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This video talks about the etiology of distal bicep tendinopathy, signs and symptoms, mechanisms of injury and risk factors, differential diagnosis, and finally treatment.

Pain on the OUTSIDE of your elbow? Watch this:    • How to Fix Tennis Elbow for Climbers ...  
Pain on the INSIDE of your elbow? Watch this:    • How to Fix Golfer's Elbow for Climber...  

WARNING (00:32): Before we delve in, I need to mention something important: If you have a distal biceps tendinopathy, you may have an increased risk of a distal biceps rupture, which will likely require surgical intervention. If you have had immediate and acute pain with a pop, please seek professional help before you develop a more significant injury. If you have been dealing with this chronically, take this seriously, because you may be increasing your risk for a distal biceps tear.

Etiology & Signs/Symptoms (01:55): Distal bicep tendinopathy is typically an overuse or degenerative disorder of the biceps tendon as it attaches at the elbow. The pain will present at the anterior (front) portion of the elbow near the crease of the elbow. It may be slightly more medial than lateral but should not be felt on the inside of the elbow. Pain may be reproduced with active and/or resisted flexion of the elbow, and may be more severe with the forearm in the supinated (palmup) position.

Mechanism of injury and risk factors (01:19): The more common activities associated with this are lifting, pulling, or overhead activities… So…. climbing. OK we get it, climbing puts us at risk, but what particular type of climbing?
Climbing preference/style: side pulls and underclings will place additional stress on the biceps. So, check your preference. Are you always in the cave and love pulling on underclings? Maybe your project has a sweet side pull move that you have tried over and over again.
Climbing technique: climbing with your arms always bent or with your legs always straight and/or not using your feet well will lead to increased strain/stress on the bicep tendon and can over time lead to this pathology..
Training style: lots of campus boarding, weighted pullups, loads of lock offs, etc. Basically, you need to look at it all. If your climbing preference and training style is leading to a lot of load on your biceps, you may need to reevaluate and see if you need to change your training or if your just not getting enough rest.

(02:30) Differentiating this from another pathology is much simpler. The two main things to be careful of are bony issues (which will typically present with significantly decreased elbow range of motion) and median nerve issues.

As we mention in the video, climbing can cause an over development of the pronator teres muscle. This can lead to entrapment of the median nerve, causing pain in that area, misleading someone to believe they have biceps tendinopathy when really they have a nerve entrapment issue. Differentiating a true bicep tendinopathy from a median nerve entrapment can be important as it will have a drastically different treatment approach. See the video to learn how to do a median nerve test.

Note on median nerve testing: this test is positive on a majority of people, so a TRUE positive is only going to be if it 1) replicates your normal symptoms and/or 2) is more significant on the affected arm compared to the unaffected arm. If both arms are affected, you can only go off of if it replicates your normal symptoms.

Treatment (04:06): treatment will be multimodal and will involve activity modification (look at your climbing style, technique, and your training), gentle stretching, soft tissue mobilization to help with remodeling tissue, and eccentric training.

Eccentric training (05:26) should involve using a theraband or free weight to apply a load to elongating tissue. This training should initiate with the forearm in a neutral or thumb up position and will progress to a supinated position. If you are able to get through both positions without pain or discomfort then you will be able to progress to eccentric elbow flexion with 90 degrees of shoulder flexion. This will isolate the long head of the biceps more and will place your arm into a more functional position that would relate to climbing.

Reminder, exercises shown in this video are to be performed at the user's own risk. This information is not meant to replace direct medical intervention and if you have serious concerns you should seek professional help immediately.

Outro & bloopers (06:57)

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Written and Presented by Jason Hooper, PT, DPT, OCS, CAFS
IG: @hoopersbetaofficial

Filming and Editing by Emile Modesitt
www.emilemodesitt.com
IG: @emile166