Progressive Loading in a Strongman Following Distal Biceps Repair: Re-Thinking Load Progression – A Case Report

BACKGROUND: Rupture of the distal biceps is relatively rare and post-operative protocols are typically vague and are used on many patients, regardless of pre-morbid status. The primary objective is to share the progressive loading strategy used in the rehabilitation of a strongman athlete following a surgical repair of the distal biceps. An additional objective is to highlight the need for individualized protocols and progressions with respect to patient goals and sport demands, as well as the need for shared decision making (SDM) between the medical doctor, patient, and rehabilitation provider. CASE PRESENTATION: The subject is a 39-year-old strong man competitor who suffered a distal biceps rupture while doing a tire flip during training. After having it repaired, the post-operative recovery was unremarkable. The focus of the described intervention was establishing load during rehabilitation exercises that were unique to this individual based on his pre-morbid level of strength and training history as well as the unique demands of his sport. OUTCOMES: The patient achieved symmetrical isokinetic strength of the elbow flexors at 60°/second in supine at six months post-operative. DISCUSSION: The case highlights a successful outcome in a strongman competitor with a distal biceps rupture repair. Typically, protocols are vague and lack specific standards for establishment of load for exercises. Often starting points and progressions are arbitrary and lack rationale tailored to individual needs and/or pre-morbid status. The case offers a framework for establishing and progressing load while also discussing how a shared decision-making model can lead to positive outcomes.