This is Part 4 in a series about torn biceps tendons. Start with part 1. It has been nearly 8 months since I tore mine. My confidence in the scarred tendon continues to grow. I’m now comfortable pushing to failure on most bicep exercises. Check out this video.
Scar Tissue Slowly Becoming “Tendon-Like”
The total healing time for an injured tendon can take over 12 months. 
What I have in my arm now is scar tissue that is acting as tendon tissue. It is relatively strong compared to 4 months post injury, but it is not “tendon strong”. Every time I perform a loaded eccentric movement, I am essentially teaching the fibrous scar tissue how to behave. Imagine a ball of cotton with fibers crossing over each other in every possible direction. This is a good analogy to what collagen matrix (scar tissue) looks like initially. During eccentric loading, the scar tissue fibers are pulled, which induces the collagen fibers to align in the direction of stress (in parallel as in the image below). During this process, the collagen matrix slowly organizes itself into a more rope like structure, gaining strength and elasticity. However, the scar tissue is physically different from the original tendon tissue, and the fibers will never look as parallel as the original. Source
It is unlikely that the new tissue will ever have the same strength and elasticity as the original tendon. I accept this fact with gratitude that I have already achieved nearly 100% function and strength. Also, I have learned to pay close attention to my movements with this arm and have eliminated some movements which I describe below. I spend a few minutes every morning stretching the biceps, which not only improves circulation, but also elasticity, and my own confidence in the repair. Source
What I still can’t do
Here are a few activities that I will still not perform due to an internal sense of caution. Anyone who has torn a tendon knows what this “sense” feels like. It is part fear and part nausea inducing discomfort that tells the nervous system to shut down the arm when risk is perceived. Obeying this feeling is the single most important key to recovery.
- Preacher curls of any weight. They just feel wrong, even at light weight.
- Deadlift with a mixed grip. The loaded bicep in full extension freaks me out. Now I deadlift with double overhand grip.
- Gymnast rings moves that put my shoulder in extension. I can do dips on rings, no problem. I can even to muscle ups. But the moment I put my fully extended arm into external shoulder rotation, my central nervous system says it’s a “no go”. I hope to return to the rings with the same vigor as before, but it is clearly not time.
Additional Strategies I Have Used to Speed Recovery
In addition to the supplements mentioned in the prior articles about this injury, I have seen several bodyworkers including a Rolfer, a deep tissue massage therapist, and a trusted chiropractor. Acute injuries cause imbalances in the surrounding tissues. This is because other muscles and connective tissues are assigned tasks normally performed by the damaged ones. Overuse injuries that develop in adjacent areas of the body can persist for months unless actively treated with proper body work. This was the case for me. My brachioradialis muscle assumed the job of flexing my arm. The muscles of my forearm began to work overtime due to the lack of supination normally provided by my biceps. I developed trigger points in the brachioradialis as well as tendon irritation at the medial epicondyle, (the bony protrusion on the inside of the elbow). These minor injuries are side effects of the larger problem, but simply did not go away until I got some professional help.
I don’t take any NSAIDs, and have instead begun a regimen of self massage, which has the added benefit of keeping the rest of my body working efficiently. NSAIDs have a laundry list of nasty side effects, including slowing injury recovery.
I continue to train 6 days a week, eat a rock solid clean diet, avoid alcohol and nicotine, and sleep at least 8 hours per night. I drink a gallon of water per day, keep my stress levels in check, and meditate daily.
Hopefully, the next update will include a video of me back on the rings!
So grateful for you sharing your journey. I have > 75% tear and went with advice from surgeon to not operate. He mentioned about scar tissue and how it won’t be exactly tendon like but will do its job in the same manner a gash, not stitched, will fill in with scar tissue and while not be exactly skin, be ‘like’ skin.
I was about to get back to P90X (did for a year two years ago and shoulder rotator cuff was getting int the way) as I put on too much weight and have not been active. But, loading a lawn tractor onto a trailer slipped and while holding the tractor with an extended left arm, I got the ‘pop’.
I am doing minor PT exercises each day and have been timid to do much else. it has been 90 days and I have some strength back.
Your article has inspired me to get to a regimen and push a little more on exercise – I fell into a, ” well – looks like I can’t do any exercise now…” funk.
Thanks again for posting and sharing – it is inspirational to me
Darin, thanks for sharing your story. I understand the “funk”, trust me. The key is to keep moving. I wish you luck with your recovery. Stay positive, stay active, and let me know how it’s going.
I tore my bicep tendon on New Year’s eve 2019 due to my arm being at full extension and trying to pull it towards me after someone pulled it off the steering wheel and was holding onto it preventing me from regaining control of the vehicle while I was driving. The first week after I literally could not use my right arm. After three weeks I went to the doctor just for documentation and after an MRI I found out I had a 50% torn long head distal bicep tendon…They treated me with NSAIDs topical and oral for a month and then the orthopedic surgeon said in order to get full function I would have to undergo surgery. You could visibly see a retraction in the long head of my bicep as I have high insertion points (long tendons, short bellies). Currently I am eight days out from surgery. They performed an endobutton with a PEEK retention screw. The doctor said the surgery went as anticipated no complications I currently have numbness due to the displacement of the Lateral antebrachial cutaneous nerve during surgery and it can take several months for that to subside. I go for my first check-up in two days at the 10 day mark (29MAR19). I honestly did not realize how intense the surgery was, they cut the biceps tendon completely, suture the end of the tendon with a whip-stitch, drill a hole in my radius bone where it was previously attached, tie the suture to a titanium button slide it through the hole and then turn it sideways so it anchors to the bottom of the bone, they then use the sutures to pull the tendon down inside the bone, and they finally put a screw on the top to further secure the tendon inside the bone and to prevent pistoning which can increase healing time.
I wish you the best of luck with your recovery. It’s a very intense surgery. Let us know how you recover.
Hi Josh, how is your bicep now? Have you fully regained the strength?
Excellent article. I injured my biceps tendon 30 years ago doing shadow boxing. It’s been weak ever since. Recently, I was hoisting an 80 lb bag of Kwikrete and I felt the damage in the shoulder … had to drop the bag. I suspect it’s the shorter tendon and partially torn at the shoulder.
Really appreciate your detailed analysis of how you handled it. Surgery is out for me, but I have to find a way to work around it. I’ve been doing upper body weights 2-3 X per week, and just recently had added biceps curls even though they generally make my left arm throb. I do HIIT 3X per week as well.
I have to figure out how I’m going to work around this injury, but I have to accept that it will likely never be 100%. It has been compromised for 30+ years already but hasn’t affected my activities. Now, I will probably have to work around it.
Appreciate your excellent guidance. Thank you.
Probably the best information I have found as I start this journey to recovery. I am an active Brazilian Jiu Jitsu student and competitor that trains from 4-6 days a week. I also work out in a gym 5 days a week. I was an addicted power lifter from about 17-27 with sporadic gym time after that until last fall at 45. I was taking it slow back with weights due to prior shoulder injury. This week I used the preacher curl for the first time in over a decade feeling confident with the gains. Wonder if that over stressed my bicep tendon as I felt very fatigued around that area. The next day at jiu jitsu, I went to roll a much larger man off me but had my right arm extended at 90 degrees grabbing his knee. I got him off just in time to hear a POP and bicep swell into a baseball…
So, a PT therapist and another student there assisted and thought it was a partial tear because I had pretty good range of motion. I iced it with 5 minutes of injury and intermittently ever since. I don’t intend on getting surgery as everything seems to indicate this was at the musculotendinous junction and partial…
Seems an MRI is at least warranted though and your advice and shared knowledge will be something I come back to often. There is a light at the end of the tunnel!! Thank you.
Gabriel, thank you for sharing your story. Many people with this injury have visited this page and felt a great deal of relief to know there is someone else out there struggling for lack of information and struggling with the decisions required. I hope you will share the results of the MRI with us. I have been exactly where you are (as have many of the other readers here). I understand what you’re going through, especially since you have been so active all your life. Stay strong and positive. And please come back here and share your recovery story with us. It means a lot to me personally and it helps people tremendously. I wish you the best.
Hi,
Really glad I’ve found your experience. Long story short, I was powerlift training AND training for a marathon about 18 months ago and felt a gradual soreness in my distal bicep.
No pop, no bruising, no “pop eye” bulge. Just an acute pain when doing any supinated
I’ve just come back from a physio appointment (I’m in the UK) having been told she thinks I’ve ruptured my bicep. I’m now waiting for an MRI appointment.
Of course, I’ve immediately gone to Dr Google to find out that it needs to be seen after a few weeks, not months!
Simply because I didn’t know I’d done this, and assumed it was tendonitis, I’ve worked around the problem. Deadlifts, squats etc are all fine… I only have problems with bicep work (I can still go relatively heavy- but it hurts) and rows are a bit painful.
I don’t want to have surgery. I don’t want to have months out from the gym, and I’m reading that the process isn’t always terribly successful.
A couple of questions… any advice would be great.
Can it get “worse”- surely once it’s gone…it’s gone? Am I likely to be doing more damage by *not* having surgery.
I read that once it’s torn it can’t actually heal on it’s own. Is that not correct?
Carlos,
The only way to shed any light on your situation is with an MRI. The MRI will show how much, if any, the tendon has retracted. After you’ve had the MRI, please come back here and tell me what the report says or email me the report if you’d like me to give my opinion. In partial answer to your second question: If there is no retraction, or minimal retraction, then your chances are good at recovering without surgery. This is because scar tissue forms and over time will become “tendon like” and take over the job that the intact tendon once performed. (This is what has happened in my case.) The fact that you are 18 months post injury is a limiting factor, but there’s no use in me expounding on this until we have the facts.
In answer to your first question: If the tendon is partially torn, then yes, you can blow it fully by ignoring the warning signs (ignoring the pain). Again, the fact that you’ve dealt with this for 18 months tells me that you are either very good at favoring the tendon, or it has enough strength.
If you have had the same symptoms for 18 months, can you tell me how, if at all, the symptoms have changed over time? Tell me about where exactly you feel the pain. I have a lot of questions for you, but I think it’s best that I don’t ask you much else until you have the MRI. Otherwise, anything I say is just a guess.
Jacob, thank you so much for writing this. I was training for my first bodybuilding show when i tore my bicep 3 weeks ago. I got surgery two weeks ago and it is healing well i think. The atrophy in my arm has been alarming and soul crushing honestly. Even my pec on that side isnt as full anymore. How have you trained your pec muscle on the injured side? I am looking for solutions for that while the tendon heals.
Thanks you Jacob! This blog is an inspiration!
Josh,
I understand the soul crushing loss of muscle. Don’t worry. It comes back amazingly quickly. You must continue to train the good side of your body. Perform single arm dumb bell press and cable flys on the good side. The injured side will respond to training the good side via a phenomenon called “contralateral effects, also known as “cross education” or “cross training effects”. These terms refer to the scientific findings that untrained limbs increase in strength and size during unilateral training of the opposite limb. Regarding training your injured side, I think you need to wait at least 6 weeks post surgery. The risks are too high. It is very difficult, if not impossible, to train your pec without engaging the biceps tendon. You simply can’t afford to blow it at this point. I know this isn’t what you want to hear.
Train your legs like crazy. Trust me on this. If you put an inch of muscle on your legs, then your upper body will respond due to hormonal cascades. Take advantage of this time to train your legs like you have never trained them before. You can train them 2 to 3 times per week and still recover since there is minimal volume load on your upper body.
Keep your diet on point as you were training for your competition. Sleep, hydration, supplements, and especially collagen, are all of utmost importance. Treat your body like you are a pro athlete. You will heal quickly.
Keep me updated on your progress and ask me questions any time. I wish you the best. I would love to hear back from you because your story will motivate and inspire someone else in the future who has suffered this injury.
Please stay in touch—Jacob
Thank you so much for this! You reached out to me on YT and I’m so glad you did. Surgeon told me that I’d need a cadaver tendon allograph and 6 months basically as a 1 armed person. I’m not a medical doctor, but common sense tells me that a cadaver tendon from most likely an untrained person being put into a person who has strengthened their bones, muscles, and tendons with 35+ years of lifting is going to be a massive weak link and ripe for rupture later. I’m still in the window of time that I can get this alternative surgery but way passed the window to do the “primary” repair. I did similar to you, working around and “listening” to my body, pushing the bicep area only enough to keep it active. I’m now 39 weeks post tear and it’s doing really well. No pain unless I accidentally push it. Still weak as heck, but seems to be improving. Different from you, I never had a “pop” or anything like that… more of a velcro like slow tear. I really thought it was just muscle until the MRI said otherwise.
Handy Dad, I’m so glad you found this site useful. I’m happy for you that it seems you are healing well. Please continue to share your story with us. There are many other people who would love to know how your recovery is going. As you know, there’s not much information out there about this injury. This means your insights and your experience are very valuable to us. Thank you for sharing your story.
Thanks so much for this. Im so glad I came across your article as it has inspired me to get moving. Im a former competitive powerlifter that partially tore my bicep. My injury occurred about 3 weeks ago and i have had an MRI that revealed a partial tear of the distal bicep tendon with intact fibres. I have some retraction but also have full range of motion and dont have supination or pronation problems however my arm does fatigue quickly when doing these motions and generally feels weak as if my bicep area is missing
Orthopedic surgeon suggested i either get surgery now to fix the tendon or wait till it fully tears at which point i would need surgery for sure in his opinion. Im no longer competing in powerlifting but its still a hobby to get in the gym and lift some weights.
Since my injury I’ve been feeling quite depressed as my doctor told me to avoid using the injured arm. But i have noticed less pain since the injury and i end up using it for things here and there.
Do you think i should start a similar training regiment as yours since i am around the same time frame of injury? In about a week I will be at 4 weeks since the injury. Thanks
Yes, I think you could begin training, but you must exercise extreme caution at this point. Your tendon is still very weak and susceptible to a complete tear. Pay attention to any pain and stop immediately if it hurts. Move slowly and deliberately. Most importantly, be patient and keep your nutrition and sleep on point. You will heal!
Jacob, Words alone don’t express how grateful I feel stumbling onto your website chronicling your inspirational story to recovery. I need to go back to the beginning and read it again, more closely this time, as I am currently in somewhat of a feeding frenzy for knowledge concerning distal biceps tendon rupture…. I am certain I ruptured mine just a few hours ago.
My short story so far: I am a 55 year-old medical doctor with a passion for surfing and staying fit. About 12 hours ago I was at the gym lifting weights per my usual routine and sat at the preacher bench for one arm bicep curls. On my second set the right elbow literally popped with immediate excruciating pain. It took all my focus not to pass out or vomit as I scurried back to my car like a wounded animal.
At home I detected a mild abnormal biceps bulge with weakness and a relatively soft muscle belly on contraction. Supination and pronation elicits great pain. I managed to get the MRI 5 hours after injury and I should have the results in a few hours. In the meantime I’m sleepless, obsessing, looking for information on the internet which is how I came to you…. you are a saint and an inspiration! Thanks again Jacob.
Bruce,
I know exactly what you are going through. The waiting game is horrible and there is so little information out there about this injury. I’ll be thinking about you in the meantime and will be anxious to hear about your diagnosis. Please come back and let us all know what the MRI revealed. Sincerely…Jacob
Jacob,
I have a severe partial tear approx 70% with 1 cm retraction. Excellent ROM with little to no pain at rest currently. Will manage conservatively without surgery for now. Plan is No loading of biceps muscle for 4 weeks with daily light cardiovascular work for increased blood flow. Increase water intake and add collagen and turmeric supplements in addition to Chondroitin and fish oil. Discovered informative journal articles on management of partial tears if anyone is interested. This will be an interesting journey…
Thanks again Jacob
Jacob, I’m 8 days out now and healing… Briefly: I have little to no pain at rest and excellent range of motion considering the injury. I’m not loading the muscle yet but I’m trying to stay active. My MRI shows a partial tear (approx.70%) with complete avulsion of the anterior aspect of the insertion. I’ve decided to try a course of conservative management without surgery for now and have the support of two orthopedic surgeons, one of which has done many distal bicep tendon repair operations. One even stated that if he tore his he wouldn’t repair it.
I found a couple of informative journal articles that influenced my decision not to have surgery and I am more than willing to share these with anyone out there. So for now I’m doing daily light aerobic exercise, increasing water intake, taking collagen supplements, abstaining from alcohol and sleeping at least 8 hours/night. Keeping a positive attitude and letting pain be my guide as I move forward…
Thanks again Jacob!!
Bruce
I would love to read the journal articles. Please share!
Jacob & everyone else, I’m exactly one week out:
MRI- completely avulsed/torn short head portion of distal tendon with 1 cm retraction and intact long head component. My distal tendon footprint on the redial tuberosity was short head 70% long head 30%. So I have approx 70% tear
Pain – markedly diminished with little to no pain at rest and mild discomfort with movement and activity mainly pronation/supination
Range of motion- seemingly full pronation/supination ROM with some loss of flexion at the extreme
Strength- afraid and unwilling to test at this point but I think I’ve definitely lost flexion strength. Grip strength feels good when opening jars or bottles.
Appearance- definite but minor loss of bulk in antecubital fossa and distal bicep muscle at rest. Don’t know what it looks like flexed yet. No bruising
Surgeon- he personally reviewed MRI images and after physical exam felt I had a total or near total rupture. Interestingly he didn’t push against my initial decision to not have surgery and told me he had a number of patients who did remarkably well without surgery. Says we can operate later if necessary
Activity- Fisrt 2 days I was in bed with severe pain and not sleeping well. Appetite came back day 3-4 and now I’m fully active but severely restricting right arm use with no loading of the muscle.
Plan- increase water intake. Started collagen and turmeric supplements in addition to Chondroitin and fish oil. At least 30 minute light cardiovascular (jogging) daily to improve blood flow and mood. No right bicep loading for at least 4 weeks.
Did a lot of research and found some informative journal articles on partial distal tendon rupture that influenced my decision to not operate. Nonsurgical management is not always successful. In one report of 64 patients with partial tears about half eventually underwent surgery while another reported that ALL of their patients failed conservative management.
It will be an interesting journey…
Thanks again Jacob
Thanks for sharing your story Bruce! Please come back and give us updates about how you are doing. I’ll be particularly interested in your story given you have opted against surgery. Best of luck to you my friend!
Jacob,
I’m one week out and the pain has greatly subsided with essentially none at rest. I’m not loading the arm st all. MRI shows partial tear approximately 70%. After consulting with 2 orthopedic surgeons I’ve decided to attempt conservative management without surgery. This will be an interesting surgery. I really thank you sharing your experience since I am using it to formulate my plan going forward…
Bruce
Hi Bruce. I wish you the best of luck. Please come back here and let us know how your recovery goes without surgery.
Jacob, I’m 8 days out now and healing… Briefly: I have little to no pain at rest and excellent range of motion considering the injury. I’m not loading the muscle yet but I’m trying to stay active. My MRI shows a partial tear (approx.70%) with complete avulsion of the anterior aspect of the insertion. I’ve decided to try a course of conservative management without surgery for now and have the support of two orthopedic surgeons, one of which has done many distal bicep tendon repair operations. One even stated that if he tore his he wouldn’t repair it.
I found a couple of informative journal articles that influenced my decision not to have surgery and I am more than willing to share these with anyone out there. So for now I’m doing daily light aerobic exercise, increasing water intake, taking collagen supplements, abstaining from alcohol and sleeping at least 8 hours/night. Keeping a positive attitude and letting pain be my guide as I move forward…
Thanks again Jacob!!
Bruce
I had a “poc” on my left biceps after boxing. I manage myself for 3-4 days and aproximatly all the pain disapeard , i try stretch , massage the biceps because it retracted up to my shoulder like 1 finger compared to the right one. I went to the doctor 3 weeks after the injury and take an MRI wich showed a 9mm tendon rupture and a blood bubble (hematoma). The doctor recomanded me to not even lift a 5liter water tank with the left arm and take a 3-4months pause , but i went to the gym like 3-4 times and stil did my full body program ,before i taked the MRI ,beside the left back and left biceps because i was afraid. I could lift 5-6 kg at biceps curls compared with the right one wich i curl 20kg. I did soulder press , push ups , chest dumbells , ,lateral raises with no pain at all and big weight. I still can’t flex my bicep at maximum because pain occure. In 4 days it will be 4 weeks after the surgery, i don’t know if i should train my injured bicep and train the right part of the body. I am afraid i would lose my muscle if i’m not training and i’f im training i’m afraid i injure more badly the actual rupture. Thank you much for sharing the experience and all my respect for everyone who manage to get over this situation.
Octavian, It seems as though you have severely ruptured your bicep tendon. You have a decision to make. You can have the surgery to have it repaired or you can live with it as is. If you have 1 inch of retraction, then your injured bicep will never perform as it once did without surgery. However, many people choose to live with this injury and have mostly normal function, but with some weakness in supination. Do not train the injured arm for 6 full weeks post injury. Then you must rehab the arm very carefully to avoid more problems. Can you email me the MRI report?
I’m glad I came across your blog to confirm some of the rehab, and general progress. I had a full distal tendon rupture of my left arm in 2013, and had reattached with the Endo button procedure. They wrapped it then put in a cast for several weeks and then brace for a month or so more, then PT to regain use of the hand. The doctor at the time said now we have to watch for the right arm, as is likely to rupture well before left arm has problems again. So January 2 of this year, a cold evening while training Brazilian jiu jitsu, I extended my arm to push on my partner’s leg, heard two pops and a tear, and knew the bicep tendon was torn. This time it was mine right arm (dominant). This one was not a complete rupture, as there was little retraction, and a lot of pain on supination. The left arm in 2013 had almost no pain, due to being completely torn. From my perspective, surgery was the only option, and this time the procedure was similar with the Endo button but with the addition of the screw and the single incision direction was parallel with the arm. Also, no brace, and after four days post-surgery was able to unwrap the arm take showers and begin rehab and straightening the arm. So I am at 12 days post-surgery, and can almost fully extend the arm, rotate the shoulder, fairly good range of motion, and even supporting its own weight for a short time before fatigue. Only the pronation and supination of the hand/arm is painful and with little range of motion. The surgeon said I should have full recovery within six months, so I’m hoping for full recovery within four or just over. I just wanted to share my experience, as I would advocate for surgery in almost all cases of fully or +50% partial tear. (unless age and health factors prevent). The non surgery seems to take just as much, if not more time to get back at full or near full range of motion and capability. So far the left arm is been fairly bulletproof. So I have high expectations that a re-rupture has a very low percentage for either arm at this point, as long as I do not do something dramatically stupid. My only regret was not knowing to shop around for surgeons for the first time in 2013. He was a great guy and fix the arm, but did not fully extend the bicep/left it a little high. So my bicep experiences severe cramps at times when fully contracted, in addition to the cosmetic issue. So far this one seems to be much better, and I explicitly asked the doctor to get it as tight as possible back to normal, which he said of course and had no problem doing apparently. In 2013 I had virtually no information on diet, supplements, and other rehab information, so it’s good to read your story to confirm what you and so are others here are doing, and that I’m generally on the right path. In addition to the collagen and other diet/supplement information, I recommend using a strong magnesium lotion on the arm and shoulder while massaging and preparing for sleep. This really helps to relax my arm, and subdue some of the pain in my shoulder which is the most painful body part at this point due to the immobilization. I didn’t see mentioned of the magnesium, but may have overlooked it. Please forgive any typos or grammar goofs, since I have to use Dragon naturally speaking to dictate (can’t type). Good luck to everyone else going through this!
Edward, thank you so much for sharing your story. I appreciate your detail and I know your story will help someone in this situation. I wish you the best of luck. —Jacob
Had my right side repaired about 5 years ago and just got the left side repaired about 1 week ago. You have the best website going. I considered doing a blog but you got this thing covered from A-Z. Nice work!
My doc also warned me when I had my right side repaired that the left was probably not far behind. Sure enough about 5 years later the left side finally went. This time it was only a partial and I struggled to make the decision whether to operate or not but I went through with it since I do like to lift heavy weights I assumed getting the operation would be the faster more promising road to recovery. The same doc that repaired my right side also repaired my left so that was also reassuring to me. This site is great. What a wealth of information. Cheers to your recovery my friends.
Hey Jacob,
I injured my right bicep while goalkeeping in August 2017, doc diagnosed that there was partial tear in my distal bicep tendon and he recommended surgery to fix it…
I was not convinced for d surgery so avoided d same…I continued to workout in gym untill Dec 2017, hoping it to recover by itself…
But from Jan 2018 since a year I have been off my workouts completely..
Post injury I have developed a Popeye muscle and my strength has also gone down..
Is there anyway that my bicep tendon can heal by itself..
Do I need to follow some specific diet..
I do not wish to go for surgery as it looks restrict my movement for at least 3 months…
Shall I resume nm y workouibas I have piles on 12 kgs already..
PL guide me
Thanks
Jayesh,
If you have developed a Popeye muscle, then you most likely have severe tendon retraction. This probably means that without surgery, you will have limited supination strength in the injured arm. Many people function fine without surgery. If you have no pain, I would say it is safe to train normally.
Hi Jacob, so glad I came across this.. I was recently doing weighted chin-ups 2 days ago and felt the pop and pain. I don’t notice any swelling at the moment , just some slight bruising at the forearm . I have full range of motion with supination, but it hurts to lift at or open doors at some angles. On a pain scale of 1-10 it’s more like a 3-4 at this point. I’m laying off any workouts that have direct bicep work or pulling. I suspect a minor tear , but I’m not planning on MRI or doctor visit just yet. What are your thoughts?
HI Derek. I’m sorry I didn’t answer this sooner as I’ve been traveling. If you choose the conservative route, then you must be extremely cautious with the arm for at least 6 weeks. Then obey any pain as you begin to rehab. Do you have any visible difference in the two biceps?
Jacob, Short refresher with update:
Ruptured distal bicep tendon 9 weeks ago with 2 cm retraction on MRI. Decided against surgical repair.
I can easily do assisted chin ups mostly pain free. Haven’t tried unassisted yet. 10 lb dumbbell curls elicit mild forearm pain at about rep 20-25 now. Mild pain in certain positions with motion like supination/pronation. I am definitely making gains, though slowly, but I’m happy where I’m at considering I didn’t have surgical repair
I have pronation/supination weakness that is really noticeable with a light dumbbell in hand and the arm straight, raised in front or lateral, parallel to the ground.
I’ll be increasing weight and resistance going forward but will continue to back off if painful. Looking forward to what the next few weeks bring.
Thanks again for your inspiration!!
Bruce
Hi there!…i completely tore my biceps distal tendon in left arm….almost 3 weeks now…im 52 and active in the gym…not sure what to do here as i don’t want SURGERY….what can i expect….if i train will i be able to do any pressing movement’s as shoulders etc…. looking for help as my Dr.mentioned i can go to gym after 6 week’s and train light.
Many people are walking around living normal lives without a distal biceps attachment. If your tendon is completely ruptured, meaning there is no attachment remaining, then you will lose some supination strength. But over time, the surrounding musculature will mostly be able to do the work of your biceps. You will certainly be able to perform pressing movements without a biceps. Let me know how you’re recovering.
Hi Jacob – Thank you for creating this site and your series of blogs regarding your experience with a distal bicep partial tear. If you were given a percentage tear by the surgeons, do you think you would have decided to have surgery? If so, at what percent of partial tearing? I noticed you mentioned none of your surgeons provided you with a percentage of tearing. My name is Jamie – I’m 34, a guy, and avid weight lifter. I had an injury doing preacher curls on Saturday, February 2, 2019. I had 25 lbs. on each side of the preacher bar. This is a normal-to-light weight for me when doing biceps curls, but I’ve not been regularly training Biceps using the preacher curl bench. I usually use 45 lb. dumbbells seated on an incline and sometimes standing. During the third set of curls, on the eccentric motion, I heard and felt a pop followed by another pop. The motion was not smooth in my left arm. My right arm was okay. I should have dropped the weight after the first pop, but the second pop followed within a second. Within seconds, I felt pain. Within minutes, I felt more pain. Since it was already my last set, I took off the weights with my right arm and finished with sit-ups and a shower. Given the pops I felt and heard and the pain, I knew something was wrong right after this happened. Nine days later an MRI was taken. The report says “High-grade partial thickness undersurface tear of the distal biceps tendon at the radial tuberosity with associated bicipital radialis bursitis and superimposed on mild tendinosis. Mild subenthesial marrow edema in the radial tuberosity. No retraction of torn fibers. Mild common extensor tendinosis.” Orthopedic Surgeon says I have very high-grade tear, stating the tendon is 80% to 85% torn off the bone and functionally almost like a complete tear. Second orthopedic surgeon says tendon is 80% torn off the bone. Both surgeons recommend surgery but say it is NOT wrong to forego surgery to observe any progress. It has been almost five weeks since I tore the tendon. I have not attempted eccentric loading yet, but I’m going to start tomorrow with 2.5 lbs. I’ve only begun to be able to flex the biceps at 4 weeks, and it’s a sad flex. Have mild irritation at outer elbow when flexing. Afraid to flex for more than a second – it feels weird and fragile. Will keep all interested parties posted. May decide to do surgery in near future, but I could not get comfortable with surgery at four weeks when given the opportunity for surgery. Felt I needed to give it more time to determine what strength I might obtain. The lingering fear is that with 80 to 85% tear, at what weight will I tear it completely as I begin eccentric loading? Hopefully that does not happen, but it’s what I’m fearfully thinking.
Jamie, Thank you so much for sharing your story. If there is no retraction, that is a very good sign that you can recover fully from this. Scar tissue can become tendon like over time. Do nothing to rush the healing process. Take it slow and do a shitload of eccentrics with super light weight. Obey any pain. Please keep us posted on your recovery. I wish you the best of luck.
Thanks Jacob. A year later, I thought I’d provide an update. After 7 weeks from my injury on Sat, Feb 02, 2019, and much self-battling over whether to pursue surgery, I threw in the towel and opted for surgery.
I had consulted with two surgeons. The second, an NYU surgeon, on my first visit to him about 3.5 weeks after the tear, reviewed the MRI and mentioned if I didn’t do the surgery now, I’d most likely be doing it in the future. The first surgeon gave me the confidence to go 7 weeks (or more) before deciding on surgery by saying with the 80 to 85% tear, it was not wrong to try recovering without surgery. Combined with the inspiration from your blog, I went about two months before the surgery. I would agree – it’s not wrong to try and see if you recover if you have a partial tear and the surgeon okays it after reviewing an MRI. But do get an MRI. Since I did not have visible retraction of torn fibers, although I had 80 to 85% tear, I tried no surgery for about two months.
At about week 4, before surgery, I tried curling 2.5 lb dumb-bells. I got up to 7.5 lbs by week 6 but it felt weird and weak. I did focus on eccentrics, but not enough of them. I may have been able to do 7.5 lbs. at week 4, but I didn’t try – started with 2.5 lbs, which felt okay and bumped by 2.5 lbs each week. Getting past 7.5 lbs in two weeks did not happen. On another note, I could still bench press at this time, but I did 60% of my usual weight when I tried. With much mental anguish for almost two months, I decided to have the surgery. My surgery happened on March 25, 2019, performed by Laith Jazrawi, M.D. of NYU.
I spent almost two weeks immobilized in a hard cast post-op. I hated it and would advise others to seek out surgeons willing to allow a soft-cast for mobility sooner, but discuss the risks. Anyhow, my surgeon put me in a hinged elbow brace for six weeks after the hard-cast was removed. The protocol is on the NYU site at https://www.newyorkortho.com/pdf/distal_biceps_tendon_repair_rehab_protocol.pdf for others who might want to compare. My surgeon wrote the protocol or was the lead author.
I started PT at week 10, per my surgeons instructions, for about two months. When I visited Dr. Jazrawi a month into PT and mentioned I was doing direct bicep curls up to 15 lbs at 14 weeks post-op in PT, he directed me and the PT to stop the direct bicep activation. We stopped for remainder of PT. I think he was cautious since I had nerve complications and complained to him about nerve tingling and persistent numbness. Those complications lasted 7 months post-op. Namely, I had numbness along the radial bone down to my fingers. You could claw me and I’d barely feel it. I also had a pins-and-needles feeling at times. Dr. Jazrawi had to move the lateral antebrachial cutaneous nerve during surgery. I suppose that caused the tingling and numbness, but it did go away after 7 grueling months. My last visit to Dr. Jazrawi was Oct 10, 2019. At that time, he cleared me to do direct biceps curls. I told him I had begun them a couple weeks prior, since it was six months post op by Sept 25, 2019 when I started, with 10 lbs. I increased by 2.5 and then by 5 lbs about bi-weekly. I allowed myself to curl with dumbbells only thus far and have not gone beyond 35 lbs with my recovering arm. My uninjured arm curls 45 lbs 3 sets of 12 without issue, for comparison. I can max it heavier, but I don’t any more. My goal is to recover 100% and get my left arm to match my right and back to where it was prior to the mess. I have ten lbs to go. I did get some weirdness feelings at the surgery site a few times after lifting, but I think that may be scar tissue I’m working around. Range of motion is about 95% on supination. That is a bummer. I am careful to stretch before I do the bicep curls by supinating fully using my right arm to supinate my left beyond 95% since when I put weight on the left for the curls, the weight allows for beyond 95%. I did lots of PT to address supination and stuck at 95%. I’m looking forward to 100% strength recovery in the next few months. Due to COVID-19, I have been unable to lift at the gym for a month, and I have access to two gyms, both closed. Perhaps I’ll buy a set of dumbbells. I’ve had weights at home before but got rid of them when I moved. Bad decision. Also, I have told myself I’ll never use the preacher curl bench again; that’s the machine I was using when it tore on the eccentric motion. Once I’m back to 100% with dumbbells, however, I plan to begin using a curl bar again for standing curls with a very slow and controlled motion. I could do them now, but I just have not out of fear. If anyone else has a partial tear up to 85% with no retraction of torn fibers visible, it does not hurt to try recovering without surgery. I’ll always wonder if I could have recovered without surgery by giving it more than two months. Happy to share my surgery notes with you and imaging if you’d like to see any of it. Thanks again for this blog post and the blog, in general.
Jamie, Thank you so much for sharing your story. I hope you reach 100% soon!
Jacob & Others,
55 year old active and otherwise healthy, decided against surgical repair
Update 4 months after complete distal biceps tendon rupture:
Steadily improving to the point that I have normal daily functioning and generally only notice weakness in the gym- specifically with bicep curls and pronation/supination motions. I suspect strength will continue to improve but I don’t believe it will ever fully return to pre-tear levels. I’m OK with this since I am back to normal surfing paddling strength and there is no effect on bicycling or running. I did have some difficulty lifting a heavy suitcase out of a truck bed using only the injured arm yesterday but I should have been smart and used both arms. There is still occasional aching pain but this is very minor.
Good luck to all of you out there…
Bruce
Hi Jacob,
I hurt my right bicep doing rings (at an indoor obstacle course) and I immediately felt a tearing sensation. This happened on April 13th. I had previously a felt a minor tearing sensation doing mixed grips DLs a few weeks earlier, but my arm felt pretty good after dialing back a little, but not as much as I should have as I obviously wasn’t fully recovered.
Pain was real bad on the 14th/15th, could hardly move the arm, poor range of motion, etc.
I just got an ultrasound last week (had to wait a fee weeks for a free appointment) and saw the doc today. The initial interpretation is a high grade partial thickness distal tear of the long head of the biceps tendon.
Since the 13th, I was put on anti inflammatory meds, been taking 2 a day. I’ve still continued to train, lower body, left upper body, running, sprinting, etc. Doing light band, weight work on right arm, physio/rehab type exercises, etc. I eat really healthy, and do intermittent Swelling is pretty much,gone, bicep looking normal again. Still a sharp pain in tendon area near elbow, but pretty much have full range of motion back.
I see an orthopedic surgeon tomorrow at the hospital to find out surgery is an option and what the best recovery options will be. My concern is that I want the arm to be %90 or greater again, and I’m not sure this can be done without surgery. I just turned 40 in March.
Hi,
Depending on the tear, you CAN recover fully. I tore mine at the age of 40 and I feel I have recovered fully. I would advise that you stop taking anti-inflammatory medications as they hamper the healing process. Follow all my supplementation advice and do a ton of eccentric exercises. Lastly, have patience. If it hurts, stop. The pain is telling you healing is not complete. I wish you the best of luck. Please tell me what the ortho says!
‘
Hi Jacob,
So the orhto doc ordered an MRI. I’m getting it on Monday. He did the hook test, and said the bicep tendon is fully intact. Since the ultrasound revealed tearing, he needs to see how bad/what percentage, then I’ll know my recovery options.
Arm is feeling better everyday. I stopped the inflammatory meds, and I’m trying some hydrolyzed collagen powder.
Thanks for this writeup Jacob. I popped my bicep tendon doing a back lever after Oly work. Was too much strain, shouldn’t have got on those rings.
I have a specialist appointment and MRI tomorrow (2 days post injury). No visible bruising, so hoping not too much swelling to require another MRI. I’ll reach back out when I have results. As others have said, I feel a bit defeated, but seeing you active with the arm out of action at the beginning gives me relative confidence I can make a full recovery.
Speaking of which, do we you feel fully recovered now? Size? Supination, pronation? Flexion, extension? You hop on those rings yet?
I wish you the best of luck. Please do come back here and let us know how you’re doing. In answer to your questions, I feel I have recovered 100%. I am back on the rings, although I am not as strong on the rings as I was pre-injury. This is mostly because I have not been training rings as much. I feel mostly confident on the rings, but I have not yet felt ready to try a front lever again. I suspect this is mostly a psychological problem. I am handling very heavy weight in the gym again with full confidence. How did your MRI go?
I had a partial rupture of distal tendon in my left arm I guess on11th of April doing preacher curl. The weight was wrongly installed with more KGs on the left side. Pain was intense as hell and continued for couple of days. I did ultra sound and they did not find any rupture. MRI was done only when I tried to do some curls and pull up. Then I heard a clicking sound and pain returned. It showed a rupture of 12 mm. The surgery was done on 2nd of May. Now I am in flex cast on the 3rd week post OP. Should wear it for 4 weeks. I am 48 and was doing heavy lifting occasionally.
Any advice is appreciated. I wish to have the 100% strength again. Hope I can reach it.
Anton, I expect you will recover fully. The surgery is nearly always successful. The rest is up to you. You must be diligent with the rehab protocol. How is it feeling now?
Thanks Jacob,
I am taking the cast off occasionally, when at home trying to move my arm, supinate and flex a little. although the surgeon gave instructions to start therapy 3 times a week from the 3rd week.130-60-0°
and 130-30-0 from the 4th till week 6. So far I did not try to extend my arm completely. Supination is painful and goes only half ways. The therapists I had were not experienced with such kind of injury. Perhaps I could go more aggressive. In 2 weeks the surgeon should allow to remove the cast completely.
By the way would appreciate the meaning of 3 angle figures.
Anton, I’m assuming the 3 angle figures have to do with degrees of flexion of your arm. It is important that you go to physical therapy and have them explain how much you should be flexing and extending the arm. The physical therapy is of extreme importance in your recovery.
Thank you Jacob, your website is really great. Regarding the injury when would you think I can start doing very light weight excercises on the biceps? Doctor said not sooner as 3 month after the OP. I am now on the 10th week and physio therapist told me I can start with small weights already.
Thanks for your opinion in advance!
Anton, I would say you are safe to start with light weight at this point. Obey any pain and go slow. Good luck!
I’m glad I come across your website can’t thank you enough Jacob. I hurt my bicep yesterday doing dl mixed grip I heard a pop and straight away I knew something was wrong. Went a&e they sent me home saying it might be a sprain. Today there is bruising at two site on my Lower bicep and near inside of my forearm. Range of motion is good I can fully straighten my arm and turn my palms over and under as well as close elbows. However it looks different than my good arm seems the bicep is missing the lower part and moved up a bit. Pain I will say is mild. Going to a specialist Thursday see what they will say and mri next week. Hoping is just a minor tear or something any help Jacob/guys would much appreciated. Thanks. Kind regards
Zee
Hi Zee,
I wish you the best of luck. Please let us know how the specialist diagnoses you.
Thanks jacob. Just went today and they said it could be a full tear or a partial one and they won’t know until I get the ultrasound results and it can’t be done straight away cause of the bruising. So maybe next week ultrasound and then go back to the same person after 3 weeks. I’m just hoping it’s not gonna be too long. I’m also hoping that it is not an old injury as I did have issues with the bicep but that was probably cause it was my weaker arm or maybe It was a partial tear leading up to the full one now. And if it is an old injury than I read it would be harder to attach the tendon cause of scar tissue and you will definitely need grafting. I’m just hoping it is a partial tear but I can’t tell the only telltale sign is bicep has gone up a bit leaving a gap but I can feel my strength is still there as well as range of motion. Thanks again man this website has given me a positive outlook.
Thank you Jacob for your awesome non surgical treatment procedure.
I’m having same issue with my main right side for nearly 6 months now.
Doc told me to just rest until pain goes away. I actually believed him… spent 5 weeks without weight lifting as whole, and nothing happened except feeling weak. It still hurt same as it did 5 weeks ago.
So I started working out again leaving out right arm curls, but still hurts. Mostly in starting position and ending. Hurts when I use screwdriver.
What do you think? I didn’t get a mri done, but I wanted to stay away from surgery.
Should I take this on like you? Take it slow and let my body do it’s thing.
I’m 36 by the way.
Thanks!
Mike
Hi Jacob!
Im greatful for finding your channel and the information you have provided. On 8/23/19 I was at a local park with my kids and was going to show my 5 year old daughter how to slide down a fireman’s pole on one of the play ground areas. I grabbed the pole with my left hand and jumped to grab a top horizontal pole with my right hand in a chinup position. As I pulled my self halfway up I felt a pop, some pain and felt like something moved in my right bicep. I let go of the bar immediately. Called my Wife who was at home and said I need to drop the kids off and I am driving myself to the hospital because something was wrong with my arm. The nurse said I have a partial distal bicep tear. I cant get in to see the ortho for approximately 2 weeks. I feel pain mostly when I have my arm out in a lateral position and try to extend my arm out fully or if I push weight with it. What you have shared thus far has been great information and inspiring to me as I enjoy working out as well. Currently have been sticking to mainly body weight squats, lunges and calf raises. I keep my arm in a sling and ice toughly every 20 mi utes as recommended by the ER. I am concerned about the recovery time. Do you have an email adrdress? I would like to talk to you more about this
Thank you for your story. I like others have been looking everywhere for more information and more cases of my injury.
I am not a body builder or a strength trainer in any way just a do it all handy man at 40 years old.
In October 2018 I was lifting something heavy never heard a pop or tear just slight pain about a day later when I would preform supination or pronation motions but still had most of my strength and full range although not painless. I did not think much of it since I had always been an active person who has pulled many muscles or had inflammation to different areas of the body. So I chalked it up as a pulled muscle.
As time went on the pain never subsided but got worse and I got to the point I could not even lift my 8 month old son without extreme pain. I finally saw a doctor in February of 2019. The Dr is fairly new (2 years as a surgeon) and said that it is very rare to have a partial year and he has only seen it twice in his 2 year career. Therefore diagnosed me with bicep tendinitis and prescribed PT. After 6 weeks of PT there was no improvement.
So the doctor ordered an MRI which showed +50% tear to my distal bicep tendon. He as well gave me 2 options. Just take it easy and let the tendon try to repair itself which could take up to a year or repair it. I made the decision to repair it because I had lived with the pain long enough and did not want to continue to live with it to possibly end up needed the surgery in the future.
I am 13 weeks post surgery and things are not looking too good. This may be my own fault because I may have pushed it harder then I should have to soon. Everything was going well and pain free for the first 8 weeks of PT. Then one day my son got sick and my wife just could not take the day off and asked if I could handle it. Sure. Well during that day I found out how much the part of the arm is used when laying him down for naps, or changing his diaper, etc. since that day the pain has come back as it was just before the surgery. But now do I not only have the SP rotation pain but a flex pain too. I have continued with the PT and trying not to use that arm as much as possible. Went to the Dr for my 12 week check up and told him my concern. He felt around and said everything was still where it was supposed and took an X-ray to make sure the button was still where he placed it. Everything looked good he said so he increase my lifting capacity to 20lbs.
Today I feel lots of pain doing anything with my arm other that at rest. I felt it had been getting better over the past week until yesterday when I was cutting a rope with a knife and it slipped sending my arm flying out to full extension.
So now I am at a point as not knowing what to do or how to proceed. I don’t have a lot of faith in my younger doctor due to the fact he stated he had only seen this 2 times in his 2 year career and he doesn’t seem to take my current concerns seriously. So my question to myself is, do it trust him and continue with the PT as planned or take a rest and seek a second opinion?
Any advisement would be great because I am almost at the point of throwing my hands up and say I guess I’ll just live with the pain.
Maybe I should point this out. My doctor didn’t say he had never seen a bicep injury before just said that in his experience that tendon either fully ruptures or not. He has done 100s of distal tendon repairs but all except 2 were fully ruptured. Just had to put that clarification out there
I have heard of many cases of partial tears.
Just wanted to say a huge thanks for this blog. 1 week after popping my distal in my non dominant (never thought I’d knew what those words meant!) I have been constantly searching for answers tmas to what to do and all I could find was operative articles.
I’m 40 and obese, but have lost 10k with HIIT and weight training over the past 10 weeks, Inc putting on 4kg of muscle mass. I was really starting to enjoy lifting with a PT to lose weight, esp goblet squats, sumo deadlifts, oh military press, bicep work (loved having bigger arms) and this has knocked me for six.
I’ve always prided myself on being strong, even when overweight I was strong and played a lot of Rugby in the past. (before kids)
I just hate the idea that this is going to affect my chances of training in the same way. It really got me down for 3 or 4 days.
As I’m heavy and have sleep apnoea the surgeons really don’t want me to have surgery and have advised not even to bother having an ultrasound to see what type of tear it is. It really feels like they can’t be bothered as I don’t seem like the sporty type and have a desk job.
However, Idon’t think I can justify the risk of surgery for me either and this nlog has really made me feel better, that there’s hope of continuing training in some form.
Can i ask, do you feel it’s still possible to grow muscle, get bigger arms, after this injury, even if the bicep is out of place?
Yes, it is still possible to have big arms and have a nice physique if you opt against surgery. The body will adapt and other muscles will take over the function of the biceps; however, you will lose supination strength.
Hi. I have had impingement in both shoulders for a year or so. I train 5-6 times a week, and about 6 months ago I tore my bicep tendon at the shoulder. Stupidly I tried to carry on training and then tore my rotator cuff in the same shoulder. I was in agony and couldnt sleep or hardly do anything because of the pain. The absolute KEYS for me was 1.working on my posture. I worked really hard on my lower traps to get my shoulders tucked right back. 2. I concentrated on doing loads of external rotation work for the rotator cuff. Within 12 weeks of starting these I am now stronger than I’ve ever been. There is still pain there and I can only train 3 times a week now, but very slowly the pain is getting better. But most important of all, I can now train, which also is important for my mental health. One final thing, it’s VITAL you find out why you got injured in the first place, or you’ll just be going back to your bad ways once healed. For me it was bad posture and overtraining. You must find the root cause.
I agree completely.
I know this is and old blog and I dont know if you will read this, I had the same injury, Im from México, Américan football player, full extended arm in a bad tackle and I heard the pop, parcial tear of the tendom, 1cm of short bíceps retracción, since day 1 I went to kinesiologist, I start season at febrary 22, what do u think???
I’m sorry it took so long for me to reply to this. It may be too late for my comment to matter, but I think that you will miss this season of play if you want to make a full recovery.
Hi Jakob,
Basically I’m quite curious about my injury and found your blog very useful and probably the best information i have found so far.
In October/November i partially tore the long head of my bicep tendon. i started physiotherapy without seeing a doctor or getting an MRI in December. I’m not sure if there was a actual moment where it tore but rather it was from overuse.
time moved on and i am still doing physio but barely able to lift like what i was before this. basically cannot train upper body. my physio states i don’t need surgery. i am a bit frustrated at the fact its been 6 months and I’m not nearly healed yet. but these things take time and i have to be patient.
Any advice?
Shane,
The best advice I can give is to keep your nutrition and your exercise regimen as perfect as possible and supplement with all the things I mentioned in my articles. It took me over a year to feel 99%.
Tore both distal bicep tendons inside of 8 months.
Appreciate you sharing – as you mentioned this is helpful when injured and looking for answers. Dr are purposely vague so sharing your experience helps.
I tore my left distal bicep tendon in April of 2019 and the right in January of 2020. Both times doing Brazilian Jiu Jitsu and both times the event was very ordinary (no hold, basic stuff I’ve done 1000x). MRIs on both showed complete ruptures and surgery was highly recommended. I had both surgeries. The immobilization for me was about 5-6 weeks in a massive arm brace locked at 90 degrees. PT started about 6 weeks out the first time and 3 weeks out the second time.
The first arm, now about 10 months out is about 99%. I still feel some discomfort at time, but it doesn’t prevent me from doing any time of exercise. I’m still doing the strength building. The arm get significantly better after 6 months and better now. I’m told a year to feel normal. PT including Blood flow restriction, which worked wonders to take strain off the tendon and build strength.
Still in the brace on the second. I’ve been much more active with this tear than first. The mirroring effective of rehabbing the other arm, combined with earlier PT seems like it has helped my right arm not atrophy like the left (just an eye test).
I’d tell anyone who suffers a full rupture that the surgery is a an effective option. Understand the alternatives and can’t comment on the partial tear. It sucks completely, but you will get back.