Name: Elbow Mobilization (Posterior to Anterior Humerus on Ulna)
Uploaded: 2023-04-23T07:03:38.000Z
Duration: 14 min 51 s
Description: Learn the proper technique for posterior-to-anterior humerus mobilization on the ulna in this step-by-step instructional video. This manual joint mobilization may help reduce elbow pain and stiffness, restore range of motion, and improve overall upper extremity function as part of a comprehensive rehabilitation program.

English captions

https://stream.mux.com/jRjgTgmRIcKV2oWASbOA4yZ01G02s2w65p5whXRiZqWss.m3u8

Learn the proper technique for posterior-to-anterior humerus mobilization on the ulna in this step-by-step instructional video. This manual joint mobilization may help reduce elbow pain and stiffness, restore range of motion, and improve overall upper extremity function as part of a comprehensive rehabilitation program.

Introduction to Joint-Based Manual Therapy

Overview of Elbow Mobilization Technique

Proper Positioning and Anatomical Landmarks

Implementing the Mobilization Technique

Understanding Mobilization Grades and Protocols

Adapting Techniques for Greater Range of Motion

Recap and Importance of Assessment in Therapy

Elbow Mobilization (Posterior to Anterior Humerus on Ulna)

This is Brett of The brookbush Institute in this video. We're gonna go over a joint-based manual therapy technique. If you're watching this video, I'm assuming you're watching it for educational purposes and that you are a licensed professional with joint-based techniques within your scope. That means osteopaths chiropractors physical therapists. You're probably all in the clear Physical Therapy assistance athletic trainers massage therapists. You need to check with your governing body in your state or region to see whether this is within your scope of practice personal trainers. This is definitely not within your scope of practice. Of course all professions could use this video for purely educational purposes to help with learning biomechanics. Anatomy. And of course palpation this video we're gonna do a posterior and to your humerus on ulna elbow mobilization with the intent of increasing and range extension. Now, I hesitate to say I might have developed this mobilization myself in a attempt to find a more comfortable way of doing elbow extension mobilizations. I have looked in various textbooks and just didn't see anything that even looked like this technique. If you guys know of a technique out there that resembles this technique, please let me know because I'd like to know the tradition. I like to know the history and the convention if you can't find anything out there, please feel free to name this one after me so I can go down in history. Maybe this will be like the bread mobilization or something. Melissa is gonna help me demonstrate this technique. Of course, I'm just kidding guys, but I think this this mobilization will come in handy for you guys. So the problem we run into with the elbow is the same problem. We run into with the knee where when we have a concave surface on a convex surface. Our mobilization Direction ends up matching the same direction. We're trying to gain range of motion in this creates a problem clinically or in practice because a lot of times that ends up pushing us into somebody's painful range, right? So if somebody doesn't have endrange elbow extension and they don't have it because at the end it hurts and I'm pushing somebody down into that extension range. They're gonna guard on me and chances are I'm not going to get what I'm looking for from the mobilization. So I started thinking with the elbow, why don't I treat the elbow a little bit more like I treat the knee rather than pushing down on the tibia. I like doing a posterior to anterior mobilization to try to get Melissa further into extension. What we did is we flipped Melissa over in that knee mobilization video. Braced her tibia and pushed down on the femur. So we went anterior to posterior on the femur because those motions are the same relatively speaking. It ends up I can do the same thing with the elbow right? I can push posterior to anterior on the humerus and kind of brace my ulna so that I'm not simultaneously pushing her further and further into extension which might be painful now with all of our mobilizations. We need to think of a few things here. We need to think of patient position our position. Our position is very important for a manual technique. So we have nice long comfortable careers. We need to think about where we're going to put our hands and a lot of that has to do with Anatomy. so with your partner client or patient go ahead and start with their elbow a little bit flexed until you get used to this technique. Feel their humorous find the epicondiles. All right, once you find the epicondiles kind of go in from the epicondiles and you know investigate the soft tissue there and you'll notice there's a hole right here a little little divot. That's your electron on fossa, right? That's where your electron process fits into on your humerus. Now, of course, if you found your electron fossa, you can just move down and you find this big bump which of course is your electron process and that's part of your ulna. So those landmarks are important because what we want to be able to do is I want to put this hand Over the top of my epicondiles of my humerus and I want to be able to find the joint line. I've talked to this talked to this point in a few of these mobilization videos. If you can put your finger on the joint line, you can feel the Glide feel the mobilization and get a little bit more tactile feedback for yourself. So what I'm gonna do is I'm going to start here put my thumbs down over that joint line and then I'm gonna wrap my fingers around Melissa's arm. So this her arm is gonna be nice and stable now for this particular technique. I find that it is helpful. To have Melissa kind of go. Okay, grab the side of the table right now relax. Now what that does is it puts her arm in a nice neutral position her forearm in a nice neutral position and she's kind of turned this way her arms hanging off just a little bit. So she's not totally an end range extension and then of course I wanted to relax because I don't want any guarding and then I'm just gonna wrap my hand around and now her ulna is braced against my fingers. I then have this hand. with my thumbs on the joint line to create that posterior to anterior Force. just like so I know let's get into grades just here for a second. What I would do is is push down. Until I felt no more Glide and we want to be gentle about that. So you start off with a little pressure see if you get any joint motion at the Joint line. Push down a little harder. Maybe a little harder still and of course you're trying to find okay. I can push as hard as I want at this point. I'm not getting any more Glide at the Joint. I'm gonna back off. So I'm going to go from first resistance barrier to end range and I'm going to find the middle at 50% and then I can either do large larger amplitude mobilizations. They're still fairly small amplitude, but you can go from initial resistance barrier to 50% here. And I'm just going to do my oscillations at one to two oscillations per second. Or I can kind of bear down into 50% or maybe even a little bit more. Do really small oscillations? And that would be my grade 4 so we got my grade three is from first resistance barrier to about 50% grade 4 is kind of bearing down on 50% or a little bit more. And I'm going to keep doing this until I find a change. in joint stiffness Now if you guys use other protocols besides the Maitland syriacs protocol that I just described that's fine. I find that the biggest mistake. physical therapist and other manual therapists make whether they're atcs or or osteopaths or even chiropractors is they know a protocol they know that protocol works and they don't follow through with it. So if you know a protocol that's let's say seven second holds seven times at end range. Make sure you do all seven and make sure each one seven seconds. If you do one oscillation per second, that's fine. Just make sure you keep doing those oscillations until you get a change in joint stiffness. And of course after I did this technique I would go ahead and retest extension. So let's let me have you set up real quick. All right. Let's have you extend your elbow. Maybe do one of these for me. There you go touch shoulders. Reach out good. How does that elbow feel? All right, I could go back to my goniometry. I could go back to any of my special tests that were causing her pain and if it worked great if I thought I could get more out of doing that mobilization again, I could do the mobilization a second time. Of course if it didn't work at all. Stop doing it. It's just that simple right assess intervention. reassess that's so go ahead and lay back down Melissa. Now the other thing I want to show you guys because obviously I kind of showed you what would be great on a patient who you need to clean up the very last five degrees, right? They're missing five degrees of elbow extension. What if you have somebody who's missing 25 degrees available extension? Well, the sandbells work pretty well. To you kind of put them in the pocket. All right of your elbow there. Alright, so if you put it right right just medial to your brachioradialis, but on the radius and ulna this is the important part. So it has to be in that little pocket of your arm, but not on the humerus on the ulna now I can kind of control. And I can get her to let's say 20 degrees with with the ulna being braced. So even if she was post-surgical right for like a biceps tendon reattachment and she had only gotten back to 20 degrees. I can keep her braced. I can keep her where I want her using this hand and this is a brace. And only push down on the humerus. If I needed to go even shorter than that. Well, some of you guys may have remembered doing something like this from your special test at the knee. But if I drop the table down a little bit. I can actually use my knee. Right have her still this hand is off the side of the table. and now I just have to kind of adjust. Maybe I'll use my other knee here. I just have to adjust myself until I get this stabilized at the degree I want. And then I can push down on the humerus now granted. This is a little sloppier. than the technique I just showed you but obviously when we have somebody who's post-surgical or we have somebody who's missing a lot more range of motion than we normally see on an everyday basis. We are going to have to improvise a little bit. Now stay tuned here. I'm going to have you guys. Go through this technique one more time with our close-up recap. All right for a close-up recap. Let's do a quick review of the anatomy here. I'm gonna go ahead and feel Melissa's humorous until I get to the end and feel those epicondiles. Now, you'll feel those kind of protrude from the humerus the way you'd feel the malleoli protrude from the tibia and fibula at your ankle. They're just kind of buried under some more soft tissue than they are at your ankle. But here they are right here and then I can kind of go on up over her elbow and I feel that little bump here, which is her electron process and kind of between her electron process and those epicondials you'll feel this line that does this Right that line right there is the joint line and that's that's where I talked about you guys put in your thumb so that you can feel the amount of Glide that is happening. Now. I'm going to move Melissa's hand so that her hand itself and her wrist is hanging off the table, and I know you guys can't see that but it's the neutral position we talked about in the the further shot. And then gonna go ahead and embrace her entire radius and ulna with my hands so that I have good control and I've also raised her up from the table just a little bit and then I'm gonna create that posterior to anterior Force by placing the weight of my torso over my arm. And slowly pushing her to the end. Of Glide. All right, so I want to see how much motion can I get at the Joint line? And once I noticed that I'm pushing a little harder but not getting any more motion. That's that's the end. Something gonna back off kind of take no, where's my first resistance barrier. So that's right there. Where's the end that's right there back off to 50% and then I can do my grade threes by going first resistance very 250% or grade 4 is by doing small amplitude at 50% or maybe a little greater. And we'll just keep going at one to two oscillations per second. And then of course, what am I going to do after? I'm going to retest elbow extension. And if elbow extension feels better or this decreases her symptoms, then we know this is a good technique for now. She didn't have this much extension. Let's say she's missing the last 20 25 degrees. We did talk about using maybe one of these sandbells and of course you guys can experiment with other objects there the most important thing to remember here is that whatever you use to brace has to brace the radius and ulna and not the humerus. So you want something that is nice and stable keeps you at the amount of elbow flexion that you need but still allows you that posterior to anterior Glide. At the humerus if I was here you guys can see how now I'm blocked. I can't get posterior to anterior Glide of the humerus and and I'm not gliding at all because now this isn't stable at all. So just moving right there kind of. Just distal to that that brachial fossa there. And then I could create the same type of posterior to anterior Force by putting my torso over my arms finding end range and then backing off to 50% and doing either my grade three's or grade fours at two oscillations per second. There you have it assess a dress reassess make sure that every time you choose a joint-based manual therapy technique. It is based on an assessment and that you return to that assessment after you finish the intervention to see if it was effective for the individual the patient or client that you have in front of you ensure that you continue to learn your Anatomy because you're Anatomy is going to help you with your hand placement with understanding what a joint can do with understanding what you may gain from this particular technique and of course practice, you have to practice these techniques. Hopefully not for the first time on a patient or client who just walked in the door if you can find a more senior instructor or mentor to give you some really good Hands-On instruction use your peers for some good feedback. And of course always look for live education. To help with your manual therapy techniques. I know these videos make education very convenient, but there is no substitute for learning manual therapy and a live setting. I look forward to talking to you guys again soon.

Home

Videos

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

The patient should be prone, with the practitioner standing on the patient's affected side.

The table should be at a height that allows the practitioner to have their elbows extended when the practitioner's chest is over the patient's elbow.

Posterior to Anterior Mobilization (Humerus on Ulna)

Note: As far as we know, the humerus on ulna approach to this mobilization is a novel technique. We hope that you find this modification as helpful as we have, and we look forward to your feedback.

If the practitioner is less familiar with the elbow anatomy, the practitioner can flex the patient's elbow to identify the olecranon process, humeral epicondyles, olecranon fossa, and joint line.

The practitioner should wrap one hand around the proximal forearm with fingers between the patient's forearm and table, and place the thumb of that hand along the joint line. The thumb will serve as a guide to aid in identifying arthrokinematic motion during the mobilization.

The proximal hand should be wrapped around the distal humerus with the palm ready to apply pressure on the posterior aspect of the distal humerus. Again the thumb can be used to aid in palpating the joint line.

Asking the patient to "grab" the side of the table will help place the forearm and humerus in a good position for this technique. The forearm should be in neutral between supination and pronation, and the elbow should be slightly flexed.

Towels or foam rolls may be used under the arm to allow for mobilization at various angles of elbow extension.

Once you are comfortable with palpating joint motion, start with small test oscillations to identify articular motions and any exquisite tenderness.

When satisfied with the feel of the technique, identify the amount of pressure needed to feel the first resistance barrier just prior to articular motion, and then pressing harder, identify the amount of pressure at which any further pressure fails to increase articular motion.

Note: The end of articular motion is the end of glide. Locate the point at which the joint will not glide any further without additional extension.

Identify the mid-point between the first resistance barrier and articular end-range; approximately 50% resistance.

Grade III - Larger oscillations between the first resistance barrier and approximately 50% resistance.

Note, these oscillations are large compared to grade IV oscillations, but are still very small motions.

Grade IV - Small oscillations at 50% resistance or more.

Continue oscillating until you feel a change in tissue resistance/joint stiffness.

Note: Feeling resistance barriers and relative motion is challenging with this technique due to the hand position and relatively small amount of arthrokinematic motion allowed at the joint. Don't let perfect be the enemy of the good. Mobilizing the joint and decreasing stiffness is more important than a perfectly executed grade III, or being able to differentiate between a grade III and a grade IV.

Elbow Mobilization (Posterior to Anterior Humerus on Ulna)

Proximal Radioulnar Joint Mobilizations

Ankle (Talus) Manual Joint Mobilization - Anterior to Posterior

Cervical Spine Posterior to Anterior Mobilization

Lumbar Spine Posterior to Anterior Mobilization

Thoracic Spine Mobilization: Posterior-to-Anterior and Transverse

Sacroiliac Joint Mobilization: Posterior to Anterior

Distal Tibiofibular Joint Anterior to Posterior Manual Mobilization

Proximal Tibiofibular Joint Posterior to Anterior Manual Mobilization

Hip Joint Lateral Manual Mobilization

Knee Joint Anterior to Posterior (Femur on Tibia) Manual Mobilization

Comments

Guest