are the most famous physical therapists
on the internet
- In our opinion, of course, Bob.
- Brad, today we're gonna talk about
the absolute best self treatment
for bicep, tears, and tendonitis.
- Okay.
- We'll do both.
- Explain to us a little bit here.
- Yeah. Actually the reason I got this in here,
Brad is if you actually tear the long head of the bicep.
- Sure.
- Bicep means two or bi means two.
- Right.
- That means it's got two attachments up here.
- Right.
- This muscle.
But if you tear it, it'll gather
down here and you'll have this big bulbous thing here.
- And that's your muscle belly.
- Yeah. Coming down here.
And that means you, you tore the long head and
that means you either have to have surgery or
you're going to be like this, the rest of your life.
I mean, it it can't reattach on its own.
- Right, because it'll break off and that tendon
will come way down and your bicep gets
like you've been doing curls for a long time.
- Yeah, exactly.
- But it's not very comfortable.
- So let's show first, Matt, Brad
I was gonna call you Matt (my son's name).
where the bicep tendon is.
- Yeah. Let's look at that a little closer here
and bring that up too, Brad.
That actually works out really good.
- Yep.
- So, am I close enough Lonnie?
- (Lonnie) yeah
- So you can see right here
there's a groove right here
and that's called the bicipital groove
which means the bicep actually comes up here
and attaches to the top of the glenoid right here.
- Right.
- And it also attaches over here.
That's the other attachment.
- That's the short head?
- [Bob] That's the short head.
- short head and the long head.
- [Bob] Yep.
- And that gives you your bisupraglenoid tubercle
or something like that.
It attaches up in here.
It goes down here.
Then it attaches down here.
- Sure.
- And it helps, you know,
it actually helps bend the arm
but it also actually supinates the hand.
- Right.
- So the forearm, so the bicep does this and this
- and a little bit of shoulder flex.
- A little bit of short flexion.
- Yeah. Good point.
- So this is biarticulate.
- Yeah.
- Going back to school, Dave.
- So you want to show the tendon on there.
- Okay. So this is actually the,
if we take the scapula off
and here's the rotator cuff muscles
and we pull this out,
so you can see the long head.
- Just pull this bone out right there.
- Sure enough, right there here goes the,
just the end of the bicep muscle, which is cut off there.
But then here's the long head goes
up around this groove right here attaches to the point.
Bob was just talking about, and there you go.
- So this is going to help you with the assessment process.
Like when you are trying to determine
is it bicipital tendonitis that you have,
you want to find that little groove
on your shoulder and rub across it.
And if it's sore, there's a good chance that you know, that
that may be, you know, part of the problem
as you're having a little bicep tendonitis.
- Right? So yeah, you get right in there
and you feel back and forth across
and you usually can get to it.
You know, if you've never done this before
you probably don't know what,
what you're feeling for.
But as a therapist, you know, we
- Right.
- Get to a good, quickly.
- it's a good start to, to try to figure out
but we'll show you another test.
- Right
- You can do too, to figure out if it is the bicep
now tendonitis tends to come from overuse injuries.
It means that you've overused the shoulder
but it also comes bicep tendonitis often comes about
when the rest of your rotator cuff isn't working right.
- When it's over stressed.
- Yeah. So the rotator cuff is four muscles.
It's not the bicep.
It's four muscles that go around the shoulder blade here.
And if they're not working, right
the bicep comes in to try to help out some more.
So at the end we're gonna show you maybe some exercises
to do for the rotator cuff, too.
- Alight. So yeah.
So that, that, those are the muscles I referred to
if we pull that out, here they are
they're flat broad muscles that really support that joint.
And so anyway, Bob, there are some people
that have never seen us before.
- Oh, yeah, Hi!
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- Excellent Bob.
- Well, I have been forgetting that one lately.
- There's new people, they see the Gumby ad (Laughing)
they're probably wondering what's going on.
- Yeah. They're wondering about us, and we do too.
So let's first just show three quick tests.
You can do Brad to rule out or
to verify that you have bicep tendonitis.
So the first one is, you know, sometimes pain can come
from your neck and go down into your shoulder.
- Very common.
- Yep. So we're going to do the Spurling test
where all you do.
It's very simple.
All you can do is turn your head and go back like this
and then you're gonna push down.
- Yeah, go ahead.
- It's good if you have somebody else do it, actually.
- Yep. And then I'm going to just gentle pressure,
- Gentle pressure,
- This is not a big push out.
Yeah. I, I can get plenty of pressure from here
and I'm not pushing hard as you can tell.
- Now you're squeezing the bones together.
And if there's a nerve problem, if there's a pinched nerve
you're pinching it even more
and it'll send pain down your arm.
- Yep. You do that.
And if you say, oh, it hurts over here.
Then you know, it's probably not the bicep.
- Did you mess up my hair, by the way?
- Yeah. It's getting, you'll have to comb it out.
We'll get it after the video,
- My few hairs that are left.
Okay. The next one you could that sometimes will send pain
down into the arm is thoracic outlet syndrome.
- Sure.
- So, this one's called the Roos test.
Very simple to do.
I don't know what Roos
like, it sounds like rooster, doesn't it?
- Right, that's what I always think about.
- So you bring it up, and you bring the elbows
back a little bit, too,
and all are you gonna do is the chicken dance.
- And how long you gonna do that for?
- About 15 times.
- And if, if it's positive
- it'll start recreating the symptoms down your arms.
- Right.
- So that, that, you know, that's one test for it.
Obviously, if you're have it positive,
then you may wanna see a doctor
and figure out what else is going on.
- Sure.
- So, now this is the test specifically
for tendonitis itself.
It's called the speed test.
It's easy to do.
And that's why I picked this one, Brad
- And this is more specific to that tendon.
I like this one.
- Yeah. So what you do is, you stand
with your arm straight like this. okay.
And you might have somebody else do it,
or you can do it yourself.
and all you're gonna do, with the arm straight.
And it opened up completely like this.
- Right? So his Palm is Palm facing you,
thumb is out that way.
- Yeah. Facing away facing Lonnie
- This way, this way
- You're gonna do, just give some resistance there.
And if you, when you, if you do that resistance,
if you feel it up here, that means it's,
you know likely you have some bicipital tendonitis.
- Sure. Go ahead and do it again as a therapist.
This is what I do stand right there.
Palm out. Okay.
Don't let me move your hand.
Hold, push, push.
- Yep.
- Any pain with that?
- No?
- No.
So I don't have it right.
- Or, or yes, or another way to check it.
Yep. Is you can also check it up here.
- Same thing, Palm up.
- Same thing, yep.
- Hold it right there.
- And now reverse, What you can do
is you can actually turn it this way and try it again.
- Yep.
- And now it doesn't hurt.
Very points, really towards bicep tendonitis.
- Sure, okay.
- So, Alright, We bring into treatment here, Brad.
- Yeah,
- Alright, the number one treatment
that we like to do for this and it responds,
typically very well; is cross fiber friction massage.
- Yeah
- So you got to find, you're going to put your arm,
you know, up on a pillow, so it's, it's nice and relaxed
at that 90 degree angle.
- There you go, yep.
- And you're gonna have the arm.
I don't want it in like this.
I don't want it out like this.
I want it just straightforward like that.
- More in that neutral position.
- Yeah. And you're gonna go ahead, and you can do this
through a shirt or you can do it with the,
you know sleeve up right on the skin
but you're going to find that tender spot.
And this is what may take
take a little bit of, you know, palpating.
- Right.
- And you're gonna rub across it and I'm rubbing
you start off generally kind of soft.
- Right.
- And then you work up to the point
where you're rubbing very, very hard,
but I'm rubbing right across the tendon.
- Yeah. Remember the tendon goes up and down.
So we're going across it.
That's why it's called a cross friction massage.
- Now what has happened usually
with that tendon there's scarring and there's
maybe even slight little tears in it
and this helps it heal by getting more blood flow with it.
And it also helps break up the scars, so they heal strong.
- Right.
- Because what happens a lot of times is
you start using it and it was getting better.
And all of a sudden it hurts again because that scars
those scars broke open,
- Right.
- Because they're not as strong as regular tendon.
- And the key thing with this is once you find it,
that sore spot you can start working it,
and put some pressure deep into it.
If it, if hurts right away, that's normal.
But after about 30 seconds, it should clearly be improving.
I just
- 30 seconds to a minute I would say, I mean, yeah,
- I just did this yesterday to someone with an ankle sprain,
because you can use this on any joint anywhere in the body.
And it's pretty clear that if it starts to feel better,
or if they say, and I've experienced this myself,
it feels kind of numbish. That's good.
That means keep working.
- That's a good sign.
If not, you may wanna put some ice on it,
and back off for a couple days and then try it again.
- Right. Right.
- So, that's the number one treatment.
A lot of times you can do this
for a couple weeks and it goes away.
Cyriax, who invented this said 20 minutes every other day.
You can't do this for 20 minutes.
I don't know of anybody who can do this for 20 minutes.
- Your fingers get sore.
So, if you do five minutes here, five minutes there,
you could even do you know, five minutes, twice a day.
- Right.
- Just, you know again, we're breaking it up.
- Yeah.
- All right.
Let's go to the, let's say you actually have a tear.
Brad. You're having the pain
in the mid muscle here, instead.
- Okay.
- And this usually came from a lift or something.
- Aright.
- This isn't overuse.
You lifted something that was too heavy for you.
Usually feel it in the middle of the belly, muscle belly.
You're going to treat it the same way.
You're going to go ahead.
And you're gonna find that tender spot on there
and you're gonna rub across it again.
I'm not just pushing skin.
I'm getting down deep into the muscle,
- Right. Yep. So it's, it's right in there.
- Yep.
- He's got his shirt on.
So it's hard to see, but with my massive bicep you can,
these people can see. (Laughter)
- Yeah. I think I need my glasses.
- All right, same thing. Same guidelines,
20 minutes every other day.
But you can go ahead and just do it five minutes here
five minutes there and pick it up.
- Right? Right.
- These again, respond very, very well to the massage.
After that you're gonna want to start
doing some strengthening.
Now the big problem I see with a lot of weightlifters,
they go back and they just start lifting the same weights.
You can't do that, you gotta start off light.
- Yep.
- I mean, you got to build that muscle.
- It's got tremendously weaker after this injury.
- Right.
- You need to come after it appropriately and progressively.
- And the good thing is just to start with a
light weight and I, it's good to start
with the arm even pronated like this.
- So Palm away, Palm away and down.
- and then go into supination because again,
that's what the muscle does.
- Right?
It bends the elbow and it also supinates the forearm, so
- and look at Bob's doing a full range of motion.
I see so many people doing curls
and they just do little short ones.
Of course they use their body to get heavier weights
but good quality full range of motion,
along with the twist and the pronation, supination.
- And you can even do some eccentric ones if you want to.
- Sure.
- You can do a heavier weight and lift up.
- yep.
- with the other arm and then lower it down.
- That's in the early phases
- In early phases. In the later phases, Brad, if you want,
go to a pull up bar, go onto a chair, lower yourself down
get back up into the chair, lower yourself down,
you know just keep lowering yourself down with your biceps.
- So you're pushing your body up with your feet
and lowering it with your, the control of your hands.
- Body, You wanna show the, with the band, Brad.
- Sure. So with the band, I'm just gonna use my foot
for an anchor and I'm gonna go up to here.
And again, You still can do the supination, right?
Palm is up here and I rotate now the Palm is away
up full range of motion, and away.
And if you can do three sets of 10 and it's easy,
it's time to do more.
- now he doubles up.
- Yep. Simply just double it up.
You know, you can do that with the same color
of thera band or thera tubing.
And of course if you're in a gym or at home,
you have multiple colors of thera tubing
you can just increase the resistance appropriately.
- And the same with weights, you know, over time you can do
I mean, what are the 8, 6, 4 ladders or what,
when they do ladder
- pyramids,
- Pyramids? is that what it's called?
- Yeah. That's what I call them
- So, all right. That should do it.
That should take care of your problem.
And remember Brad and I can fix just about anything.
- Yeah. But we're working on this
that broken heart, Bob.
- That broken heart.