Bicep tendinitis and strength training

August 8, 2016 9:24 AM

After about 12 weeks of working out (mostly dumb bells, cables and bands), I've developed bicep tendinitis (I think) that mostly hurts in my elbow. I'm taking ibuprofen, icing it, and resting it as much as possible but I don't know when I should worry and when I should suck it up.

Normally I'd just take six weeks off from working out and rest it as much as possible, but I'm having FTM top surgery (bilateral mastectomy) in the next few months and it is very important that I build up my chest muscles as much as possible. This is so important to me that I will work through any amount of pain. However, I don't want to risk permanently damaging anything. (After surgery, I will have to take six weeks off from working out anyway, so it should heal fully then.)

Aside from working out, I experience pain in daily life when I move my arm in certain ways (often unpredictably). It's worse in the morning and (generally) gets better throughout the day. I cannot avoid using that arm because it's my dominant hand and I can't do everything I need to do with the other one (even brush my teeth). I have made some adjustments, such as using the computer mouse with my better hand.

1. Besides ice, ibuprofen, and as much rest as possible, is there something else I can do to prevent further injury?

2. Are there exercises I can do to build up my chest that minimize triggering the tendinitis? (I cannot use barbells. I have every other piece of equipment available to me.)

3. Or should I really, really avoid everything possible and/or see a doctor because $TrulyHorribleThing will happen? (And what kind of doctor?)

posted by AFABulous to Health & Fitness (8 answers total)

The type of doctor you'd want to see about this is a Sports Medicine specialist.
posted by griphus at 9:31 AM on August 8, 2016

When I had biceps tendinitis I needed physical therapy -- no amount of resting made it not come back when I resumed activity. It was a hassle to see a doctor, get diagnosed, get the referral, and go to PT, but it was ultimately very beneficial for me. The PT also reviewed the workouts I had been doing and helped me understand why I developed tendinitis and how to modify my workouts in the future so I could accomplish my goals without (in my case) ruining my shoulder. Since PT (it's been five years now) I've been able to make significant strength gains without any recurrence of the tendinitis.

So, in short, I would find a way to see a physical therapist. The best route to get there depends on your location and insurance, a GP or sports medicine doctor is probably your best bet.
posted by telegraph at 9:32 AM on August 8, 2016 [1 favorite]

Response by poster: Thanks. Is seeing a doctor/PT something I have to do before I start working out again? Am I going to tear or break something? The pain isn't fall on the floor and cry-while-swearing pain, it's occasional sharp twinges that make me gasp. It goes away almost immediately when the activity is stopped (and sometimes I can just continue, for reasons I don't understand).
posted by AFABulous at 10:11 AM on August 8, 2016

It's not biceps tendonitis if it's in your elbow (golfer's elbow is what I wound up with under similar conditions, but ymmv). You can look up PT exercises for different conditions yourself, but you should go in to get their diagnosis if at all possible. Briefly, you can absolutely rupture or tear something if you're working through the pain unintelligently.
posted by hollyholly at 10:47 AM on August 8, 2016 [1 favorite]

While a lot of people jump to tendinitis, it's not always the case. Take a read at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/ while waiting for your doc/PT appointment.

Is your tendon area actually inflamed, or just painful? NSAID's inhibit tendon repair; so if you're suffering from an overuse issue (which given your strength work might seem more likely), you might actually be delaying you're healing. Additionally, NSAIDs inhibit the muscle response, so you're putting back your strength work as well. (www.ncbi.nlm.nih.gov/pubmed/23013520 as an example, or generally: http://scholar.google.ca/scholar?q=study+NSAID+and+muscle+response&hl=en&as_sdt=0&as_vis=1&oi=scholart) Unless/until I'm told to take NSAIDs, or any pain reliever, I stay away from them.

Anything sharp isn't something to be worked through. "No pain, no gain." isn't actual truth. Working through discomfort is less catchy. Note that DOMS even has "soreness" in it, and not pain. Additionally, soreness that doesn't go away is also indicative as a problem. (said by someone currently getting physio for soreness that wouldn't go away (yay, I finally caught something before it got really bad))

If I was experiencing sharp bits of pain, I'd stop any strength work until I saw a physio. I'll note that I'm a runner and the strength work I do just just bodyweight work. But I'm currently working on the tendinopathy issues.
posted by nobeagle at 11:28 AM on August 8, 2016 [3 favorites]

Sharp pain isn't something you want to just work through unsupervised. I have been working through sharp pain under the guidance of my physical therapist, but generally speaking sharp pain is bad. [In my case it is rehab from ACL surgery and the sharp pain - patellar tendonitis - was/is related to lack of strength in the muscles around my knee, so continuing to work it, carefully, to strengthen those muscles is part of the solution.]

The good thing is that physical therapy is basically working out. So if you can get in to see a sports medicine doc and get a diagnosis, you should end up with a bunch of exercises to do. If maintaining/building chest strength is important for your upcoming surgery, your physical therapist can help figure out the best way to do that. It has been my experience that your PT wants to help you reach your goals, whatever they may be.

I wouldn't go to a GP about this unless you have to get a referral for insurance; GPs can sometimes tend towards "if it hurts when you do that just stop doing that" whereas a sports medicine doc, orthopedist, etc. will help you maintain your desired activity. Good luck!
posted by misskaz at 5:53 PM on August 8, 2016

Two thoughts.

1) You can work out your pecs without bending your elbows. Dumbell flys etc.

2) Check out Do It Yourself Joint Pain Relief. This is a website by a long time massage therapist. It has sections for every joint in your body. The idea behind it is that joint pain is generally caused by tight muscles. Those tight muscles pull the joint out of wack. In his videos he shows you how to find the muscles that are pulling your joints out of wack and how to release the muscle tightness. The muscles that are pulling on your joint aren't always or even often intuitive.

Good luck!
posted by GregorWill at 10:12 AM on August 9, 2016 [1 favorite]

I know I'm a little late to the party here, but to add to the comment above about DIY pain relief, it's totally true that tight muscles can often have an affect on other types of pain you're experiencing. While I didn't have tendinitis like you, I did have some other issues in the lower back/hip area and I found that foam rolling really helped to relieve the pain by massaging out the muscle tightness.

Since you're experiencing pain in your arm, it might be a little hard to get the precision you need from a foam roller, so I'd suggest trying a small massage ball to help release the tightness. There are some exercises in this foam roller guide that show you how to massage your arms (but again, I'd say a massage ball would probably be better in this case), but be conscious of how much pressure you put on the area. As always, listen to your body. A little bit of pain from the pressure is alright, but too much pain and you're doing more harm than good.
posted by cmatthews at 9:55 AM on September 8, 2016