What an Elbow Alone Can Tell You About Strength and Conditioning Program Design (Part 2)
Written on October 9, 2011 at 7:48 am, by Eric Cressey
Today marks Part 2 of this mini-series covering just how much you can learn from looking at an elbow before writing up a strength and conditioning program. In Part 1, we talked about what can be learned from our first potential scenario, elbow hyperextension. Today, we’ll focus on the lessons to be learned from three more scenarios.
Full Elbow Extension, Muscular End-Feel – This simply means that you have all your extension and no “empty” end feel; it eases to muscular stretch (of the elbow flexors).
This is probably the most common presentation pattern in the general population, and you can generally expect these folks to respond to need equal amounts of mobility and stability training. More thorough assessments will give you more information on where to focus your efforts.
Incomplete Elbow Extension, Bony End-Feel – These are, in many cases, guys who did not get full elbow extension back following a surgical procedure. Or, it may just be someone with bone spurs on the underside of the joint that interferes with elbow extension.
It’s a bold assumption to make, but these individuals are almost always (in my experience) athletes who have profound limitations in other regions, as poor glenohumeral mobility, rotator cuff function, scapular stabilization, thoracic spine mobility, and terrible tissue quality can all contribute to these kind of issues presenting at the elbow. So, when I see and feel an elbow this “gross,” I usually know that I have my work cut out for me. Generally, these guys wind up needing a hearty dose of mobility training, soft tissue work, breathing drills, and longer duration static stretching.
That said, with respect to the elbow itself, these guys need to be cognizant of maintaining every little bit they have. If you’ve got a 10° elbow extension deficit because of bony changes, you can probably get by. However, if you allow that 10° to become 30° because you pile soft tissue shortness/stiffness on top of it, you could be waiting for some serious problems to come around. To that end, I always encourage these guys to get routine soft tissue work and plenty of static stretching in to maintain whatever elbow extension they still have.
Incomplete Elbow Extension, Muscular End-Feel – These guys look very much like our previous category, but the end-feel has much more “give” to it; it’s not a “concrete-on-concrete” end-feel. This is a very good thing, as you know you can work to get it back. This athlete, for instance, got 15° of elbow extension back in a matter of a few minutes following a Graston treatment with our manual therapist and some follow-up stretching.
I wouldn’t expect him to maintain 100% of those improvements from treatment to treatment, but over the course of 3-4 bouts, he should get to where he needs to be.
Expect to see some of the same things with the rest of the body, as elbow extension deficits rarely occur in isolation. In throwers, they’re usually accompanied by poor glenohumeral internal rotation on the throwing side, poor hip internal rotation on the front leg, and a host of other stiffness/shortness issues. In the general population, you see them in people who are locked up all over – especially in people who sit at computers all day long.
That wraps up our look at four elbow presentation patterns and what they may mean for your strength and conditioning programs and corrective exercise approaches. For more information, check out the Everything Elbow In-Service, an affordably priced 32-minute in-service where half of all proceeds go to charity.
Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!
|
October 9th, 2011 at 9:54 am
Is there anything someone can do at home to end elbow tendonitis, besides rest and ice? Besides extending the arm straight out and stretching the fingers up and down? Or, holding a hammer with your arm locked out and lifting it up and down with your wrist? None of these worked. Going to a Chiropractor and him doing “electric” treatments on it started to, but I don’t have the money for medical treatment.
October 9th, 2011 at 4:34 pm
This was a very interesting read. I have a friend who works out that fits the “Incomplete Extension/Bony End” profile. I have never had an answer for him. It was beyond my scope of knowledge and frankly I would forget about it and never researched it. 🙂 I could only give him educated guesses. This provides a more complete explanation. Thanks, Eric!
October 10th, 2011 at 1:13 pm
i have a sligth incomplete extension on the left elbow (may be between 5 and 10° but i’ve never have any serious injury there. i’ve been training for 23 years with intensity. the only injury i had 10 years ago was a little tear of the rotator cuff of the left shoulder but i’ve recovered pretty well without doing nothing. i can extend completely the right elbows but in exercises like bench press and military press i can see this asimmetry when i look in the mirror and i fell i could lift more if had not that problem. when i try to maximally extend the left arm i can fill a pull in the low lateral part of the arm, i’m not sure if it’s the brachialis or brachiradialis or the lateral head of the tricep. visually the elbow is normal and if i touch it hard i can’t fell any pain. I don’t think that this problem is congenital because i remember that 4 or 5 years ago i could extend completely the arm. in my case, what could be the more convenient solution?
October 10th, 2011 at 4:07 pm
Hey Eric:
I’d like to know if you’ve run across folks with persistent muscle spasms in the arm (flexors) and forearm (supinators/pronators) following arthroscopic surgery for bone chips in the elbow joint. These spasms ‘resist’ extension after any period of elbow flexion (but not flexion after a period of extension) and supination/pronation. A period of active warm-up and/or immersion in warm water reduces these reactive spasms for as long as the warmth/activity is maintained. Your thoughts/experience welcome. No paresthesias or other neuro type involvement. Time-frame is during six months following scope.
October 10th, 2011 at 6:01 pm
What would you recommend for someone who works at a desk all day (a former great athlete 🙂 ) and is suffering from Incomplete Elbow Extension, Muscular End-Feel?
October 10th, 2011 at 7:01 pm
Jason,
I’m a huge fan of direct manual therapy. http://www.grastontechnique.com for more info.
October 10th, 2011 at 7:02 pm
Alex,
I’d try some soft tissue work and longer-duration static stretching.
October 10th, 2011 at 7:06 pm
Tony,
I haven’t seen it, but I could easily imagine it happening after someone was braced in a more flexed position for an extended period. My hunch is that some manual therapy would get the ball rolling in the right direction. I’d also look at bloodwork to see if there were issues with Vitamin D, electrolytes, hydration status, EFAs, etc.
October 10th, 2011 at 7:07 pm
Jeff – Soft tissue work and static stretching.
May 9th, 2013 at 10:08 am
Hey Eric,
I am currently a Graduate Assistant for a collegiate baseball team. One of the players I inherited is in his 8th week post op Tommy John and is still lacking 10 degrees extension. Would soft tissue work and static stretching be my best bet to retain those final degrees? He had been at Physical Therapy the previous 8 weeks and now has been given to me.
May 10th, 2013 at 4:17 am
Adam,
He might very well respond to soft tissue work, but you shouldn’t be the one doing it from a scope of practice standpoint. Every post-op elbow is different, so it’s very difficult to make recommendations online. I’d refer him out to someone who has handled these before if you feel that he could gain that 10 degrees with the right treatment.