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This is Brent of the Brookbush
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Institute at the Independent Training
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Spot, and in this video we're doing self-administered elbow mobilization. So
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we've already discussed how there is more to postural dysfunction than just
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muscles. We have to look at joints and how joints move, there are arthrokinematics.
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Before we look at which mobilizations we're going to do for the
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elbow, we need a model for what dysfunction of the elbow looks like. So what
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I see with my patients and clients is what comes down to a tracking issue. So
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this tracking issue involves increased valgus, all right so increase lateral
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deviation of the ulna, increased compression within the joint space
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itself, and insufficient glide to go along with extension. It's basically a
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tracking issue. It may be due to the over activity in the extensor mass, or over
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activity of the elbow flexors. Or it may be causing the over activity in the
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extensor mass and elbow flexors. Needless to say, we have to start affecting the
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elbow joint if we want to correct this problem. What we're going to need to do
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is if we have too much compression and insufficient glide, I'm going to need a
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distraction technique, and if I have too much valgus, I'm going to need to find a
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way to push into varus. So I'm going to bring my friend Mike out here. Mike is
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going to help us demonstrate how we're going to create this force while going
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through elbow extension, to help mobilize the elbow. Now first things first, we're
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going to get into kind of a quadruped type position. I find that these closed chain
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positions with the fists on the floor, and his whole bodyweight over his
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body, makes sure that the the distraction force we create doesn't just get turned
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into an osteokinematic motion like extension, and actually create some
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arthrokinematic motion. Now you'll notice that he's on a soft surface,
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that's actually really important for this mobilization. Not just for the
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comfort of his fists, but even if these pads weren't here, use an errant pad
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or something, because I want something that's he's going to kind of sink
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into so that he has a little bit more friction right, so his fist doesn't move
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around much. The other thing you'll notice is I have
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them in neutral position, this is going to cross the radius over the ulna. So
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we're going to get kind of a gross effect on the ulna itself, or on the
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whole forearm mass so to speak. This is not a radioulnar or radiohumeral
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mobilization, it's an ulnohumeral mobilization. You'll notice that I have him
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in a distant position. My hope is that if he closes his fist, that he's going to
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increase activity of his flexors, and help reciprocally inhibit some of the
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over activity in his extensor mass. So the first mobilization we're going to do
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from this position is he's going to take one of these big monster bands, he's
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going to set it up at elbow height, it's going to go just below his elbow, and
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it's going to be an anterior to posterior pull. This is the equivalent of
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distraction for the elbow. I'm trying to increase the joint space between his
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olecranon process and its trochlear, as he pushes himself into extension. So
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I'm gonna have him bring his fist out just a little bit, and what he's
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literally going to do is almost a mini push-up. Yeah you don't have to back up
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or anything, I just want you to kind of sink down let your elbow flex. Alright so
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once again I had him in fisted position so I get his extensor mass tone down, the
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extension of his triceps forcing him through extension probably
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helps inhibit some of the flexor mass that's a little over active, and as he's
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going through extension this force is increasing in his band, pushing his
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olecranon process that way, and opening the space between his olecranon
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on process and trochlear. This is real effective for people who have almost
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that impingement type pain at the elbow, at the end of extension, really good for
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increasing the amount of extension. If somebody is limited in extension you
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guys can go through the same logic that you would for manual mobilization
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techniques. So I can do something really small amplitude right just at the end of
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his range, and you can do almost like little,
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little oscillations, little vibrations. They're just a design range, you can go a
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little larger, then do more of like a grade three large amplitude mobilization,
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or if he had pain of course I'd only have them do this just up to the point
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of pain, just touching that pain, because I don't want to risk increasing
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inflammation, increasing pain, and flaring them up. Now other than this mobilization,
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we also want to decrease that valgus, that increase in lateral motion of the
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ulna. So what Mike's going to do is he's going to actually turn around so he's
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facing the camera, and he's going to create a medial to lateral force,
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actually we get on your other side here, he's going to create a medial to lateral
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force on his ulna, and hopefully you guys can kind of see how if he was like this
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now, that's going to push them like this. You have to watch to make sure that they
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don't go elbow out on you and don't internally rotate at the humerus. Alright
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So get those fists nice and solid, and then he's going to do the same thing.
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Alright so I'm just a little bit of flexion, a little bit of extension, this
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is Mike's end range, so i can make the decision whether i want him to stay
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really close to his end range extension and just kind of oscillate, or go through
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larger amplitude motions, and of course once again if he was in pain i would
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just have him, like let's say he was missing the last 25 degrees of extension
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because of pain, some sort of impingement, some pinching right, i would have
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him get down to maybe like 45 degrees, so down here, and then i would have them
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come right up to like let's say there where he started feeling pain, good.
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Just stay right there for me Mike, good, and go up and down for me good.
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As far as repetitions, you guys could set a timer to this 30 seconds to a
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minute, or you could set maybe 20 reps if somebody's doing a nice slow tempo. And
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then of course what I would do after that is retest Mike. Alright Mike go
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ahead and pull this off, go ahead and flex for me, good extend, how do you feel,
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good. Alright he feels better, I know I'm on the right track. If he feels worse
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with all of these mobilization techniques guys, be very careful, you
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don't want to flare somebody up. So if he felt worse obviously i wouldn't try this
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technique again. Mike thank you so much for helping me out with this technique. I
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hope you guys really enjoy this video, and I hope you get a lot of results from
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this particular technique.