How the biceps attaches at both ends
The biceps brachii, the biceps, is the muscle on the front of your upper arm that stands up when you flex. It has two tendons at the top and one at the bottom. Up top, the long head and the short head both anchor onto your shoulder blade, though only the long head passes through the shoulder joint itself on the way. At the bottom, a single tendon attaches to the radius at the elbow, on a bump called the radial tuberosity. Between them they bend your elbow, turn your forearm palm-up the way you turn a doorknob, and help lift the arm at the shoulder.
The long head at the shoulder
It runs in a groove on the front of the humerus and then straight through the shoulder joint, and that route leaves it open to irritation, inflammation and tearing in a way the short head never is. In rugby it gets damaged in a few ways:
- Repeated overhead and throwing work grinds the tendon down over months, and that is what a tendinopathy is.
- A blow to the front of the shoulder or the upper arm in a tackle can damage it in one go.
- Eccentric load tears it too, when your arm is dragged away from your body while the biceps is still pulling, which is what happens when someone grabs the arm you are fending with.
- The rotator cuff and the long head can go together, so a shoulder that has been grumbling for a season is worth getting looked at properly rather than waiting for it to give out.
When the long head ruptures completely, the muscle belly slides down towards your elbow and sits there as a lump in the lower half of your upper arm, which is where the Popeye name comes from. It looks worse than it plays: the short head and the brachialis underneath still bend the elbow, so the arm keeps doing most of its job. What you notice more is supination, the strength to turn your forearm palm-up.
Tears at the elbow end
A rupture of the distal tendon costs you more of the arm. It happens when a bent elbow gets forced straight under load, which is exactly what a tackler’s arm does when the ball carrier keeps driving and the tackler will not let go. Players describe a pop at the front of the elbow, then pain, swelling, and an arm that has gone weak.
| Feature | Proximal rupture (shoulder) | Distal rupture (elbow) |
|---|---|---|
| Location of pain | Front of shoulder and upper arm | Front of elbow and lower arm |
| Visible deformity | Popeye deformity: the ball of muscle drops lower down the arm | Reverse Popeye: the muscle bunches higher up the arm, and the normal shape of the elbow crease goes |
| Key strength loss | Mild loss of elbow flexion, with supination the more obvious weakness | Both are worse than at the shoulder, and supination takes the bigger hit |
| Hook test | Not applicable | Positive: the examiner cannot hook a finger under the tendon at the elbow crease, because it is no longer there |
| Surgery in athletes | Often managed conservatively; surgery (tenodesis) considered if persistent bicipital groove pain or cosmetic concern | Surgical repair strongly recommended for athletes; conservative management results in significant, permanent strength loss |
How each one gets treated
Which way you go depends on where the tendon tore, how much of it tore, how old you are, and how much you need out of the arm:
- Long head tendinopathy, the slow grumbling kind, is usually handled without surgery: back off what aggravates it, work the rotator cuff and scapular control with a physio, then build the load back up in stages. Settling it can take three to six months.
- A proximal rupture does not have to be repaired. If the shoulder keeps hurting, or the muscle cramps, or you cannot live with the shape of the arm, a surgeon can do a tenodesis and reattach the tendon to the humerus outside the joint.
- Partial tears of the distal tendon can start conservatively, in a brace with loading added slowly, and move to surgery if the symptoms stay put or the tear gets bigger.
- Complete distal ruptures get repaired in rugby players, with the tendon reattached to the radial tuberosity using suture anchors, an endobutton, or an interference screw.
Rehab after a distal repair
After the surgery you work through phases that give the tendon time to knit while you get your movement and then your strength back. Your surgeon and physio set the timings for your repair, and the shape of it usually looks like this:
The arm stays splinted
0–2 weeks
A posterior splint or a hinged brace holds the elbow at 90 degrees of flexion with the forearm neutral to slightly palm-up. Move your fingers, wrist and shoulder gently. No active elbow bending and no forearm rotation.
Movement comes back first
2–6 weeks
Range of motion returns gradually, with active-assisted bending and straightening inside a protected range, often 30 to 130 degrees to begin with. Turn the forearm only as far as is comfortable, lift nothing, and work the grip with putty.
Light resistance starts
6–12 weeks
You should have full range of motion by now. Light resistance goes on elbow flexion and supination, building as the tissue takes it, and upper body pulling comes back at reduced weight.
Load goes up properly
12–20 weeks
Resistance climbs on curls, supination work and pulling. Compound lifts like rows and pull-ups return at moderate load, alongside grip and arm work that looks like rugby.
Back into contact
20–28 weeks (five to seven months)
Full strength training is back on. Contact conditioning first, then tackling drills with progressive resistance, then return-to-play testing that checks your strength and how the arm functions before you are cleared.
Lowering the risk in training
You cannot stop a tendon tearing in a bad tackle, but how you train around it is still worth getting right:
- Put the weight up gradually on curls and pulls, with no big jumps from one session to the next.
- Eccentric work earns its place here, so lower the bar slowly on curls and on your pulling exercises rather than dropping it.
- Warm the arm up before a heavy upper body session, with some light biceps work ahead of the heavy rows and curls.
- Tackle technique keeps the elbow out of trouble, because arm placement and body position stop the arm being forced straight while you are holding on.
- Balance the programme so isolation curl volume is not outrunning your compound pulling.
- A rotator cuff that is not doing its job pushes work onto the biceps tendon instead, so get a shoulder that keeps nagging you looked at.