Ep 185 – The Biceps Brachii: Smoke and Mirrors: “The Rebel MT” with Allison Denney

0:00:00.0 Speaker 1: Anatomy Trains is delighted to announce a brand new dissection live stream specialty class in September 18th, Lumbopelvic Stability, a one-day layer dissection with Anatomy Trains' author, Tom Myers and master dissector, Todd Garcia. The early bird price of $150 is held until September 10th. After September 10th, the price is $250. Come see the body's actual core for yourself. This course will be provided over Zoom webinar with multiple camera views, live chat and Q&A. Visit anatomytrains.com to sign up.

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0:00:35.1 Speaker 2: This episode is brought to you by the Massage Mentor Institute. Diane Matkowski, also known as the Massage Mentor, and Allison Denney, also known as Rebel Massage, have teamed up to bring you the Massage Mentor Institute. MMI is a collection of teachings and education opportunities from industry leaders around the world, because your continuing education experience should be whatever you want it to be. They are building community one body part at a time, and they want you to be a part of it. Head over to the massagementorinstitute.com today to see more, learn more, and do more.

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0:01:21.5 Speaker 3: Hi, my name is Allison Denney, and this is the Rebel MT podcast, where you'll hear me forcibly colliding the worlds of anatomical jargon and humor. I believe that when you know your anatomy, the what, and you know your physiology, the how, the techniques will follow. But the loads of Latin and the gobs of Greek can make a cranium convulse. It is a little overwhelming to dip your toe into the sea of anatomical knowledge, only to find that it is a bottomless ocean. You are smart, but this is intimidating. You will get there eventually. In the meantime, let's look at things differently so that you will actually want to take a swim, or at least hop in a boat and take a peek at what's under the surface.

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0:02:09.5 S3: Welcome back to the podcast, everybody, happy January 2022, Happy New Year, and happy all the things that we're celebrating in this hopes of a New Year and in hopes of things to come. So one of those things is to bring you guys interesting and fun information about the anatomy that lives underneath your skin and that you work with every day in the work that you do, and I'm continuing to do that with this episode focused on the biceps brachii. I'm choosing this muscle, because it is one of those muscles that everybody knows about before they go to massage school or take an anatomy class and yet it's one of those muscles that is the hardest ones to understand. So, when you're taking an anatomy test and you need to spew out the information about the origins and insertions, it's one of the harder ones to understand. It's got a couple of different attachments at its insertion or at its origin, and then it's got a couple of funky attachments at the insertion that shift the way that it works.

0:03:16.4 S3: And so, to dive into this muscle, I wanted to first express a sentiment that a friend of mine reiterated to me that I needed to hear recently, and it was really helpful to me. It's a saying that Mark Twain was accredited to... It's something like, Don't let schooling interfere with your education. And I love this thought because I love the idea that we know stuff, and then when we dive in to learn the stuff even in more detail, we tend to forget what we know, and the biceps is a great example of this. So we know the biceps, but then when we start learning about them and all of the little nuances and intricacies of where this muscle is and what it does, we forget kind of the big picture of what we really know originally. And especially, when it comes to body work, we can get lost in the details, and then we're starting to work on somebody's upper arm and issues they may have with the biceps or related to the biceps, and then we get so lost in the details of the anatomy that we forget that we really know this muscle is an upper arm muscle, an elbow flexor and attaches in through the shoulder. So, basic stuff here, but also really cool, also really intricate.

0:04:37.6 S3: So, all that being said, I wanna dive in. So I'm gonna start off by talking about why the biceps are called the biceps? So the formal name is the biceps brachii, and if we break this down really easily, biceps means two, two heads, bi is the word two, and then brachii has anything to do with the arm. And so, this is a muscle that has two heads and it's in the arm. And you see this play out with a lot of other names of muscles, the coracobrachialis or the brachioradialis, you get all the names. And all those Latin names intertwined with the name of the muscle telling you kind of where it is and what it does or what it attaches to, and I love that about anatomy. And the biceps brachii is no different, but the fun little tidbit that I don't think many people know is that the biceps, every once in a while can actually have a third head, which makes the name of the biceps kind of comical, but it only happens in about 10% of the population, and I've never come across it in my practice. I'm not sure if you have, but it's one of those little fun facts, it's called biceps, and every once in a while it has a triceps, which is not the muscle we're focusing on.

0:05:48.3 S3: But the biceps, the origin of the biceps. So if you look at the biceps on a picture, you see that there are two heads, like I talked about before, and the origin is a short head and a long head. And the short head is gonna fall more immediately or closer to the chest. And that attaches onto the coracoid process of the scapula, and the long head crosses up over the shoulder a little more laterally, and its attachment is the super glenoid tubercle of the scapula. So the first thing that I want you to notice is that both of those attachments are on the scapula, which is otherwise known as your shoulder blade, very floating moving bone. And so, the fact that the biceps attach onto this funny wing on your back is an interesting look into how this front arm muscle can attach on to this bone that's actually on your back. The coracoid process as you might already know pops through the shoulder and you can feel it in the front of your shoulder, it's pretty sensitive to feel. And that's again, where the short head attaches.

0:06:51.8 S3: And then the long head attaches onto the supraglenoid tubercle of the scapula, which is a really fancy way of saying, it's the top part of where the humerus fits into the scapula. So, the humerus and the scapula are like a ball and socket joint, the head of the humerus is the ball and the scapula is the socket, and that little socket is called the glenoid fossa. And so, anything that we talk about around the glenoid fossa is gonna have that glenoid word in it. So, when we talk about the supraglenoid tubercle, it's a super fancy way of saying the bump at the top of the glenoid cavity. So, the origin of the long head of the biceps basically runs deep into the shoulder and latches on to this bump at the top of the glenoid fossa of the scapula. So already we're looking at an interesting relationship between these two attachment sites and on to this bone that moves, but around different aspects of the humerus to get there.

0:07:54.2 S3: So, then as these tendons come down and form the belly of the muscle that we all know and love and is happily flexed among all those who like to workout and get buff, the convergence of this muscle is the main chunk of the anterior aspect of your upper arm, and then it comes down and attaches technically onto the tuberosity of the radius, and the aponeurosis of the biceps brachii. But what's interesting here is that when we're talking about this attachment, the radius is the only bone that is spoken about, but the aponeurosis that is part of this insertion actually attaches onto the ulna. And so, you get this really cool thing that the biceps do, because of the insertion all the way down after it crosses over the elbow. So to make this a little more clear, the biceps come down, they sink deep into the front of the elbow, and if you flex your elbow with a little resistance, you can see that tendon of the biceps pop up right in the crease of your elbow. It's one of the more common things to play with when you're starting to palpate anatomy, and this is one of the things that I loved to do when I used to teach.

0:09:02.0 S3: But what you're really feeling there is that combination of the biceps tendon and the aponeurosis. But the aponeurosis is gonna slide off and go a little bit more towards the ulna, which is the pinky side, and the main tendon is really attaching onto that tuberosity or that bump of the radius, which is your thumb side. But when we flex the elbow or when somebody wants to show off how strong their biceps are, how big their biceps are, they'll typically point their elbow out to a wall and then pull their wrist towards the shoulder, which is flexing the elbow. And then every once in a while, you'll see somebody who takes their wrist and kinda moves it like a little head looking around the room. So, pointing the wrist first towards their own head and then pointing it away towards the wall where their elbow is pointing, you start to see the biceps move. So this is a strong man trick. It's totally fun, like, you can make your muscles move, and the way to do that is by moving your wrist around.

0:10:01.1 S3: But the reason why this happens is because of that division of the tendon attachment onto the radius and on to the ulna. So when you move your wrist while you have your biceps flexed, and that's actually creating a supination and a pronation of the forearm, which there's lots of different muscles that do that, but the biceps are one of them that can create that movement. And what you're looking at with that rotation is the lengthening of the attachment of the aponeurosis as it goes down to the ulna, and you're moving your wrist away from you, so your little wrist that's acting like a head is turning away from your own face, that's pulling the ulna away from the shoulder, or moving it into pronation. And what that does is it lengthens out the biceps a little bit, but you still have the biceps contracted, because you're technically flexing your elbow.

0:10:52.9 S3: So this is also why when you work your biceps out and you're trying to get them stronger, you do the different bicep curls or you do the different chin-ups and pull-ups with your wrist in different positions, because it changes how those fibers of this muscle contract and this is where I think it gets really cool. So technically speaking, the biceps brachii are responsible for three actions, flexing the elbow, which I already talked about, it's also responsible for flexing the shoulder, and then it's got a third action, which is to supinate the forearm. And that just means that it's bringing your palm up to the sky, or if you've got that flexed position with your elbow pointed out, you're bringing your fists towards your own face. So that extra attachment, that extra aponeurosis that spans out away from the radius down at the insertion of the biceps is this awesome little nuance part of what the biceps are and what the biceps do that can create this little movement that gives you so much information about how to work with this muscle when you're doing any body work.

0:12:03.6 S3: I wanna get back to the word flex for a second, because I think this is another one of those terms that we know before we learn about anatomy, and then it changes once we start taking classes. So, flexion in the world of anatomy and physiology is an anatomical movement, but before we get to massage school, before we take those classes, we think about flexing as making your muscles bigger, and that's not the case. We're actually contracting a muscle. So when I start to talk about the biceps, I can't not talk about this, because it's all kind of in that same conversation. When we flex our biceps we're making them bigger and we're flexing our muscles and we're showing off our guns and which way to the gun show and all that fun stuff, get swell, get ripped, blah, blah, blah. But really what we're talking about is an action of a joint that this muscle is doing and the muscle is contracting to make that joint move, in which case the biceps are contracting, the elbow is flexing, the shoulder is flexing, and the forearm is supinating.

0:13:02.3 S3: All of this language can feel confusing when you start to take these classes, but just remember that if you're talking about flexion before you get to massage school, it's that classic Dwayne Johnson posing for a picture. If you're talking about flexion, once you understand the principles of anatomy and physiology, you are now talking about what a joint does. A whole different thing, same word, don't let your education get in the way of what you already know. Tet this be something that you can know in your own head, but when your client starts talking about flexing their muscles, don't get technical with them while they're on the table, because that's not what they're there for. The other cool, fun fact that I wanna mention about the biceps is that it's a superficial muscle, but it's also deep, and having this information in your pocket is really handy. So, it's a superficial muscle in that you can palpate it, you can feel it right at the surface just underneath the skin, but the attachments dive down pretty deep, which is true for a lot of muscles.

0:14:00.5 S3: But if you think about the origins up at the scapula, they really dive into the shoulder capsule and become intertwined with a lot of other intricate elements to how the shoulder functions and then their insertion, crossing over the elbow down at the forearm, also diving down into what the radius and the ulna does, creates this complicated position about how many things can go wrong for the biceps or because of the biceps. What I found most commonly is that people with bicep issues are not people who are gonna have a pain or a dysfunction in the belly of the muscle. This does happen every once in a while, especially, if you've got a body builder who is very focused on making their shoulders and their arms huge. A lot of the discrepancies of how a body builder will workout is that they wanna make one part of their body huge and that throws everything out of balance and so, the whole conversation about creating strength in other places to hold balance is one of those things that I'm always battling with my bodybuilder clients.

0:15:04.5 S3: But for the most part, unless you've got somebody really focused on making their biceps ripped, the bicep brachii dysfunction shows up typically as elbow pain or shoulder pain. And shoulder pain tends to be more about 75% of what you're gonna see in your office, because the shoulder is the shoulder. The shoulder is the most vulnerable complicated joint in the body. It is the most movable, therefore it is the least stable. So, part of the job of all of the tissues around the shoulder joint are to create stability, and the bicep tendons up at the coracoid process and up at the supraglenoid tubercle are not void of that responsibility. They don't technically have that job listed in their actions in most anatomy books, but what you've got here are tendons that are very long and stringy, surrounded by a lot of other long and stringy tendons and trying to maintain integrity in a joint that really can pop out of place at any given moment.

0:16:05.2 S3: One of the most common complaints I hear about with clients who come into my office is this vague shoulder pain that they can't really understand at the front of their shoulder, and I usually spend a lot of time trying to figure out which attachment finding its way onto the head of the humerus has gone awry. And the bicep tendons, more typically the long head of the biceps is one of the ones that can start to feel that strain and the responsibility and the weight of the world and start to deteriorate a little bit faster than other ones. Keep in mind too that that long head of the biceps tendon passes through a bony landmark that is specifically named for it. The bicipital groove is a little divot at the front of the head of the humerus, in which the bicep tendon lays, kind of like when a rope swing has been wrapped around a tree for so long, it'll start to sink into the branch of the tree. This tendon has been hanging out in this bony landmark for so long that it's got its own little groove, it's own little divot named for it.

0:17:11.1 S3: But it's also so precarious that it needs to be held in place. So the transverse humeral ligament is a tiny little band of connective tissue that acts like a bungee cord and tries to hold that tendon in place. Sometimes that can get weak and that tendon can pop out and the weakness downward spiral just goes from there. So between the long head and the bicep attachments at the origin and the tendons at the insertion that attaches to the radius and then slips off into an aponeurosis onto the ulna and the ability for it to be superficial and deep, and all of the different nuanced movements that this muscle creates, I like to think about the biceps a little bit like I think about David Blaine. I think all magicians are really cool, but I have an affinity for David Blaine, because I think the way that he presents his magic with such an understated presentation, that is how I think about the biceps.

0:18:06.7 S3: They seem so cool on the surface, especially when they're super well developed, but there's so much happening underneath the surface that we don't see all these smoke and mirrors to make the appearance of this muscle be what it is, makes me feel like all of those attachments and all of those details are really just magic. Try this, with your client supine on the table, remove their arm from the drape and stand next to their torso so that their arm is pointing out to the wall, 90 degrees abducted. Let's say you're working on their right arm, you are gonna stand positioned so that you're facing their head and you're gonna take their right hand in your left hand. Create contractions with the knowledge of what these different attachments do. So, hold their elbow at 90 degrees of flexion, place your right arm down onto their biceps and have them face their fist towards their own shoulder as they go to flex their elbow, contracting the biceps.

0:19:04.7 S3: And then have them repeat that process, but with their wrist facing away from their torso towards the far wall. You can get a sense here of where they might be stronger or weaker, and then where you might best apply your work. You can also use the same knowledge or the same trick to create a detailed pin and stretch. So, shorten the muscle by flexing their elbow, as you sink down into the biceps, you wanna allow their elbow to extend, but position their hand either up or down into pronation or supination and create a lot of length throughout all the different fibers of what these muscles are doing, how these tendons are attaching and opening up this commonly hyper-contracted bundle of muscle fibers. For an added bonus, if you wanna have them slide to the edge of the table, you can drop their arm down off the table. This creates a horizontal abduction or just allows the arm to fall down away from their own body, which is gonna create even more length and where this muscle originates through the front of the shoulder at the scapula.

0:20:04.8 S3: From here you can squat down, place their forearm on to your knee and get refined with your work at the top of the biceps into the origin of this muscle through all of those complicated tissues of the shoulder and open up the tissues and create blood flow that quite possibly hasn't been there in a long time. There is indeed so much to do with this information. The biceps brachii are full of magic and smoke and mirrors underneath that skin, and the more you understand it, the more you can do with the client that is on your table. I will repeat what I've said at the beginning of most of my podcast episodes, if you know your anatomy and you know your physiology, the techniques will follow. But don't let that information get in the way of your wisdom. You know where the biceps are, you know what they do, play around with them, discover how cool they are, and use that wisdom to help your clients find freedom from pain.

0:21:02.2 S3: And here we are, the end of the episode, thank you to the extraordinary crew over at ABMP for helping me get my words into your ears. And if you wanna get any of your words into my ears or more accurately into my brain via my eye balls from a computer screen, drop me a line at rebelmt@abmp.com. That's R-E-B-E-L-M-T@abmp.com. I always wanna hear your questions, comments, suggestions or salutations. Also, if you're interested in checking out anything else I'm doing, head over to rebelmassage.com, where you will find all sorts of fun things to click on, like homemade organic products for your practice, cool links to continuing education classes, thoughts I have typed up and posted here and there, and other rebel massage dabblings.

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