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.