Why do the biceps tear during the deadlift? We cannot state for certainty why each individual experiences this type of injury during deadlifts but anecdotally there are some observations and theories that we can discuss.
Bicep tears during the deadlift often occur with the following characteristics:
1. They tend to happen to bigger lifters
2. They tend to occur to mixed grip deadlifters
3. They tend to occur to the arm where the hand is supinated ie. palm facing forward
4. They tend to occur on the distal tendon of the bicep ie. tendon closest to the elbow
5. They tend to occur in tear maximal weight attempts
There have been a growing number of case reports in the media about these injuries - in particular athletes such as powerlifters and bodybuilders with a history of anabolic steroid use. More recent studies have shown that the incidence of this injury is increasing and the age group that sufferers is getting younger. It is believed that full tendon ruptures will require surgery to restore the biceps role as an elbow flexor and supinator of the forearm to prevent loss of strength in these movements.
The most common mechanism of injury is a sudden elbow extension force applied whilst the elbow is flexed. This eccentric force produces a tensile stress that can suddenly rupture the distal tendon. Added to this may be the added compression of the tendon found in pronation and with the forearm flexors contracted, which may tense the aponeurosis and displace the tendon medially, thus producing a torsional force to the tendon. It is a rare injury (1.2 ruptures per 100,000 patients per year) and the typical sufferer age is a male in his late 40s. The dominant arm is involved 86% of the time, and smokers have 7.5 times greater risk of injury.
Patients with a distal biceps tendon injury typically experience a tearing sensation or ‘twanging’ and an acute onset of pain after an unexpected or massive extension force has been applied to the flexed elbow. Typically, there is pain and deformity with weakness of supination. Gross swelling may develop over the cubital fossa in the hours following. If the biceps aponeurosis remains intact, the rupture may be clinically missed.
It is generally accepted that operative repair leads to better functional outcomes versus non-operative repairs. To summarise some of the leading studies on non-operative versus operative management:
1. Operative repair leads to better supination strength and elbow flexion strength and endurance.
2. An untreated biceps tendon rupture can result in 40% loss of supination power, with 30% loss in elbow flexion strength.
3. There are better subjective outcomes and objective isokinetic testing following operative repairs.
Retrospective studies of non-operative versus operative repair show that at 5 years post injury, supination strength was only 74% to that of operated tendons. Flexion strength was 88% compared to repaired tendons. The difference was even more pronounced if the dominant arm was injured.
Non-operative treatment is now generally reserved for sedentary patients who do not require elbow flexion and supination strength/endurance, or for patients who are not medically fit for operative treatment. Non-operative treatment consists of temporary immobilisation, pain control, and physiotherapy.
If surgical treatment of a complete distal biceps tendon rupture is delayed, a combination of muscle retraction, adhesion formation, distal tendon shortening, and degeneration can make anatomic reinsertion of the original tendon difficult. Outcome comparisons of acute and chronic repairs suggest a surgical delay greater than 10 days post-injury increases the risk of complications and the extent of anterior dissection required.
The literature describes anatomic versus non-anatomic repairs, single incision repairs and two incision repairs using bone anchors, suture tunnels, suture anchors, cortical buttons and interference screws to attach the distal tendon to the radial tuberosity.
But how do you deadlift with a bicep tear? There are three main ways to train the deadlift movement with a bicep tear. You can either deadlift using double overhand hook grip, deadlift using a Barbell Strap from Repel Bullies or train movement patterns similar to the deadlift. The severity of the bicep tear will determine which is best.
#deadlift #biceptear #TornBicep
28 сен 2024
