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ESSENTIAL SKILLS Test 1. Resisted Flexion of the Elbow With the client standing, have the person hold the elbow of the injured arm at a right angle, with the palm toward the ceiling. Now place one or both of your hands just above the wrist and ask the client to flex the elbow as you apply an equal and opposite downward pressure. This test stresses both the biceps and the brachialis muscles, so you need to do the next test to figure out which one is injured. Test 2. Resisted Supination of the Forearm Again, have the client standing with the elbow at a right angle. With both of your hands just above the wrist, grip the wrist to hold it in place. Now ask the client to try to supinate (outwardly rotate) the forearm, so that the palm faces the ceiling. Apply an equal and opposite force, not allowing the wrist to rotate. Pain felt on both Test 1 and Test 2 indicates that the biceps is injured. Test 3. Passive Pronation of the Forearm Perform this test if Test 1 causes pain at the crease of the elbow or below the elbow at the tendon attachment to the forearm. With the elbow slightly bent, forcefully pronate the forearm to the end of the range of motion. This movement does not use any resistance; the client's arm should remain limp. If the lower attachment of the biceps is injured, the very end of this movement will pinch the tendon and be quite painful. Once you've established that the biceps is injured, palpate the structure to see which fibers have been affected. If the pain is felt in the upper arm, palpate the upper tendon body and the muscle belly. If the pain is felt in the elbow region, palpate the lower tendon and the lower attachment to the radius. If you're unsure about your findings from the palpation, compare the injured side with the uninjured side. TREATMENT CHOICES SELF-TREATMENT For a relatively recent, mild injury to the muscle belly, a few weeks of rest along with some biceps exercises will often help resolve the problem. Tendon strains are usually more long lasting and generally need some treatment. (See Exercises for specific exercise recommendations.) FRICTION THERAPY AND MASSAGE Hands-on treatments are effective when the strain has occurred in the muscle belly or in an easily accessible portion of the upper or lower tendon. They do not work if the injury is in the part of the tendon that penetrates the shoulder joint. When performing any of the following friction techniques, work 10–15 minutes at a time, taking breaks as necessary. Follow the friction with massage to the upper arm, lower arm, and shoulder. Repeat two or three times a week for four to six weeks. Location and Friction of the Upper Biceps Tendon Sit at the side of the table facing the client. Have the client flex the biceps slightly against resistance, as in Test 1, to make the biceps tendon taut and easier to locate. Then use your thumb pad to palpate the tendon, while applying a counter-pressure with your fingers at the back of the arm. Once you've located the structure, have the person relax and apply cross- fiber friction in a medial-to-lateral direction. Alternatively, you can leave your thumb in place and rotate the client's humerus medially and laterally underneath it. The tendon will snap back and forth as you move the lower arm. This technique is less tiring. Location and Friction of the Biceps Muscle Belly Sit facing the client and grasp the posterior surface of the biceps muscle (near the bone) between your fingers and thumb, in a claw-like position. visit massageandbodywork.com to access your digital magazine 107