Ken Blaze, USA Today

Doctor's Take: Abraham Almonte

Injuries are starting to seem like a never-ending occurrence for the Indians now that Abraham Almonte has also been added to the disabled list after re-aggravating his previous right biceps strain. IBI's resident medical expert Brandon Bowers shares his thoughts on whether or not Almonte will return to the field soon in the latest edition of Doctor's Take.

On Monday, May 15th, Tribe outfielder Abraham Almonte re-aggravated his right biceps strain, an injury which initially occurred on May 10th against the Blue Jays. Almonte has been placed on the 10-day disabled list and joins fellow outfielders Brandon Guyer and Austin Jackson on the DL in the process.

What is it? The biceps brachii muscle is made of two parts, hence the prefix “bi-“, meaning two. The long head of the biceps originates from the top of the shoulder socket via an attachment to the labrum and the short head of the biceps originates from the coracoid process (part of the shoulder blade on the front of the shoulder). Both the long and short heads of the biceps connect and insert into the forearm. The biceps muscle is responsible for bending the elbow and turning the palm face up. The muscle also functions at the shoulder to lift the arm in front of the body. A strain refers to an over-stretching of a muscle; often strains are referred to as “pulled muscles”. Strains are graded based on severity with grade one strains being the least severe and grade three strains being the most severe. Grade one strains involve the slight over-stretching of the involved muscle(s), grade two strains involve the over-stretching of a muscle with partial tearing involved and grade three strains involve the over-stretching of a muscle with near-complete or complete tearing of the muscle involved.

How is it fixed? Conservative management of less severe biceps strains usually involve a period of rest and time off from activity which aggravates pain symptoms. Initial physical therapy intervention involves pain control via ice and activity modification. Stretching early on in the rehab process is usually gentle, as to not increase soreness or pain through the biceps brachii muscle. Once pain is under control, an effort to improve eccentric (lengthening of a muscle) strength is made. Due to the direct relationship of the biceps to the shoulder, rehab also includes maintenance of strength and range of motion of the shoulder joint and other surrounding musculature. Once pain, range of motion, and strength are all within normal limits, the initiation of return to sport activities can be initiated. Such activities include throwing and/or batting at a lesser than maximal intensity. As the individual progresses through the return to sport phase, intensity of simulation activities is increased. Finally, once an athlete is able to meet the criteria to begin live game action, set out by the team’s medical staff, he will be allowed to head out on a rehab assignment. In more severe cases of biceps strains, such as a grade three injury, surgery may be required. In surgical cases, return to play time is much longer than treatment of biceps strains managed conservatively via physical therapy.

My take.  Per the Indians, Almonte will be shut down from all baseball activities over the next three to five weeks after he was diagnosed with a high grade strain to his right biceps tendon. Being that this injury has been recurring in nature, I don’t anticipate that the team will rush him back. Following the initial injury on May 10th, Almonte received two days off prior to returning to the lineup, only to make the injury worse almost a week later. The team is going to take their time with Almonte’s rehab with the long haul that is a major league baseball season in mind.

We will continue to monitor the status of Abraham Almonte throughout the rehabilitation process and will provide the most up to date injury breakdown, analysis and explanation as new information becomes available.

Brandon Bowers, PT, DPT, is a graduate of the University of Toledo, Doctor of Physical Therapy Program and currently practices in Columbus, Ohio. He is an avid Cleveland sports fan and has experience rehabbing athletes of all levels and from a variety of sports. Follow Brandon on Twitter for more Cleveland Indians injury insight and analysis: @blbowers12

The information provided is the professional opinion of Brandon Bowers, PT, DPT and is based on his clinical experience and the most current clinical evidence available. This information should not be interpreted as or substituted for medical advice for a specific condition or diagnosis.

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