Would you like to view this video?

Join

OR

Login

Radial Head Manipulation

Radial Head Manipulation is a treatment procedure which involves precise, manual manipulation of the joints of the elbow to diagnose and treat related conditions. It can be used to reduce pain and other symptoms of conditions such as tennis elbow, golfers elbow, ligament sprains, bursitis, and arthritis of the elbow. The technique works by releasing tight muscles, improving joint range of motion, and improving joint alignment. Studies suggest that a number of treatments, including manual manipulation of the elbow joint

Transcript

00:00:0400:00:07
This is Brent of the Brookbush Institute
00:00:0400:00:07
in this video we're going to go over
00:00:0700:00:11
manipulations or high-velocity thrust techniques. I assume that if you're
00:00:1100:00:14
watching this video you're watching it for educational purposes and that you
00:00:1400:00:18
are a licensed professional with high velocity thrust or manipulation
00:00:1800:00:24
techniques in your scope of practice. If you are not sure check with your state
00:00:2400:00:28
board. Most physical therapists, chiropractors and osteopaths you're in
00:00:2800:00:33
the clear. I believe that ATC's you can't do manipulations in the United States,
00:00:3300:00:38
although other countries again check your scope. Of course massage therapists
00:00:3800:00:41
and personal trainers these are generally not within your scope, of
00:00:4100:00:47
course you could continue to watch these videos just for educational purposes,
00:00:4700:00:51
learn a little Anatomy, learn a little biomechanics. If you're going to do these
00:00:5100:00:56
techniques please make sure that you have a good rationale for putting your
00:00:5600:01:00
hands on a patient, this should be based on assessment, and if you're going to
00:01:0000:01:06
assess I'm hoping that you'll assess, use these interventions and reassess to
00:01:0600:01:09
ensure that you're getting the result that you're looking for and have good
00:01:0900:01:13
reason to continue using this technique. In this video we're going to go over radial
00:01:1300:01:15
head manipulations. I'm going to have my friend Yvette come out, she's going to help
00:01:1500:01:18
me demonstrate. Now remember if we're doing manipulations we're doing them to
00:01:1800:01:22
increase joint mobility based on not just subjective symptoms, but some
00:01:2200:01:26
objective tests as well. So I might do some passive accessory motion
00:01:2600:01:31
but also maybe some elbow flexion extension, maybe some pronation
00:01:3100:01:35
supination goniometery so I have something to use for reassessment after
00:01:3500:01:40
this technique. Now I have seen a couple of different techniques for the radial
00:01:4000:01:45
head, and supposedly one of them's for the proximal radioulnar joint, the other
00:01:4500:01:50
ones for radial humeral joint, and the only consensus I have to tell you
00:01:5000:01:55
is they probably both do both. I think sometimes when we get a little too
00:01:5500:01:59
detailed about our biomechanics we actually lose a little bit of our
00:01:5900:02:04
accuracy. So what I'm going to tell you is try both of these techniques, they
00:02:0400:02:09
both probably work fairly well, and a lot of it probably depends on what you get
00:02:0900:02:13
comfortable with. You might find that you get a lock position in one and not in
00:02:1300:02:17
the other. You might find that it depends on which patient you have,
00:02:1700:02:23
whether you can find locked position. So they both have a few things in common,
00:02:2300:02:28
number one, all of them involve this underhand grip of the distal humerus
00:02:2800:02:35
with palpation of the radial head. Now if you've never palpated the radial
00:02:3500:02:39
head what you could do is just reach on either side of the brachial radialis
00:02:3900:02:44
real close to the elbow, and start pronating and supinating the wrist, and
00:02:4400:02:50
you'll actually get to a point where you feel the radius go out until
00:02:5000:02:56
like a disc shape, and you can feel it spin underneath your fingers. So once,
00:02:5600:03:01
once you have that thing spinning under your fingers right, now I want you
00:03:0100:03:07
to stick your thumb right there, alright so your thumb is going to be applying
00:03:0700:03:16
this type of force that is the big manipulative motion. Now the question is
00:03:1600:03:23
how do we get lock out? Lock out comes in one of two forms, you either see
00:03:2300:03:32
people do a lot of supination, or you see people do pronation. I really think if
00:03:3200:03:36
you get to the end of either one you end up locking out this joint.
00:03:3600:03:43
Alright so either here or here. So now we got that, we'll start with this one. All
00:03:4300:03:46
right this one I find tends to be a little bit more general elbow because
00:03:4600:03:53
you get so much of this snapping going on without as much radial head
00:03:5300:03:59
motion. But once you get here now the force is going to be kind of into
00:03:5900:04:04
extension while I press posterior to anterior with my thumb, and it's going to be
00:04:0400:04:10
a little varus force too, which is the equivalent of me trying to take her arm
00:04:1000:04:15
and break it this way. I'm not going break your arm I promise. Okay so just a
00:04:1500:04:18
little bit of force this way, we're just kind of like as we're pushing into
00:04:1800:04:25
extension we're kind of pushing this way with extension. So I said
00:04:2500:04:29
it's extension with a little bit of this way, and I'm going to go ahead and finish
00:04:2900:04:34
out with supination while keeping this thumb really rigid. So the first thing
00:04:3400:04:40
I'm going to do, is as I do this combination of techniques I got to find my lock,
00:04:4000:04:44
there we go we're getting there we're building off all that tension. All
00:04:4400:04:48
right you can tell Yvette love's manipulations, she's been so kind to
00:04:4800:04:54
volunteer for these videos, and then once I get there, that's it, it's just a little
00:04:5400:04:59
whip. All right sorry I did it to you twice. All right so there you have
00:04:5900:05:03
it. Now we didn't get a cavitation there, but don't forget that with manipulations
00:05:0300:05:08
the success comes from doing the manipulation not from hearing a sound. I
00:05:0800:05:14
would reassess and see what this did to her concordance sign, what it did to her
00:05:1400:05:18
continuous interval measures like goniometry and see if I got a
00:05:1800:05:21
successful manipulation before I just sit there and keep yanking on her arm.
00:05:2100:05:25
Could I have missed, absolutely. I'm far from perfect when it comes to these
00:05:2500:05:29
techniques, but you don't want to just keep grinding away at a technique
00:05:2900:05:32
assuming that you missed because you might have been very successful and now
00:05:3200:05:37
you're just flaring things up. Now the other technique all I'm going to do is use
00:05:3700:05:41
a little bit of wrist flexion, you don't have to do this, but just a little bit of
00:05:4100:05:44
wrist flexion this is kind of like a modification of what's called the Mills
00:05:4400:05:51
manipulation. It's still the same position here, I'm still kind of bringing into
00:05:5100:05:59
that same bit of varus force, so the bendiness, and this is actually the
00:05:5900:06:03
technique I prefer because I tend and find it a lot easier to get a lock
00:06:0300:06:07
position here, and I find that I don't have to get all the way into elbow
00:06:0700:06:15
extension, which on a humeral joint or a humeroulnar joint extension can
00:06:1500:06:19
be a little painful at the end range. Instead I can get locked out
00:06:1900:06:24
short of full extension and then once I'm there and I get all of it, and you
00:06:2400:06:28
you can see in Yvette's face we're there. All right and then it's just
00:06:2800:06:33
a whip, and we actually got a nice little cavitation on that one. All right good
00:06:3300:06:38
stuff. So the one I prefer again is just a modification that Mills technique,
00:06:3800:06:41
just a little bit of wrist flexion so you can just grab the hand like
00:06:4100:06:47
this, we're going to pronate all the way, and then I'm pressing up with
00:06:4700:06:53
this hand as I apply a posterior to anterior force this way, and then it's
00:06:5300:06:58
just a little whip right, and I'm not just so you are clear, I'm not
00:06:5800:07:01
pulling her all the way into elbow extension, we were actually short
00:07:0100:07:04
of elbow extension, and I think if you practice this a little bit slowly
00:07:0400:07:11
first, you will feel that if you twist all the way this way and push up a
00:07:1100:07:15
little this way, you actually hit lock before you hit full elbow extension
00:07:1500:07:19
if you were to let this relax. All right if you have any questions on this
00:07:1900:07:25
technique, it is tricky. It takes some practice, the lock position is
00:07:2500:07:30
deceptively hard to find on this particular technique, but practice with
00:07:3000:07:36
with some friends and some colleagues, and then maybe find some patients who
00:07:3600:07:41
aren't elbow patients to start. So what I mean by that is you know this could have
00:07:4100:07:45
a positive effect on an upper-extremity issue that's mostly shoulder, but you
00:07:4500:07:49
know you manipulated their elbow because you think it might help,
00:07:4900:07:54
this is a little trick I am teaching you, as in don't start practising on elbow
00:07:5400:07:58
patients, practice on patients that elbow manipulation might help some other
00:07:5800:08:02
symptoms somewhere else. If you have any other questions leave them in the
00:08:0200:08:07
comments box below. a couple of points to recap, knowing your anatomy and knowing
00:08:0700:08:11
your biomechanics will certainly help you choose the right technique for the
00:08:1100:08:15
right patient. if you're unsure whether manipulations are appropriate due to
00:08:1500:08:21
their higher intensity it's okay to do mobilizations, most research points to
00:08:2100:08:25
manipulations being slightly more effective, but mobilizations being very
00:08:2500:08:29
effective, and of course we have those videos for you if you want to start with
00:08:2900:08:35
those less intense techniques. Make sure that if you are doing any technique that it
00:08:3500:08:38
is based on assessment, and of course that you're reassessing ensuring that
00:08:3800:08:42
the technique is effective for the patient that you're working on, and when
00:08:4200:08:46
it comes to all manual techniques, manipulations maybe more than any other,
00:08:4600:08:52
look for opportunities to get live education. Although I know videos are
00:08:5200:08:57
convenient and I'm happy to have these up for you to watch, it would be so
00:08:5700:09:04
much more helpful to use those videos as a recap of one-on-one attention with
00:09:0400:09:09
somebody who's experienced with manipulation techniques. At the very
00:09:0900:09:15
least grab a colleague, grab a friend and start practising these before you bring
00:09:1500:09:20
them into clinic and start using them on patients and clients. I hope you enjoyed
00:09:2000:09:23
this video, if you have any questions please leave them in the comments box