Circumventing biceps rupture in the deadlift

Though a relatively rare injury, there appears to be a non-trivial number of social media videos showcasing distal biceps brachii tendon ruptures (DBBTR).

No injury is absolutely ‘preventable’ but the likelihood of incurring something as unfortunate as a DBBTR can be reduced significantly with programming and biomechanical considerations.

Pre-disposing factors to DBBTR:

-Conventional deadlift

-Mixed grip (with most tears occurring in the left bicep)

-Eccentrically loaded elbow extension

DBBTR almost exclusively occurs when a mixed grip is employed. The supinated bicep must brook a greater internal moment than the contralateral, pronated arm, and there is higher margin for eccentric bicep loading; especially when the deadlift is initiated with an excessive degree of elbow flexion. 

Given the mechanism of injury, reducing its incidence altogether may be achieved with a hook grip and/or a double overhand grip. These have their own limitations though, with hook grip imposing a huge amount of stress and often pain on the thumb (not to mention its susceptibility to osteoarthritis), and double overhand typically not allowing a strength trainee to lift maximal loads. The mixed grip is slightly more risky with regard to DBBTR, but the documented incidence is still a mere 3% of all biceps injuries. *For the sake of this short article, deadlifting with straps will not be expounded.

The mixed grip for maximal deadlift attempts is worthwhile for the reward, and there are notable strategies one can implement to innoculate the distal biceps tendon from rupture:

  1. Awareness of proper latissimus dorsi (lat) engagement from the floor, when initiating the conventional deadlift. The DBBTR is observed when the bicep tendon cannot withstand the eccentric load of a heavy deadlift, so we need to commence the pull with maximal lat engagement  and minimal elbow flexion (cue “long arms”). If commencing the pull with even a few superfluous degrees of elbow flexion, this represents heightened mechanical demand on the bicep. On the other hand, conceptualising the barbell as an extension of both arms (and particularly the supinated arm), the arms will remain securely taut and enable a biomechanically efficient deadlift. The DBBTR tends to occur in the second half of the deadlift, when the lifter is exerting effort to extend the hips and trunk – it is during this portion that a mildly flexed bicep naturally succumbs to fall extended, while the body stands erect and joints stack in alignment

2. Chin-ups and pull-ups with a controlled eccentric phase, employing full range of motion (ROM). Staple movement aside, chin-ups are a terrific prophylactic exercise for DBBTR because they build specific load capacity in the distal biceps tendon. And when one progresses to weighted chin-ups with external load added, while retaining tempo eccentric and full ROM, the biceps tendons acquire kevlar-like tensile strength.

Don’t let the fear of a DBBTR pose a deterrent from either conventional deadlifts or mixed grip, but do pay heed to the above suggestions. After all, a few sets of heavy conventional deadlifts is more effective than the average person’s entire month of training. King of the lifts.