Distal Biceps Rehab Protocol

Distal Biceps Rehab Protocol

Dr. Brian Hill, outlines a structured recovery guide following distal biceps tendon repair surgery. It details the essential rehabilitation phases designed to safely guide patients from early post-operative elbow protection and passive movement to active range of motion and progressive strengthening.

Key Goals & Rehabilitation Objectives

• Protect the Surgical Repair: Allow the reattached tendon to anchor securely into the radial tuberosity without excessive tensile stress or premature heavy loading.
• Restore Range of Motion (ROM): Gradually regain elbow extension, elbow flexion, and forearm rotation (pronation and supination) within safe, surgeon-approved limits.
• Control Swelling & Soft-Tissue Healing: Use regular icing (cryotherapy) and gentle active distal movement (fingers, wrist) to improve circulation and reduce post-surgical edema.

Overview of Rehab Phases

1. Early Post-Op Phase (Protection & Passive Motion)

• Bracing / Splinting: The arm is typically kept in a protective hinged elbow brace locked at a safe angle to prevent full extension initially.
• Distal Mobility: Performing active hand clenching (fist pumps) and wrist movements to keep blood flowing without engaging the biceps.
• Passive Range of Motion (PROM): Gentle, assisted flexion and extension within the allowable brace range. Active flexion using the repaired biceps is strictly avoided at this early stage.

2. Intermediate Phase (Active-Assisted & Active Motion)

• Forearm Rotation: Gentle pronation (turning palm down) and supination (turning palm up) exercises.
• Active Range of Motion (AROM): Slowly transitioning to lifting the weight of the forearm independently without added resistance.
• Gradual Brace Adjustments: Incrementally increasing allowed extension over several weeks as the tendon heals.

3. Late Phase (Strengthening & Functional Return)

• Progressive Resistance: Introducing light resistance (elastic bands, light dumbbells) for biceps flexion and supination once solid healing is confirmed.
• Functional Integration: Returning to normal daily activities and gradually building back toward sport- or work-specific loads.

Essential Precautions

• Avoid Passive Extension Stretching: Never force the elbow straight beyond the designated brace limit, as this directly strains the reattached distal biceps tendon.
• No Heavy Lifting: Avoid lifting objects or performing resisted biceps movements during the early recovery period without explicit clearance from your orthopedic surgeon.