Sebastian Brosche · 7 min · 1,311 words
Sport-physio elbow mobility and rehab for grapplers, for armbar tweaks and awkward posts. Keep your elbows healthy on the mats.
Hey guys, Joel Kreska, sport physiotherapist back here again. Today we're going to go over some injury rehab for elbows. And now it's again, it's kind of a weird area where people kind of don't know what to do. And especially when we start dealing with arm bar injuries or injuries where we've planted and twisted or just done a weird post.
And so when we look at elbows, it's really important that we start to look at the fundamentals. Just like the shoulder, we have to make sure that we have proper rotation through the elbow. And I'll tell you more often than not, whether it's from injury or whether it's just from the way we are. When we're looking at an injury, especially chronic injuries of the elbow, first thing we look for is limited pronation, which is palm up to palm down rotation of the elbow.
And if that's not there, interestingly enough, it actually has an effect on the rotator cuff of the elbow. So again, remember when we were talking about the shoulder, we have problems with stiffness and poor position of the scapula thoracic joint or the glenohumeral joint that affects the rotator cuff. In this scenario, we're concerned about the mobility of the elbow and therefore it affects the rotator cuff of the elbow. So in this particular scenario, what I see a lot of, especially in arm bar injuries, there's sort of two injuries that happen in an arm bar and it depends on the angle that it happens.
One is we're going to see damage to the ulnar collateral ligament. And that's what gives, provides stability to the side to side motion of the elbow. The other one that happens is we get an injury to what's called the anconious ligament. It's not a big fancy word, but essentially what it is, is it's the ligament that wraps around the radial head of the bone.
Okay. So when we start to think of anatomy of the elbow, in this palm up position, we have the two bones that come down straight like this. And then when we go palm down, essentially what's happening, if this is my right hand, it's rotating over like this. And then when we get the thumb stacked, they're kind of sitting like this.
Okay. So they're not fully rotated. They're not fully open. And so when they're stacked kind of like this, and then we arm bar someone, you can even see with the way my arms go that there's going to be a fulcrum that happens and it tends to injure the radial head ligament.
So when that is healing, there's different ways that we can protect this. There's a really neat tape job that I'm going to go over at some point. So if you have an acute arm bar injury, it feels really good to actually take this thing, to take pressure off that ligament. But when we're talking about rehab, which is what we're talking about right here, we often will lose that pronation mobility.
And so the first thing we want to try and do when we have an arm bar injury or even an elbow dislocation, I've seen one of those recently. And the first thing that was lost in that again, was that pronation. So what we're going to do here is we're going to keep our elbow pinned to our side. I'm going to grab palm.
My other hand is going to go palm down on the top side of my hand. Okay. And I don't want to grab with my thumb, just like with a lot of grappling. I don't want to grab with my thumb on the outside.
I want to grab it on the inside. Okay. And you get a way better purchase on this thing. And I'm actually going to use the heel of my hand on the top part of my radius here.
And I'm going to crank it almost like a motorcycle grip. So if I'm looking at restricted pronation, you'll see this angle here. If I'm going to, I want to crank it so that I get almost straight flat. Now, if you're unsure about how much am I stiff on this whole pronation side of things, if I'm going to put the hand completely flat and it won't go, I can angle my elbow out until this goes flat.
And that angle right here between your elbow and your body will tell you how much you're off. Okay. And then eventually, as you get this going more and more, then you can sort of see, okay, I've now got 90 degrees of pronation or neutral or 90 degrees supination. Okay.
So the first thing here, like I said, is we're going to try and get that pronation mobilization back with your elbow bent. Now, this whole setup here falls apart when my elbow is straight. And just like in everything in the body, if my elbow is bent, it will be a lot stronger than it is if it's fully straight. Similarly, if I've got mobility down here, I may not have full mobility with a straight elbow.
So what I have to do once I've regained this mobility of turning palm down all the way to 90 degrees, then I also have to check and see, do I have it with an elbow being fully straight? Now, the problem is, again, it's really hard to kind of figure out these angles. But one thing that I sort of, I figured out with my own injury here is what we can do is, again, if my elbow is pinned, I can go all the way flat. I go to do that with a straight arm and I can't pin the elbow and things just keep rotating, rotating, rotating.
So the way to figure this out here of am I stiff and do I need to work on this is if we keep the thumb down and then I grab again, just like I did before at the wrist, now I'm going to try and rotate my elbow by tightening up my shoulder and rotating it under this way. So it's almost like we swapped origin and insertion on this whole thing. Rather than keeping the elbow pinned and rotating the hand, we're going to keep the hand pinned and rotate the elbow. And it's a very small motion.
If you look at mine, you'll see there is a motion there. And often when you go to do this on someone who's had a recent elbow injury or even a chronic elbow, they won't have this ability to rotate the elbow under keeping their hand perfectly still. So both of these are excellent exercises to help mobilize the elbow, especially post injury or post stiffness that's been there either because of an old injury or just because that's the way you are. And when we start to think about this functionally, we think about keyboards.
Imagine if I can't go palm down all the way and I'm on a keyboard, then I have to start to flare my elbow, like I mentioned, and that starts to stress the elbow and the shoulder. So when we're thinking about grappling, because we want our hands in all the time, it's important to make sure that we can move our hands into both directions with our elbow bent and with our elbow straight. Again, if I'm going to be doing motions where I'm trying to say, maybe do a hitchhiker escape on an armbar, I have to make sure that I got nice rotation going both ways. I hope you enjoyed that.
And if you have any questions, please drop me an email. Otherwise, I'll see you on the mat soon. Have a good one.
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