scapula shoulder structure

Bicep Injury: Scapular and Core Weakness

As the next part of the discussion related to the bicep injury, here is a personal exchange I had with Mr. Paul Butcher. He is an orthopedic and sports medicine physical therapist at the New Mexico Sports Fitness and Physical Therapy practice. He writes monthly articles for Bowling This Month.

Hello Mr. Butcher,

My name is Dr. Tamer. I am a competitive bowler and avid reader of Bowling This Month. Being a clinician myself, albeit PharmD, I read your articles with much interest. I was wondering if you could help me with a specific injury.
During my last two competitive bowling seasons, I have sustained bicep injuries, approximately 15 months apart. In December of 2009, I felt sharp pain in the belly of the bicep. I was examined by my primary doctor and orthopedic surgeon, specializing in sports medicine, and both concluded that I had a bicep tear with no other functional damage. The recommendation was simply rest.

Then last month, I sustained a second injury to my bicep. This time, upon physical exam, the surgeon thought it was certain I had completely severed the Long Head Biceps Tendon, with the muscle bulging down by the elbow. There is some significant bleeding, which is apparent near the bottom of the bicep and creeping down into the forearm. I was told this was to be expected. After the MRI, the surgeon was pleasantly surprised to tell me there was absolutely no injury to any of the 3 bicep tendons and that the bicep itself appeared full and intact. So he attributed the bleeding to a bicep strain/tear. He ordered PT follow-up for rehabilitation.

Sorry for the long history, but hear is my question to you. I would like to better understand why I am sustaining such an injury and what rehabilitation or exercises could be done to stretch out or enable the bicep to function in such a way that I do not have to sustain such a traumatic injury every year or so. I realize that you are not performing a physical exam yourself, but given your expertise and understanding of bowling’s physical aspects, I thought you can make some conditioning/strengthening recommendations. Your recent article “The Fab 5 – exercises for the shoulder” triggered that perhaps you might have a recommendation for conditioning of the bicep. I really don’t know how common bicep tear/strain is in bowlers but I’m really hoping you can help me. It can only go to supplementing what my local PT can do for me. I just don’t have any locals who specialize in the bowling mechanics, although I imagine it might not be too difficult to understand the nature of the sports injury.

I’ve tried to examine video of myself to understand where/why I would sustain such an injury as I do not feel that I do anything extraordinary.
I’ve included a link to a recent ball review I’ve done so that perhaps you can visualize my physical game.

Thanks for taking the time to read and respond. I appreciate any feedback you can provide.

Here’s Mr. Paul Butcher’s response:

It’s great to hear from a fellow bowler with a medicine background. Thank you for reading the column.
You sent me some great information and I (and actually another PT at the clinic) examined your history and then analyzed the video of your bowling mechanics. Here are my thoughts and observations:

  • I think you are a very good bowler and I see nothing biomechanically with your game that I would change.
  • You all may have been looking at the wrong thing to treat in terms of your injury. Yes, we treat the bicep to get it well with physicians and therapists. But, the reason you wrote is you are asking “what is the root of the cause” for your bicep injury and recurrence. It has been well documented that when distal injuries occur there has been a strong link to proximal weakness. I believe this may be a strong link for your bicep injury. For example, please review the pdf fle that I titled Prox hip wkness. This is an excellent article that shows how a weak hip is strongly correlated with ankle sprain. These injuries occur in the upper and lower extremities.
  • In high level baseball pitchers there are many shoulder, elbow (and bicep) problems that occur. The culprit,Tamer is often scapular and core weakness. Check out some of those functional tests in an article I attached from Dr. Ben Kibler who I feel is the expert on scapular/core strength issues in relation to distal limb injury of the upper extremities.
  • I attached another article from him about a “non shoulder” exam. Again, an excellent article discussing scapular and core strength issues in relation to injury/sport.
  • So, read these articles and then find out where you are at for scapular stability and strength, rotator cuff strength, core strength.
  • I believe you will find the answer there. Then, get your strength training going for these areas.
  • If you want more data on this check out the references in the last 2 articles. There is a plethora of other data that support what I am talking about.

Please let me know how things are going along the way with your bicep/rehab/training. Any other questions I would he happy to address.


Paul Butcher

Prox hip wkness
Non shoulder examination
Core Rehab Kibler

4 thoughts on “Bicep Injury: Scapular and Core Weakness”

  1. This is very inetesting. Will you be able to post the files concerning measurement of core, scapular and rotator cuff strength? Or perhaps have Dr. Butcher write this for BTM?

    Hope rehab goes quickly for you.

    1. Thanks Jeffrey. I can pull those files and post them. Dr. Butcher actually did write this article in BTM. He pulled it from our exchange so although some may recognize it verbatim from BTM, it was actually an exchange between he and I directly, which he then published. I have to find it and let you know which one it is.

      Rehab…well I’ve done it. Now I bowl but far less than I used to. This whole season has been an experiment to find ways to bowl that will avoid reinjury.

  2. Any follow up to this?I can’t open the PDF files.My Adobe reader say their damaged. I’m very
    interested in this as I injured my bicep bowling this past Thursday.The bicep pain was so
    bad I had to stop bowling.Thanks.

    1. Hi Neil, I’m trying to locate the articles to re-post. Ultimately, the articles focus on core weakness as a cause for injuries in the extremities. If you have a bicep tear like I did, you will definitely need rest and then gradual restrengthening. The main thing when seeing a physiotherapist is they will focus on stretching to allow the muscle to heal without an extremely stiff scar. Then after a few weeks when the muscle has scarred over, you can begin strengthening. Seeing a physiotherapist would be worthwhile to get this healed properly. Unfortunately, I had this injury 3 years in a row before finding a physio who really took care of ensuring proper healing and strengthening.

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