Joint Manipulation: Elbow (Radial Head) and Wrist

Introduction

This course describes joint manipulation techniques for the elbow (radial head) and wrist. Various synonyms and definitions have been used to describe the term "manipulation". The Brookbush Institute uses one conventional definition of the term "manipulations;" implying low-amplitude (relatively small motions), high-velocity (quick) techniques, intended to target and reduce the stiffness of specific joints or segments, that exhibit a decrease in passive accessory range of motion (a.k.a. stiffness during arthrokinematic motion; specifically glide ). Research does imply that manipulations affect multiple joints simultaneously; however, the Brookbush Institute asserts that efforts to target the stiffest joints or segments will increase the likelihood that the stiffest segments are included in the "multiple joints" affected.

The Brookbush Institute has carefully selected manipulation techniques with the intent to increase the probability of practitioner success. That is, techniques have been chosen that are relatively easy to teach, reliably improve outcomes, and are the most commonly used. The Brookbush Institute does not wish to assert that these manipulation techniques are the only techniques that are effective, and/or that these are the best techniques for every outcome measure. It is possible that a highly complex, and/or advanced technique, may result in better outcomes, or that a particular pathology is better addressed with a rarely used technique.

Note, the term "mobilization" is reserved for low-velocity techniques that are taught in a separate set of courses.

This course includes manipulation techniques that intend to reduce excessive stiffness of the radiohumeral and radioulnar joints of the elbow, and the carpal joints of the wrist, with the intent of addressing upper extremity dysfunction. For example, elbow pain has been correlated with altered scapular motion and a reduction in grip strength, both of which can have a significant effect on the strength and power of the upper extremity during sports and functional activity. These techniques may also be used in an integrated approach for cervicothoracic dysfunction and upper body dysfunction (UBD) including lateral epicondylitis (tennis elbow), medial epicondylitis (golfer's elbow), carpal tunnel syndrome, double-crush syndrome, shoulder impingement syndrome (SIS), chronic thoracic pain, chronic neck pain, and acromioclavicular dysfunction.

The techniques in this course are recommended for all clinical human movement professionals (physical therapists, physical therapy assistants, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) to develop an evidence-based, systematic, integrated, patient-centered, patient-centered, and outcome-driven approach.

Techniques Covered in this Course:

• Elbow (Radial Head) Manipulation
• Wrist Manipulation

Related Courses

Additional Joint Mobilization Courses

• Joint Manipulation: Cervical Spine
• Joint Manipulation: Thoracic Spine
• Joint Manipulation: Lumbar Spine, Sacroiliac Joint, and Pubic Symphysis
• Joint Manipulation: Elbow (Radial Head) and Wrist
• Joint Manipulation: Ankle, Midfoot, and Tibiofibular Joint

For an introduction to joint mobilizations and manipulations:

• Joint Mobilization and Manipulation: Introduction
• Joint Mobilization and Manipulation: Reliability
• Joint Mobilizations and Manipulations: Effects
• Joint Mobilization and Manipulation: Risk of Adverse Effects
• Joint Mobilizations and Manipulations: Evidence-based Teaching and Learning

Pre-approved credits for:

• Integrated Manual Therapist (IMT) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Physical Therapists
• Physical Therapy Assistants

This Course Includes:

• AI Tutor
• Study Guide
• Text and Illustrations
• Audio Voice-over
• Research Review
• Technique Videos
• Sample Routine
• Practice Exam
• Pre-approved Final Exam

1. Verhaar, J. A. N., Walenkamp, G. H. I. M., Van Mameren, H., Kester, A. D. M., & Van der Linden, A. J. (1996). Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. Journal of Bone and Joint Surgery: British Volume, 128-132.
2. Fathy, A. A. (2015). Iontophoresis versus Cyriax-type exercises in chronic tennis elbow among industrial workers. Electronic physician, 7(5), 1277.
3. Coombes, B. K., Connelly, L., Bisset, L., & Vicenzino, B. (2016). Economic evaluation favours physiotherapy but not corticosteroid injection as a first-line intervention for chronic lateral epicondylalgia: evidence from a randomised clinical trial. Br J Sports Med, 50(22), 1400-1405.
4. Olaussen, M., Holmedal, Ø., Mdala, I., Brage, S., & Lindbæk, M. (2015). Corticosteroid or placebo injection combined with deep transverse friction massage, Mills manipulation, stretching and eccentric exercise for acute lateral epicondylitis: a randomised, controlled trial. BMC musculoskeletal disorders, 16(1), 122.
5. Hsu, C. Y., Lee, K. H., Huang, H. C., Chang, Z. Y., Chen, H. Y., & Yang, T. H. (2016). Manipulation therapy relieved pain more rapidly than acupuncture among lateral epicondylalgia (tennis elbow) patients: a randomized controlled trial with 8-week follow-up. Evidence-Based Complementary and Alternative Medicine, 2016.
   • Comparing manipulation to exercise
6. Koch, M., Kamath, M. S., & Chetri, B. (2015). Efficacy of Cyriax physiotherapy versus eccentric strengthening and stretching exercises in chronic lateral epicondylitis patients. International Journal of Physiotherapy, 2(5), 731-737.
7. Viswas, R., Ramachandran, R., & Korde Anantkumar, P. (2012). Comparison of effectiveness of supervised exercise program and Cyriax physiotherapy in patients with tennis elbow (lateral epicondylitis): a randomized clinical trial. The scientific world journal, 2012.
8. Baltaci, G., Ergun, N., & Tunay, V. B. (2001). Effectiveness of Cyriax manipulative therapy and elbow band in the treatment of lateral epicondylitis. European Journal of Sports Traumatology and Related Research, 23(3), 113-118.
9. Nagrale, A. V., Herd, C. R., Ganvir, S., & Ramteke, G. (2009). Cyriax physiotherapy versus phonophoresis with supervised exercise in subjects with lateral epicondylalgia: a randomized clinical trial. Journal of Manual & Manipulative Therapy, 17(3), 171-178.
10. Stasinopoulos, D., & Stasinopoulos, I. (2006). Comparison of effects of Cyriax physiotherapy, a supervised exercise programme and polarized polychromatic non-coherent light (Bioptron light) for the treatment of lateral epicondylitis. Clinical Rehabilitation, 20(1), 12-23.
    • Additional comparisons
11. Dasm, P. G. (2012). Comparative analysis of Cyriax approach versus mobilization with movement approach in the treatment of patients with lateral epicondylitis. Physiotherapy and Occupational Therapy, 6(1).
12. Goyal, M., Kumar, A., Monga, M., & Moitra, M. (2013). Effect of wrist manipulation and Cyriax physiotherapy training on pain and grip strength in lateral epicondylitis patients. Journal of Exercise Science and Physiotherapy, 9(1), 17.
13. Patel, N. (2013). Effectiveness of mobilization with movement of elbow compared with manipulation of wrist in patients of lateral epicondylitis. Int J Physiother Res, 1(4), 177-82.
14. Burton, A. K. (1988). A comparative trial of forearm strap and topical anti-inflammatory as adjuncts to manipulative therapy in tennis elbow. Manual medicine, 3(4), 141-143.
    • Combining Interventions
15. Prabhakar, A. J., Kage, V., & Anap, D. (2013). Effectiveness of Cyriax physiotherapy in subjects with tennis elbow. J Nov Physiother, 3(3), 156.
16. Shaik, J. (2000). The relative effectiveness of cross friction and Mill's manipulation as compared to cross friction alone in the treatment of lateral epicondylitis (tennis elbow) (Doctoral dissertation).
17. Richer, N., Marchand, A. A., & Descarreaux, M. (2017). Management of chronic lateral epicondylitis with manual therapy and local cryostimulation: a pilot study. Journal of chiropractic medicine, 16(4), 279-288.
    • Comparing Manipulation to Exercise
18. Moitra, M., Sharma, S., Kumar, S. P., & Samuel, A. J. Efficacy of Wrist Manipulation and Phonophoresis on Pain and Grip Strength in Lateral Epicondylitis: A Randomized Clinical Trial.
19. Joshi, S., Metgud, S., & Ebnezer, C. (2013). Comparing the effects of manipulation of wrist and ultrasound, friction massage and exercises on lateral epicondylitis: a randomized clinical study. Indian Journal of Physiotherapy and Occupational Therapy, 7(3), 205.
20. Struijs, P. A., Damen, P. J., Bakker, E. W., Blankevoort, L., Assendelft, W. J., & van Dijk, C. N. (2003). Manipulation of the wrist for management of lateral epicondylitis: a randomized pilot study. Physical therapy, 83(7), 608-616.
    • Combining Interventions
21. Taylor, D. (2019). MANAGEMENT OF CARPAL TUNNEL SYNDROME WITH CONSERVATIVE MULTIMODAL THERAPY: A PROSPECTIVE CASE SERIES OF OUTCOMES WITH CONCURRENT WRIST AND CERVICAL MANIPULATION. Journal of Contemporary Chiropractic, 2, 123-130.
22. Sharth, U. R. (2005). Combined effect of wrist manipulation and elbow taping in patients with tennis elbow (Doctoral dissertation).
    • Wrist Manipulation and Performance
23. Taitz, M. S. (2015). Chiropractic wrist manipulation on performance indicators in asymptomatic male golfer (Doctoral dissertation, University of Johannesburg).