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Elbow Orientation with Medial Elbow Pain - BillHartmanPT.com Q&A for The 16%
Bill Hartman
Overview
This video explains medial elbow pain by focusing on bone and joint orientation, rather than just muscle activity. It clarifies that conditions like golfer's elbow and tennis elbow are not necessarily sport-specific but rather result from prolonged exposure to specific rotational forces and subsequent changes in elbow alignment. The discussion emphasizes a sequential, top-down approach to identifying and correcting these issues, starting from the axial skeleton and moving down to the hand and wrist, to resolve compensatory strategies that lead to pain.
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Chapters
- Elbow pain, often categorized as golfer's or tennis elbow, is primarily related to bone and joint orientation, not just muscle strain.
- The difference between medial (golfer's) and lateral (tennis) elbow pain lies in the duration of exposure to specific forces and the resulting changes in elbow orientation.
- Understanding elbow orientation requires looking beyond the elbow itself, considering the entire kinetic chain from the axial skeleton down to the hand.
- Distinguishing between muscular/musculotendinous issues and injuries to passive structures is crucial for effective treatment.
This chapter reframes elbow pain as a problem of alignment and force distribution, moving beyond simplistic muscle-overuse explanations and highlighting the importance of a holistic assessment.
The speaker mentions that the difference between lateral and medial elbow pain is how long the elbow is exposed to certain forces, leading to a change in its orientation.
- The body doesn't simply replace old movement strategies; it adds new ones, leading to a progression of compensations over time.
- These compensatory strategies, similar to those seen in the axial skeleton, can cause a loss of original movement capabilities.
- Understanding the sequence of these adaptations is key, as they represent a chronological development of how the body manages load.
- The same underlying twists and orientations are present throughout the body due to similar anatomical construction.
Recognizing that compensations build over time helps explain why pain might develop gradually and why addressing the root cause, rather than just the symptom, is essential for lasting relief.
The speaker uses the analogy of twisting a towel to explain how forces can accumulate and lead to excessive rotation at the elbow if not managed proximally.
- To understand elbow orientation, one must first assess the orientation of more proximal segments, like the axial skeleton.
- This proximal orientation provides a baseline for understanding how the arm and elbow are positioned.
- By examining how the arm bends and straightens, one can infer the orientation of the elbow and subsequently the wrist and hand.
- A sequential assessment from the axial skeleton down to the hand allows for the identification of the root cause and the development of a targeted solution.
This chapter introduces a systematic method for diagnosing elbow issues by breaking down the assessment into manageable, sequential segments, making complex problems easier to solve.
The speaker describes a 'finger test' to assess wrist position, then links it proximally to the forearm, distal humerus, proximal humerus, and finally the axial skeleton to find the solution.
- Medial elbow pain (often associated with golfer's elbow) can arise from a posterior medial compressive strategy that pushes the bone forward.
- This often involves the arm trying to achieve more external rotation, leading to compression and a need for compensatory inward twisting.
- The solution involves creating posterior expansion to allow for legitimate external rotation, reducing the need for compensatory bony adaptations at the elbow.
- This approach releases tension in the musculature that was excessively twisting the arm into external rotation.
This section provides a specific mechanism for medial elbow pain, linking it to external rotation demands and offering a clear strategy for correction by addressing the root cause of the compensatory twist.
The use of an 'offset dumbbell' or 'offset load' is mentioned as a way to create posterior expansion, allowing for legitimate external rotation and clearing up the need for compensatory strategies at the elbow.
- Lateral elbow pain (often associated with tennis elbow) can be addressed by 'twisting the towel inward' or facilitating internal rotation.
- This involves taking tension out of the system by allowing for some degree of untwisting before re-twisting in the opposite direction.
- Techniques like 'pump handle' movements can help achieve the necessary internal rotation and coordinated movement.
- The goal is to have all segments moving in the same direction simultaneously, rather than fighting against each other.
This chapter offers a contrasting approach for lateral elbow pain, emphasizing the importance of internal rotation and coordinated movement to alleviate the compensatory twists that cause pain.
The 'pump handle' motion is suggested as a way to facilitate internal rotation and help untwiste the arm, thereby reducing tension and improving overall movement coordination.
- Climber's elbow can manifest as either medial or lateral elbow pain, often related to gripping and finger flexion.
- Medial elbow tendinopathy in climbers is frequently a distal-to-proximal problem, originating from excessive finger flexor activity.
- The hand and wrist must be addressed to reduce the 'overcoming action' at the elbow, as the elbow flexors may be delayed in their response.
- Solutions must incorporate strategies for the wrist and hand to alleviate the concentrated load on the medial elbow tendons.
This chapter extends the principles of elbow pain assessment to a specific activity like climbing, highlighting how issues originating in the extremities (hands/wrists) can significantly impact the elbow.
The 'little hook thingy' grip used in climbing is cited as an example of intense finger flexor activity that can overload the medial elbow.
Key takeaways
- Elbow pain is fundamentally about joint and bone orientation, not just muscle overuse.
- Compensatory movement strategies develop over time and can lead to a loss of original movement capabilities.
- Effective diagnosis requires assessing orientation segmentally, starting from the axial skeleton down to the hand.
- Medial elbow pain is often linked to excessive external rotation demands, requiring posterior expansion to correct.
- Lateral elbow pain can be addressed by facilitating internal rotation and coordinated movement.
- Problems in the hand and wrist, particularly with gripping and finger flexion, can directly cause medial elbow tendinopathy.
- Treating elbow pain involves identifying and resolving the underlying compensatory strategies in the entire kinetic chain.
Key terms
Medial elbow painLateral elbow painGolfer's elbowTennis elbowBone orientationJoint orientationAxial skeletonKinetic chainCompensatory strategyDistal to proximal influenceMusculotendinousExternal rotationInternal rotation
Test your understanding
- How does the concept of bone and joint orientation differ from traditional explanations of elbow pain?
- What is the significance of assessing orientation segmentally, starting from the axial skeleton?
- Explain the relationship between excessive external rotation demands and medial elbow pain.
- How can problems originating in the hand and wrist lead to medial elbow tendinopathy?
- What is the role of compensatory strategies in the development of elbow pain over time?