Severe bicep muscle pain

14 yea old son 5’11" 200 lbs. starting having severe bicep pain in march. Its in middle of the bicep in the muscle not the bone. He says it feels like his muscle is tearing apart. His bicep hurts when he throws or tries to do curls or anything using bicep muscle. Shut him down for a month. started throwing again and had the pain come back. shut him down for a month again. started throwing and the pain was still there. Took him to the MISSISSIPPI SPORTS MEDICINE – and Orthopaedic Center. They did an x-ray of his arm. Everything looked good. They gave him some exercises to do with the rubber bands for a month. At first he really hurt when doing the bands, but it got better but still hurt. After the month was up, we went back and they did an MRI. Everything looked good. We waited another month and started throwing again. Still severe pain. He wants to play with it but I want to get it fixed. Any ideas on what it could be? We are supposed to go back to the Dr. soon and wanted to see if you could give me questions to ask. This picture is from last year but he still does this. I was wondering if his forearm laying flat back could be the cause of the problem.

Edited to add: bicep doesn’t hurt when I squeeze or poke it.

It’s really difficult to answer this from a still photo. However, if he is doing everything correctly with his motion the most logical flaw would be to check to see if he is dropping his elbow below the shoulder in the act of throwing. Dropping the elbow below the shoulder will cause his bicep to become inflamed and cause much pain. Pull out some old video or take some video of him throwing and see if he is dropping his elbow. One more important point, check to see if he is letting his hand come off the side of the ball upon release. If so, have him correct this immediately by having him stay behind the ball thru release. You can check the by having him throw a two seam fastball.When the ball is thrown you should only see the two seams rotating.

Also, ff your son is doing curls to strengthen his bicep you may want him to do hammer curls and have him cut back on traditional frontal curls. Traditional curls will shorten the bicep. Furthermore, have him begin doing exercises that with strengthen his scap muscles that will support his bicep tendon.

Please try this and and post an update after a few weeks to see if this helped.

Good luck,
From a former college pitcher and current pitching coach.

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Thanks for the quick reply.
I will check old video and new video to see if his elbow is dropping below his shoulder. He doesn’t normally do traditional curls. it was just a test at the Dr’s office to see if it hurt. When he was several years younger he definitely let his hand turn when releasing the ball but he doesn’t anymore. We have worked to the point that he was starting to drive the thumb down when he releases so that he has movement away. We were doing some scap work till we shut down.

Your son has very good external rotation in the photo. Pronating as you mentioned in your response should be a comfortable natural movement upon his follow through. Pronating will help save his arm during deceleration.

I am sending you a video of Sonny Gray in slow motion that you and your son can watch. Look at the positioning of his elbow above the shoulder as it should be upon release. However, I would like his elbow to be back more behind his face. Just be cognizant of the positioning of your son’s elbow which should be behind the face and at or above the shoulder… This is not my video nor am I affiliated nor endorse the individual who posted the video.

Also, many big league players today throw across their bodies upon follow through. I am old school and continue to teach my pitchers to follow through to the outside of the opposite knee.

Hope this helps.

One more tip or two if you will. I can’t stress this enough to save the elbow. Keep the elbow back behind the face and please make certain the arm is in the cocked position or very close to it upon front foot strike.

So let’s review to save your son’s elbow and shoulder -:

  1. Elbow above shoulder when throwing

  2. Elbow back behind face

  3. Arm in cocked position or very close to it upon front foot strike.

  4. Stretch during stride should be close to, equal to, or slightly longer than your son’s height.

  5. Stride leg bent at approximately 45 degree angle upon front foot strike then straighten upon follow through.

  6. When following through have pitching arm come down and outside the opposite knee.

  7. Let his arm rest between throwing sessions and more importantly take at least three months off after the season. This means no throwing for three months.

Please let us all know how your son is doing after following these instructions. Safety first!

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Your boy is in the growth and development stages of his life, and as such, muscles and other components of his body are still forming. Now we’d all like to think that your youngster should be like all the others that play this sport - but he’s as individual as he is unique.

Perhaps his muscles look fine under the scopes - but, a few more years of forming and maturing may be just the ticket to avoid what he’s gong through now.

I remember as a youngster I wanted to play hockey because everyone in the neighborhood played hockey. Now this was before all this fancy equipment came out. Back in the 50’s, it was first get a good orthodontist, a hockey stick and then a pair of skates. Well, to make a long story short, I couldn’t stand up on the #@%$! skates to save my life. So, I was a goalie - for about fifteen minutes. I was removed from the game, looking like a peg board. No matter how hard I tried, I just couldn’t stand up on skates. Everyone else could, but I couldn’t.

So look, perhaps, just perhaps, pitching is just not your son’s thing. Perhaps, he could be just as effective in the game at third. Gotta have a good arm at third… and sometimes, perhaps the name of a good orthodontist.

thanks for the replies and explanations. that photo was from last year since he never got to pitch much this year so we have tried to correct some things since then.

  1. He definitely still has his elbow slightly below his shoulder. From trying to put my arm in the same position as his with my elbow lower and higher than my shoulder, I can definitely feel a difference in my bicep. So we will start workign on getting his elbow up.

  2. back when the photo was taken, he was flying open early. He is staying closed much better now, so I think his elbow will be in a better location in relation to his face, but I will check with video.

  3. When he comes to his cocked position, his elbow was above his shoulder so that his hand was close to his head. I think that this was forcing his elbow low when he went forward but we are working on this. His elbow is getting lower when it comes to cocked position.

  4. He was having problems with his plant foot sliding on those stupid portable mounds with carpet and wouldnt stretch out during his stride. Does anyone have any suggestions on better shoes to wear on them. Steel cleats are not allowed.

  5. I pointed out that his leg was bending to much.

  6. I showed him what you were talking about with opposite knee.

  7. We dont throw at all from November through February.

We are going to try to do some easy throwing this weekend with no purpose but getting elbow down at cocked position and keeping it above shoulder.

External Rotation is how flat his arm lays back, right?

thanks again.

Really impossible to say from a still photo the cause or extent of an injury. After amount of time and rehab the fact he still has recurring pain would leave me with a recommendation of seeking a second opinion. I’m not knocking your current physician it’s just something doesn’t seem right with your sons arm. I noticed you’re in Mississippi. Not sure of your proximity to Birmingham but there would be a great place to check; following is a link to James Andrews group. Best wishes and a speedy recovery for your son.

You are correct on external rotation - arm laying back-

Just bring your son back slowly and continue to keep his elbow up and back. It appears that you have a handle on the other mechanical issues such as his front shoulder flying open which is the main culprit of arm drag. He will want to rush things being that he’s used to throwing hard, but slow in this instance is fast. He should be able to see a difference after a few weeks time.

When pitching off of portable mounds many pitchers use the Boombah turf shoes or something very similar to them. I am posting a link below for you. Once again, I do not endorse Boombah nor am I affiliated with them or any other shoe manufacturer. I have not used them, but others I have worked with say they work. Hope this helps.

Once again, please post updates as your son continues his rehabilitation to let others know how he is improving. I have had much success with others having pain in the bicep region just by raising the elbow above the shoulder. However, If after a few weeks you see no reduction in pain you may want to get a second opinion as Pitcher17 above stated. Dr. James Andrews in Birmingham is the go to doctor for pitchers as he also mentioned.

Good luck

This may be of some help.

In addition to what I just posted - video, there are things that are overlooked with coaching and managing pitchers. Those things are:
(1.) capabilities
(2,) tolerances
(3) longevity

Regardless of age and maturity, these topics all play important roles with evaluating the physical stamina and healthy state of the human body while performing. Unfortunately, youth athletics uses a benchmark of - do this, do that, compared to mature professionals. Form and style is a mixture of fully developed men who somehow are an overlay, or template if you will, on a youngster who has none of the benefits of growth and experience of the professional.

Capability is so dependent on what there is to work with that … somehow coaching gets dumped in the blender… hit puree boys, and walla… a perfect smoothie, one pitcher deluxe. A human being under the age of 18, just doesn’t come around to holding his/her own like others his/her age on the field of athletics. Youth has it’s limitations, despite all the wants and desires on all sides wanting better.

Tolerances impact the mental and physical stress is unique to all, and that varies from day to day. Unfortunately, the amateur ranks rarely has the professional coaching that can monitor tolerance. Tolerance - in my opinion, can indicate just how well, or not, coaching and performance come together.

Longevity is the litmus test of how everything comes together. Now this doesn’t mean strike out, after strike out. Longevity is witnessed by the smooth fluidness of delivery after delivery during an appearance.

Pulling the glove back can cause bicep pain. Look at these pictures of Maddux and Ryan at about the same point in their deliveries…

Notice the position of their gloves out in front of their torso. Then notice how you can’t see your son’s glove in his picture. This can be fixed by getting to your “equal & opposite” (at as close to front foot plant as possible timing-wise) and then turning the glove over and stabilizing it somewhere above the front foot while bringing torso towards the glove.

Thanks guys. We are going to give it a couple more weeks rest and then start slowly working on keeping the elbow up.

Roger, that picture was from last spring, we have been working on staying closed and its getting much better. I just used that picture because it showed the external rotation that he has and I was concerned that he was letting his arm too flat.

When we start back I will get some new video and pictures of his “hopefully” improved elbow location and staying back and closed better.

thanks again for the help.

Rest until your son has no more pain or inflammation before throwing - I am pretty confident that keeping the elbow up and back will solve the problem. The doctors have already stated there is no damage that they can see. Therefore, rest and proceed with the plan of taking it slow videoing each session for arm and elbow location. Stop any forcing of extreme pronating and let it come naturally. As your son gets older and has muscle maturity, then you can begin more advanced movements.

Be aware if pain returns when he begins to throw; if this occurs allow more time to rest and if pain still returns an MRI may be warranted.

Please keep us updated so others can learn from what your son is doing.
Good luck

We plan to wait a couple more weeks before trying. that will give the arm about 5 weeks. Is that enough or should we wait longer? The Dr has already done an MRI. He said that he couldn’t see any damage in MRI or anything wrong in the X-Ray. I am really hoping that you are right about the elbow. I will keep everyone updated when we start back.

thanks so much for your help.

If it still hurts after 5 weeks I’d get a 2nd opinion. My son had two High School teammates that were misdiagnosed; one with an MRI the other without. They were prescribed rest & rehab; continued to pitch with pain & discomfort. One ended up with a torn UCL and the other with a slap tear. Both ended up needing major surgery. It seems your son has rested his arm several times. If they’re finding no damage & another 5 weeks rest doesn’t do the trick I’d seek a 2nd opinion. Just my 2 cents worth. Better safe than sorry.

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No telling on time limit - just do not rush him back throwing even if it means missing the upcoming season. Now I am not a medical doctor, but take a look at this page.

Good luck

We will definitely take it easy. I am now thinking that we will wait longer than 2 more weeks. I looked at the link you provided. It looks like all of that article is referencing pain more in the shoulder area. His pain is about half way between shoulder and elbow in the middle of the bicep muscle. But it doesn’t hurt to poke or squeeze the muscle within reason. No pain in shoulder or elbow at all. I guess if it hurts again when we try to start back up, we will go to another doctor for a second opinion.

Okay, just trying to eliminate certain causes-

One last thing to try when we have a pitcher complain of bicep pain - Hope this helps

Just remember to have your son use proper mechanics with elbow up and back and do not have him use extreme pronation for ball movement. Pronate naturally at this young age.

I have found that having my pitchers throw a football no longer than pitching distance will help with proper pronation. You can see if your son is having issues finishing with proper pronation if he can not throw a spiral, with the nose down. Proper pronation can eliminate future arm and shoulder problems. Try working the football into your throwing program and concentrate on proper pronation. Take a look at this site below for proper pronation of the football. Once again, I am not affiliated with this site just trying to get you the correct information to help your son.

Hope this helps

ok. thanks we will include all of the things ya’ll have mentioned in our workouts going forward. I didn’t meant to sound defensive, just trying to clarify where his pain was.

thanks again for al the helpful responses. Once we start back up I will update this post and let everyone know how he is doing.