Training the biceps when you have shoulder problems

Posted on January 9, 2015

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A theme on this site throughout the years has been the need to train the upper body overhead. Especially for those with shoulder (and or neck) issues. I’ve covered the rationale behind this thoroughly in:

This is antithetical to many shoulder rehabilitation philosophies, which seem to take the approach of “Never raise your arms overhead again;” “Do a ton of rowing and pulling;” “Strengthen your rotator cuff.”

The excessive rowing and pulling not only gets people nowhere, it’s detrimental. When we’re working on trying to more easily raise our arms overhead, we don’t want to be doing a bunch of exercises which hypertrophy and stiffen the musculature which pulls our arms down! In many shoulder cases, you want to be doing zero rowing and pulling. At least temporarily.

For instance, if you go from a relaxed posture to one in which your shoulders are pulled back, then try to lift your arms…you can’t. By definition, doing something like “pulling your shoulders back and down” prevents one from lifting their arms up and forward! If you’re trying to make something like lifting your arms up easier, you don’t want to be practicing the opposite all day.

-> If you’re wondering why this approach started and has lasted so mind-boggingly long, I will write about that eventually.

This presents a conundrum when it comes to training the biceps.

Biceps Brachii Kenhub

www.KenHub.com

Biceps Brachii Kenhub close up

Both images from www.KenHub.com

We all know the biceps brachii flexes the elbow, but take a closer look at where it originates:

Biceps Brachii Close Up Attachments with circle

One of the areas the bicep pulls on is the coracoid process. The bicep can pull the forearm to the humerus -elbow flexion- but it can also pull the coracoid process down to the forearm.

Bicep Brachii GIF FULL

Biceps contraction: Opposite ends, coracoid process and forearm, getting pulled towards one another (arrows).

GIF made from this cool video: http://www.youtube.com/watch?v=0kFmbrRJq4w

Sliding filaments aka muscle contraction. Note filaments coming towards one another -contraction- then away from one another -relaxation. (GIF made from this cool video: http://www.youtube.com/watch?v=0kFmbrRJq4w )

If we pull the coracoid process down -we grab the front and top of the scapula and pull it down- the bottom of the scapula will reciprocate by moving back and up. The scapula anteriorly tilts.

When superior aspect of scapula tilts forward, inferior aspect tilts backward. (Red lines. Some removed for clarity.)

When superior aspect of scapula tilts forward, inferior aspect tilts backward. (Red lines. Some removed for clarity.)

Red is anterior tilt; green is posterior tilt.

Red is anterior tilt; green is posterior tilt.

Scapular tilt with lines and text

Notice the line of pull between the coracoid pulling aspect of the bicep and anterior scapular tilt:

Scapular Tilt with Bicep Contraction GIF

This is an aspect of the biceps we don’t want to be training when it comes to dealing with shoulder issues. Excessive scapular anterior tilt is anathema to good shoulder function, particularly when the arms are trying to get overhead.

You can gain an appreciation for this quite easily. Try to lift your arms up with your shoulders rounded forward and notice how much more uncomfortable it is compared to when you’re nice and upright.

Hunchback starting arm raise position

This starting position (of scapular anterior tilt) causes…

Arm Raise from hunchback position

this lack of range of motion. (Arms aren’t fully overhead, and this is going to feel crappy.)

Arm Raise from Nice and Tall Starting Position

Contrasted with a nice and upright starting position (good scapular posterior tilt). This is NOT the same as pulling the shoulders “back.” The above is thoracic extension; not scapular retraction.

However, the other origination of the biceps:

Biceps Brachii Close Up Attachments with circle 2

Connects over the humeral head into the supraglenoid tubercle.

Supraglenoid_tubercle_of_left_scapula01

Supraglenoid tubercle, lateral view, left scapula.

This is an important site because when the bicep pulls here, the humeral head will be pulled back towards the glenoid. For many, the humerus glides too far anteriorly, so anything that can help posterior glide is great. The biceps brachii can act similarly to the rotator cuff in this regard: keeping the humeral head snug in the glenoid fossa.

Tight lats

Anterior glide: Right picture is bad, left is better. From: www.manualtherapymentor.com

So far, we have a biceps brachii which we don’t want pulling the scapula into anterior tilt, yet a biceps we do want helping out with humeral posterior glide. The conundrum continues though.

Looking below, we can see when the shoulder (proximal humerus) glides too far forward, the elbow (distal humerus) is typically gliding too far backwards -the humerus is extending. Again, there’s a level of reciprocation here. When one side of a lever goes forward, the other side goes backward.

Jeremy side anterior glide linesThe bicep helps with humeral posterior glide, and in conjunction with this helps flex the humerus.

Shoulder flexion and extension

Using Jeremy (pictured above), let’s do a little “biceps recap.”

  • Scapulae are anteriorly tilted => coracoid process of bicep can contribute to this, and we don’t want it to.
  • Humeral head is anteriorly gliding => bicep can prevent this, and we want it to.
  • Humerus is in extension => bicep can prevent this, it helps flex the humerus, and we want it to.

But we’re not done yet. Notice how Jeremy’s palms naturally face behind him some -his forearms are pronated.

Jeremy Pronated Forearm with arrows

The biceps brachii also supinates the forearm, turning the palms so they face more forward. In someone like Jeremy, when it comes to supination, the biceps brachii aren’t working enough. This is particularly true on his right arm. Notice his elbow is pointing nearly directly backward, but his palm is turned in. His humerus is not internally rotated, but his forearm is pronated.

This makes sense as Jeremy makes a living on the computer (as so many of us do now). Think about the arm positioning when you’re typing. Elbows are flexed, but forearm is pronated.

Typing side view

And what are Jeremy’s elbows held in? Flexion.

Jeremy Side elbow flexion lines

There’s a hang up here though. Some may be expecting me to say, “The biceps are too active into elbow flexion,” but that’s not quite true. Jeremy’s elbows are held into some flexion and forearm pronation. The biceps flex the elbow more with supination. The biceps aren’t really too active into flexion here, they’re not active enough.

-> If you’re wondering what muscle is doing a lot of the elbow flexion work here, it’s the extensor carpi radialis longus (amongst others). Discussing that is beyond this post. I actually wrote a whole book about this though. My tennis elbow one.

Let’s recap again:

  • Scapulae are anteriorly tilted => coracoid process of bicep can contribute to this, and we don’t want it to.
  • Humeral head is anteriorly gliding => bicep can prevent this, and we want it to.
  • Humerus is in extension => bicep can prevent this, and we want it to.
  • Forearm is in pronation => bicep can prevent this, and we want it to.
  • Elbow is in flexion but with pronation => indicative bicep is not active enough as elbow flexor.

In other words, we want to:

  • Posteriorly tilt the scapulae
  • Posteriorly glide the humeral head
  • Flex the humerus
  • Supinate the forearm

That is,

  • We want to flex the elbows with the forearms supinated, humeri flexed, scapulae posteriorly tilted, and humeral heads posteriorly glided.

There is potential for this to be accomplished with simple, yet mindful, good ol’ fashioned bicep curls.

First, rather than do these free standing, we set up against a wall. Using the wall to insure our entire spine is upright, we get a little scapular posterior tilt, especially compared to the common kyphotic posture. (We also straighten out the neck.)

Bicep Curl Head Off Support

Typical relaxed posture.

Bicep Curl Head On Support

Pushing against the support.

Bicep Curls with different head set ups side by side

Right is more relaxed; left is more upright against support.

Bicep Curls with different head set ups side by side and shading

Next, we bring the hands in front of the body some, flexing the humeri, and further helping posteriorly tilt the scapulae.

Bicep Curl Humeri Flexed

Bicep Curl Humeri Flexed with good line

Bicep Curl Humeri Flexed with shadings

At worst, we want the elbows a little in front of being vertical, with more forward being better (green). We never want them behind vertical (red).

Turning the palms up -supination.

Bicep Curl Humeri Flexed and Forearm Supination

And flex:

Bicep Curl Full

This can work quite well. There is one hiccup though. Especially as the weight gets more challenging, and sometimes with even very light weight, it can be very, very hard to prevent the scapulae from anteriorly tilting. No matter the concentration given.

One way to help with this is to further cue for humeral flexion. The more we flex the humeri, the more our scapulae are likely to posteriorly tilt.

Sometimes no matter how diligent someone is, their technique leaves something to be desired. At some point, you have to acknowledge this isn’t on the person, but the exercise. Where, if you can, you change the exercise so better technique is facilitated.

Because of this, I’ve been playing with a different version of a bicep curl. An overhead one.

Set up at a normal pulldown station. Forearms are supinated (palms facing you), the weight is overhead (your shoulders are flexed and shoulder blades posteriorly tilted), and you curl:

If you don’t have a pulldown machine, you can set up on your knees with an overhead cable. Rope attachment works well.

Overhead Bicep Curl Kneeling

This allows one to hit everything we’ve discussed, it’s just even easier to have solid form. Such as preventing anterior tilt. Posterior tilt and glide are hit, humeral flexion and supination, plus there’s the added benefit of working with the arms overhead. Just holding this position, as well as letting the machine pull the arms upwards each rep, is going to generate a good stretch in something like the lats.

If you perform the kneeling version, upon letting the weight up, you don’t want to let the lower back arch. This is true for the pulldown machine version too, but it’s more likely to occur on the kneeling version:

The abdominals will have to contract some to prevent this. So, you actually get a little ab work during the curl. It’s like a vertical ab rollout.

And of course, you don’t want to let the elbows drift downwards on this either.

We want these curls to be pure elbow flexion, not humeral extension. It’s a bicep exercise; not a latissimus dorsi, or long head of the tricep, exercise.

-> The long head of the tricep connects to the scapula. The triceps extend the elbow, but the long head also extends the humerus. When you flex the elbows, the long head may not like that full stretch (some stiffness). It reciprocates by attempting to generate humeral extension -lessening how much it’s on stretch. You pull the rubber band one way -elbow flexion- it tries to slacken the rubber band by not letting the other end stretch -humeral extension.

Triceps brachii with scapular attachment circle

The catch to this exercise is you have to have the requisite mobility to get in the starting position. For some, this isn’t going to happen. Their shoulders aren’t initially ready for this. If you’re this banged up, getting a bicep pump shouldn’t be high on the priority list anyways.

“How about a preacher curl?” To which my response is “eh.” When flexing the elbows, a preacher curl can actually provide some nice elements. The humeri are flexed, palms supinated, and towards the top of the rep some humeral head posterior glide can occur. But it’s the bottom part of the movement that never looks very good:

Tracing the humeral head, we can see the significant anterior and superior translation occurring:

Preacher Curl humeral anterior glide GIF

Notice the humeral head gliding anteriorly and superiorly.

Each version has its pros and cons. I tend to use these as a means of getting people either 1) Back into some pulling or 2) As a break from pulling, but still getting some bicep work. Rather than immediately go into seated rows or something of that nature, these are a friendlier approach.

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