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Joint Mobilization: Elbow and Proximal Radioulnar Joint Audio

Joint mobilizations for the ankle and tibiofibular joint. Types of mobilizations, self-administered mobilizations, and interventions for upper body dysfunction (UBD), wrist, and elbow dysfunction. Optimal intervention for pain, grip strength, elbow and shoulder ROM, and lateral epicondylalgia (epicondylitis). The risk of adverse events, validity, efficacy, screening, and reliability of elbow and wrist/forearm mobs.

Joint Mobilization: Elbow and Proximal Radioulnar Joint

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I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

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I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

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Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

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Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

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This course describes joint mobilizations for the elbow joint (a.k.a. humeroulnar joint) and proximal radioulnar joint (a.k.a. RU joint or ulnoradial joint). Several terms and definitions have been used to describe the "mobilizations" (e.g. mobilisations) that are taught in this course. The Brookbush Institute uses a conventional definition of "mobilization" that includes low amplitude, low-velocity, oscillatory techniques intended to reduce the stiffness of joints exhibiting a decrease in passive accessory range of motion (a.k.a. arthrokinematic motion and specifically glide or slide). Note that "manipulation" is reserved for high-velocity techniques taught in a separate set of courses.

This course includes mobilization techniques that intend to improve excessive stiffness of the elbow and proximal RU joints, improve flexion, extension, pronation, and supination range of motion, and reduce forearm, elbow, and upper extremity dysfunction. For example, wrist and forearm dysfunction has been correlated with scapular dyskinesis (altered shoulder blade motion), and a reduction in upper extremity function (e.g. negative impact on activities of daily living and sport). These techniques may also be used in an integrated approach for cervicothoracic dysfunction and 

 including radiculopathy, double crush syndrome, upper thoracic pain, acromioclavicular (AC) joint pain, frozen shoulder (post-acute phase), lateral epicondylitis (tennis elbow), and postural dysfunctions including rounded shoulder posture and excessive forearm pronation. Several studies even demonstrate that treating elbow dysfunction (e.g. lateral epicondylalgia) with conventional treatment (ultrasound, stretching, and strengthening exercises) and the addition of these mobilizations, resulted in significantly larger improvements in grip strength, function, and/or pain when compared to conventional therapy alone.

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, and outcome-driven approach.

Sample Intervention (Lateral Epicondylagia)

Joint Mobilizations: Ankle and Tibiofibular Joints

Joint Mobilizations: Lumbar Spine and Sacroiliac Joints

Joint Mobilizations: Cervical and Thoracic Spine

Joint Mobilizations: Shoulder, Sternoclavicular, and Acromioclavicular Joints

Joint Mobilizations: Elbow and Proximal Radioulnar Joints

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

Course Description: Elbow and Proximal Radioulnar Joint Mobilization

Introduction

Research Corner Summary

Efficacy

Comparing Interventions

Systemic Response

Research Corner: Elbow

Unfortunately, there are very few studies on radioulnar joint mobilizations. Coyle et al. compared sustained stretches to oscillatory mobilizations for the radioulnar joint following 6 weeks of immobilization for Colles's fracture, demonstrating that mobilizations were more effective for improving ROM if the patient was experiencing pain and during the early phase of treatment, and sustained stretches were more effective for improving ROM when pain was not present and in the later phases of treatment (24). An RCT by Lal et al, compared paraffin wax bath and home exercises, to the same treatment with the addition of radius mobilizations following immobilization for distal radius fracture, demonstrating that the addition of mobilizations resulted in larger improvements in pain, function, grip strength, and ROM (25). An RCT by Drechsler et al. compared a group receiving radius and radial nerve mobilizations, to a group receiving ultrasound, transverse friction massage, and wrist extensor stretching and strengthening for the treatment of lateral epicondylitis. After 6 - 8 weeks of 2 sessions per week, data was collected 3 months post-treatment, demonstrating that the mobilization group exhibited less pain, disability, and better function (26). An RCT by Kay et al. treatment including advice and exercise with and without radioulnar joint mobilizations for treatment following immobilization of a distal radius fracture, demonstrating no significant differences in function, pain, or ROM between the groups during follow-up at 6 weeks (27). These studies suggest that radioulnar mobilization may be more effective than soft tissue techniques and stretching, especially in the early phases of rehabilitation, and may improve outcomes when added to conventional treatments for LE and radius fracture. An additional study by Ohshiro et al. demonstrated that glide during anterior/medial radius mobilizations was greatest during 60° - 90° of elbow flexion, and glide during posterior/lateral radius mobilizations was similar at all elbow flexion angles (). These findings may be used to refine practice (28).

Reserach Corner: Radioulnar Joint Mobilization

Elbow Mobilization

Proximal Radioulnar Joint Mobilization

Video Demonstration

Ganesh, B. R., Gurav, G., Gonsalves, J., & Patel, J. (2016). EVALUATION OF THE EFFECT OF MOBILIZATION WITH MOVEMENT ON PAIN, KINESIOPHOBIA AND ACTIVITIES OF DAILY LIVING IN LATERAL EPICONDYLITIS-AN EXPERIMENTAL STUDY. 

International Journal of Therapies and Rehabilitation Research

Kim, L. J., Choi, H., & Moon, D. (2012). Improvement of pain and functional activities in patients with lateral epicondylitis of the elbow by mobilization with movement: a randomized, placebo-controlled pilot study. 

Martínez-Cervera, F. V., Olteanu, T. E., Gil-Martínez, A., Díaz-Pulido, B., & Ferrer-Peña, R. (2017). Influence of expectations plus mobilization with movement in patient with lateral epicondylalgia: a pilot randomized controlled trial. 

Vicenzino, B., Paungmali, A., Buratowski, S., & Wright, A. (2001). Specific manipulative therapy treatment for chronic lateral epicondylalgia produces uniquely characteristic hypoalgesia. 

Abbott, J. H., Patla, C. E., & Jensen, R. H. (2001). The initial effects of an elbow mobilization with movement technique on grip strength in subjects with lateral epicondylalgia. 

Abbott, J. H. (2001). Mobilization with movement applied to the elbow affects shoulder range of movement in subjects with lateral epicondylalgia. 

Vicenzino, B., Smith, D., Cleland, J., & Bisset, L. (2009). Development of a clinical prediction rule to identify initial responders to mobilisation with movement and exercise for lateral epicondylalgia. 

Ibc, K. D. B., Smidt, N., Tulder, M., & Bouter, L. (2001). COST‐EFFECTIVENESS OF INTERVENTIONS FOR LATERAL EPICONDYLITIS: RESULTS FROM A RANDOMIZED CONTROLLED TRIAL IN PRIMARY CARE. 

Bisset, L., Beller, E., Jull, G., Brooks, P., Darnell, R., & Vicenzino, B. (2006). Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. 

Coombes, B. K., Bisset, L., Brooks, P., Khan, A., & Vicenzino, B. (2013). Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. 

Burton, A. K. (1988). A comparative trial of forearm strap and topical anti-inflammatory as adjuncts to manipulative therapy in tennis elbow. 

Afzal, M. W., Ahmad, A., Waqas, M. S., & Ahmad, U. (2016). Effectiveness of therapeutic ultrasound with and without Mulligan mobilzation in lateral epicondylitis. 

Kochar, M., & Dogra, A. (2002). Effectiveness of a specific physiotherapy regimen on patients with tennis elbow: clinical study. 

Belomazheva-Dimitrova, S. (2013). Study of the Effect of Mobilization and Muscle-inhibitory Techniques on an Elbow Arthrokinematics after Conservative Treatment of Intra-articular Fractures of the Elbow Joint. 

Scientific Report Physical Education and Sport

Amro, A., Diener, I., Isra’M, H., Shalabi, A. I., & Dua’I, I. (2010). The effects of Mulligan mobilisation with movement and taping techniques on pain, grip strength, and function in patients with lateral epicondylitis. 

Wrist Manipulation compared to Elbow Treatment

Manchanda, G., & Grover, D. (2008). Effectiveness of movement with mobilization compared with manipulation of wrist in case of lateral epicondylitis. Indian J Physiother Occup Ther, 2(1), 16-25.

Patel, N. (2013). Effectiveness of mobilization with movement of elbow compared with manipulation of wrist in patients of lateral epicondylitis. 

Dasm, P. G. (2012). Comparative analysis of Cyriax approach versus mobilization with movement approach in the treatment of patients with lateral epicondylitis. 

Hariharasudhan, R., & Balamurugan, J. (2015). Effectiveness of muscle energy technique and Mulligan's movement with mobilization in the management of lateral epicondylalgia. 

Paungmali, A., O'Leary, S., Souvlis, T., & Vicenzino, B. (2003). Hypoalgesic and sympathoexcitatory effects of mobilization with movement for lateral epicondylalgia. 

Paungmali, A., O’Leary, S., Souvlis, T., & Vicenzino, B. (2004). Naloxone fails to antagonize initial hypoalgesic effect of a manual therapy treatment for lateral epicondylalgia. 

Journal of manipulative and physiological therapeutics

Paungmali, A., Vicenzino, B., & Smith, M. (2003). Hypoalgesia induced by elbow manipulation in lateral epicondylalgia does not exhibit tolerance. 

Slater, H., Arendt-Nielsen, L., Wright, A., & Graven-Nielsen, T. (2006). Effects of a manual therapy technique in experimental lateral epicondylalgia. 

Lal, R. K., Bhat, K., & Sanjay, P. Efficacy of Passive Mobilization and Home Exercises in Post Immobilization Period of Distal Radius Fracture.

Coyle, J. A., & Robertson, V. J. (1998). Comparison of two passive mobilizing techniques following Colles' fracture: a multi-element design. Manual therapy, 3(1), 34-41.

Drechsler, W. I., Knarr, J. F., & Snyder-Mackler, L. (1997). A comparison of two treatment regimens for lateral epicondylitis: a randomized trial of clinical interventions. 

Kay, S., Haensel, N., & Stiller, K. (2000). The effect of passive mobilisation following fractures involving the distal radius: a randomised study. Australian journal of physiotherapy, 46(2), 93-102.

Ohshiro, S., Hidaka, E., Miyamoto, S., Aoki, M., Yamashita, T., & Tatsumi, H. (2009). Influence of elbow flexion angle on mobilization of the proximal radio-ulnar joint: A motion analysis using cadaver specimens. 

Bibliography

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Joint Mobilization: Elbow and Proximal Radioulnar Joint

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