Progressive Loading in a Strongman Following Distal Biceps Repair: Re-Thinking Load Progression - A Case Report.
Daniel Lorenz
PMID 36518828WHAT IT FOUND
At six months, a 39-year-old strongman had symmetrical biceps strength after distal biceps repair, though he had an 11% elbow flexion deficit at 16 weeks.
This is one person's course, not proof that this loading plan works.
Key findings
01The repaired arm had an 11% elbow flexion deficit on isokinetic testing at 16 weeks, but testing was symmetrical at six months.
02Resisted biceps work began at six weeks under physician clearance with a five-pound restriction, although the original protocol had limited resisted biceps activity until eight weeks.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was a case report of one person, so it cannot show whether the treatment works or is safe for others. The subject received many treatments together, including progressive loading, blood flow restriction, neuromuscular electrical stimulation, ischemic preconditioning, cross-education, soft tissue and scar mobilization, passive range of motion, elbow joint mobilization, and isometric exercises, so the contribution of any one component cannot be separated. The physician protocol was not fully followed: the subject did active flexion out of the brace early, and resisted biceps work began at six weeks despite the written protocol saying eight weeks. The physical therapist could not reach the provider to confirm the six-week clearance. Hand-held dynamometer values were not maximum force tests and the uninvolved side was lower than expected, so they may not reflect his true pre-morbid strength. The subject was a 39-year-old male strongman with very high pre-morbid strength, so the plan may not apply to patients with lower training status. The paper reports outcomes only to six months and does not describe longer-term return to competition or repair integrity.
Declared interests
The author offers a continuing education course on blood flow restriction therapy and is compensated for it. He states that this did not affect the content or presentation of the case report.
The easy way to misread this
Do not read the symmetrical strength at six months as proof that earlier resisted biceps loading is safe after distal biceps repair. This was one athlete, and he received progressive loading, blood flow restriction, neuromuscular electrical stimulation, ischemic preconditioning, cross-education, soft tissue and scar mobilization, passive range of motion, elbow joint mobilization, and isometric exercises together. The contribution of any single component cannot be separated.