0:05 This is Brent of the Brookbush Institute at the Independent Training 0:09 Spot, and in this video we're doing self-administered elbow mobilization. So 0:13 we've already discussed how there is more to postural dysfunction than just 0:17 muscles. We have to look at joints and how joints move, there are arthrokinematics. 0:21 Before we look at which mobilizations we're going to do for the 0:25 elbow, we need a model for what dysfunction of the elbow looks like. So what 0:30 I see with my patients and clients is what comes down to a tracking issue. So 0:35 this tracking issue involves increased valgus, all right so increase lateral 0:41 deviation of the ulna, increased compression within the joint space 0:46 itself, and insufficient glide to go along with extension. It's basically a 0:53 tracking issue. It may be due to the over activity in the extensor mass, or over 0:59 activity of the elbow flexors. Or it may be causing the over activity in the 1:03 extensor mass and elbow flexors. Needless to say, we have to start affecting the 1:07 elbow joint if we want to correct this problem. What we're going to need to do 1:11 is if we have too much compression and insufficient glide, I'm going to need a 1:14 distraction technique, and if I have too much valgus, I'm going to need to find a 1:19 way to push into varus. So I'm going to bring my friend Mike out here. Mike is 1:24 going to help us demonstrate how we're going to create this force while going 1:30 through elbow extension, to help mobilize the elbow. Now first things first, we're 1:35 going to get into kind of a quadruped type position. I find that these closed chain 1:40 positions with the fists on the floor, and his whole bodyweight over his 1:46 body, makes sure that the the distraction force we create doesn't just get turned 1:52 into an osteokinematic motion like extension, and actually create some 1:56 arthrokinematic motion. Now you'll notice that he's on a soft surface, 2:00 that's actually really important for this mobilization. Not just for the 2:04 comfort of his fists, but even if these pads weren't here, use an errant pad 2:07 or something, because I want something that's he's going to kind of sink 2:10 into so that he has a little bit more friction right, so his fist doesn't move 2:15 around much. The other thing you'll notice is I have 2:18 them in neutral position, this is going to cross the radius over the ulna. So 2:23 we're going to get kind of a gross effect on the ulna itself, or on the 2:28 whole forearm mass so to speak. This is not a radioulnar or radiohumeral 2:34 mobilization, it's an ulnohumeral mobilization. You'll notice that I have him 2:38 in a distant position. My hope is that if he closes his fist, that he's going to 2:44 increase activity of his flexors, and help reciprocally inhibit some of the 2:50 over activity in his extensor mass. So the first mobilization we're going to do 2:55 from this position is he's going to take one of these big monster bands, he's 2:59 going to set it up at elbow height, it's going to go just below his elbow, and 3:07 it's going to be an anterior to posterior pull. This is the equivalent of 3:12 distraction for the elbow. I'm trying to increase the joint space between his 3:16 olecranon process and its trochlear, as he pushes himself into extension. So 3:23 I'm gonna have him bring his fist out just a little bit, and what he's 3:26 literally going to do is almost a mini push-up. Yeah you don't have to back up 3:32 or anything, I just want you to kind of sink down let your elbow flex. Alright so 3:38 once again I had him in fisted position so I get his extensor mass tone down, the 3:44 extension of his triceps forcing him through extension probably 3:48 helps inhibit some of the flexor mass that's a little over active, and as he's 3:53 going through extension this force is increasing in his band, pushing his 3:58 olecranon process that way, and opening the space between his olecranon 4:03 on process and trochlear. This is real effective for people who have almost 4:07 that impingement type pain at the elbow, at the end of extension, really good for 4:11 increasing the amount of extension. If somebody is limited in extension you 4:16 guys can go through the same logic that you would for manual mobilization 4:21 techniques. So I can do something really small amplitude right just at the end of 4:26 his range, and you can do almost like little, 4:30 little oscillations, little vibrations. They're just a design range, you can go a 4:35 little larger, then do more of like a grade three large amplitude mobilization, 4:41 or if he had pain of course I'd only have them do this just up to the point 4:47 of pain, just touching that pain, because I don't want to risk increasing 4:51 inflammation, increasing pain, and flaring them up. Now other than this mobilization, 4:57 we also want to decrease that valgus, that increase in lateral motion of the 5:03 ulna. So what Mike's going to do is he's going to actually turn around so he's 5:08 facing the camera, and he's going to create a medial to lateral force, 5:16 actually we get on your other side here, he's going to create a medial to lateral 5:21 force on his ulna, and hopefully you guys can kind of see how if he was like this 5:26 now, that's going to push them like this. You have to watch to make sure that they 5:32 don't go elbow out on you and don't internally rotate at the humerus. Alright 5:37 So get those fists nice and solid, and then he's going to do the same thing. 5:41 Alright so I'm just a little bit of flexion, a little bit of extension, this 5:46 is Mike's end range, so i can make the decision whether i want him to stay 5:50 really close to his end range extension and just kind of oscillate, or go through 5:54 larger amplitude motions, and of course once again if he was in pain i would 6:03 just have him, like let's say he was missing the last 25 degrees of extension 6:07 because of pain, some sort of impingement, some pinching right, i would have 6:13 him get down to maybe like 45 degrees, so down here, and then i would have them 6:18 come right up to like let's say there where he started feeling pain, good. 6:21 Just stay right there for me Mike, good, and go up and down for me good. 6:28 As far as repetitions, you guys could set a timer to this 30 seconds to a 6:35 minute, or you could set maybe 20 reps if somebody's doing a nice slow tempo. And 6:39 then of course what I would do after that is retest Mike. Alright Mike go 6:45 ahead and pull this off, go ahead and flex for me, good extend, how do you feel, 6:52 good. Alright he feels better, I know I'm on the right track. If he feels worse 6:56 with all of these mobilization techniques guys, be very careful, you 7:00 don't want to flare somebody up. So if he felt worse obviously i wouldn't try this 7:04 technique again. Mike thank you so much for helping me out with this technique. I 7:07 hope you guys really enjoy this video, and I hope you get a lot of results from 7:11 this particular technique. 7:21
