How To Fix Biceps Tendinitis In Baseball Players
The most common cause of Biceps Tendinitis is excessive forward movement of the Humeral Head which occurs at Max External Rotation
HERE IS THE MOST BASIC CONCEPT:
The Goal of the Fix should be to significantly decrease that glide and that can be done 2 ways:
Decrease the forces of the Glide by dispersing the ER into Scapular Posterior Tilt and the Horizontal Abduction into Scap Retraction (Picture a Scap that is stuck in an Anterior Tilt, as the Athlete goes into layback, he would need WAY more Local Shoulder ER to get there than if the Scapula laid back into a nice Posterior Tilt. When you force the local shoulder joint to make up for all that Range, it will try to glide forward to achieve that)
Improve Dynamic Stability of the shoulder: This is the part that most Rehab programs address which obviously is very important, but it’s much more effective when working in combination with part 1
HERE IS A DEEPER DIVE
Typically presents more as a position based issue than a biceps contraction based issue. It is usually present on the positions lead to the most anterior translation of the humerus (Think Max ER or the bottom of a deep bench press/dip). The consistent drift forward of the humerus applies excessive stress to the Biceps Tendon irritating it and restarting the inflammation process over and over again. It is very common to see absolutely no symptoms with max loading of the biceps due to the underlying mechanism of the issue. This is unlike most other tendonopathies throughout the body.
Clinical Nugget: As always, we HAVE to test out hypothesis! A good way to test if it is truly the anterior shear that is driving the issues locally is to use this combination of tests:
1) Does the Jobe Reclocation Test (Adding a Firm Posterior Glide and Preventing the translation) improve symptoms in passive ER?
2) Does performing the ER in Scaption Plane produce less symptoms than at the standard 90/90 Postion? Bringing the elbow forward into the Scaption plane will decrease sheer forces which can give us more info on the comparison between the two positions
3) Have the Athlete Maximally Squeeze Scaps and retest 90/90 ER while doing so
Another great benefit here is that it helps us identify the cause rather than just the structure. Often times, other tissues in the anterior shoulder can pay the cost of this Anterior Glide, so Biceps Tendinitis may be more of a bucket diagnoses. Who cares! While not perfectly accurate in some cases, we care far more about cause and fixing the issue!
It is common to see to the typical: Soft tissue work, Biceps Isometrics, and Biceps eccentrics used as the treatment here. That would be a great option for the standard tendonitis (Tensile), however, it does not address the underlying cause of the Baseball Specific version (Shear forces at layback). We believe this is why this continues to be such a pesky and recurring issue in some arms.
When treating the underlying factor, it is important to understand what drives anterior shear. The two primary drivers are
Excessive Local Horizontal Abduction without optimal control
Excessive Local ER without optimal control
Athletes need high degrees of these total motions to throw hard so we do not want to simply take that away! This would lead us to our goals to address the underlying factors:
Avoid contstant re-irration if possible
Improve T Spine/Ribcage Mobility into Extension and Arm Side Rotation
Improve Scapular External Rotation (Sets the Base For Horizontal And)
Improve Scapular Posterior Tilt (Sets the Base for ER)
Improve End Range Control of Glenohumeral (Local Shoulder Joint)
Address any mechanical issue that can be playing a part
