How do we treat thrower’s elbow?

In my last post, I highlighted elbow injuries in the throwing athlete. Lets review!

“For many pitchers, the first sign of impending trouble with the UCL(ulnar collateral ligament on inside of the elbow) is pain or stiffness in the flexors of the forearm. The flexors and pronators of the forearm are the active restraints and the UCL is the primary passive restraint to the extreme valgus forces that occur at the elbow during terminal cocking phase and early acceleration. Did you know that when the UCL is tested in isolation during cadaver studies that it only takes 32 newton/meters of force to rupture it? Guess how much valgus stress is on the inside part of the elbow during terminal cocking phase….64 newton/meters!! It has been shown that the UCL takes on 35 newton/meters of that force. Yikes!! So why doesn’t it rupture? It doesn’t rupture because the rest of that stress is controlled by the active restraints…your muscles in the forearm. You can probably guess what happens when you ignore your forearm muscles?”

It is my job as physical therapist to not only emphasize prevention of  an injury but to provide the most effective treatment of an injury. This video demonstrates the use of Active Release Technique, Graston Technique, and a compression flossing technique to treat elbow pain. Check it out!!

 

The Subscapularis Release Miracle!! Impingement And Beyond….

Subscapularis Release for Shoulder Pain

The main purpose of the rotator cuff is to keep the head of the humerus bone centered within the shoulder joint  The subscapularis muscle functions as the internal rotator of the rotator cuff.  It serves to hold the head of the humerus down and to limit forward glide of the humerus while the arm is raised.  It is a powerful stabilizer of the shoulder.  Repetitive overhead activity such as throwing or swimming may create micro-trauma to the fibers of the subscapularis.  The healing process may lead to adhesion formation with a subsequent imbalance of the rotator cuff leading to altered shoulder biomechanics.  The genesis of shoulder impingement syndrome!

Subscapularis Treatment

Manual therapy plays a pivotal role in the effective and expeditious treatment of impingement syndrome as well as recovery from a Type II SLAP repair surgery.  Active Release Technique has been clinically shown to resolve the impingement pain caused by a subscapularis dysfunction in as few as 2-6 sessions.  We assess the length of the muscle from the lesser tuberosity of the humerus to the subscapular fossa in order to locate the lesion.  The lesion is tensioned in a slackened position as the arm is taken through a range of external rotation and elevation in order to release the adhesion.  Refer to pictures below.  The release is also demonstrated on my website at orthowellpt.com.

Standard Type II SLAP repair protocols limit the PROM of external rotation from 0-30 degrees for the first 4 weeks post-op.  Most patients are placed in a sling in an internally rotated position.  Therefore, this limits the mobility of the subscapularis.  Trevor Winnege,DPT demonstrated that massage of the subscapularis in combination with PROM during the first post-op month improved the external rotation motion of the shoulder by 24-25 degrees at the 4 week mark compared to a control group that received PROM only. Check out the free shoulder pain treatment guide to learn more.

Keeping you informed of the latest and most efficacious physical therapy interventions is our goal at OrthoWell Orthopedic and Sports Physical Therapy and WalkWell Rehabilitation.  Please call if you have any questions about our subscapularis release and whether it would be right for you.

All the best!

Chris Dukarski,PT, Owner of OrthoWell and WalkWell

Active Release Technique

Active Release Technique or ART is a patented and proven manual therapy technique that can speed recovery from injury or surgery.  ART can alleviate symptoms that have been unresponsive to other treatments. Certified practitioners for the NBA, NFL, PGA Tour, and Ironman events utilize Active Release Technique.  It is a hands-on system that allows the practitioner to diagnose and treat soft tissue injuries and peripheral nerve entrapments. ART uses the fundamentals of anatomy and biomechanics to determine and to treat dysfunction in the system.  The “touch” is developed through a comprehensive certification process.  At OrthoWell/Walkwell , we are certified in Active Release Technique for the lower extremity.

So how does it work?  As repetitive injury or cumulative stress occurs to soft tissue, the normal longitudinal arrangement of fibers can become disrupted via the haphazard and erratic formation of scar tissue.  Stretching a muscle with scar tissue only stretches the area above and below the “knot”.  Hence, more stress occurs at the point of dysfunction.  ART entails the application of specific pressure via one’s thumbs or hands on an area of fibrosis or adhesion as the patient actively or passively moves through a specific, guided range of motion.  The “knot” will release through the applied tension.

SO WHAT DO OUR PATIENTS THINK ABOUT ACTIVE RELEASE?

After 13 months of suffering through debilitating left hamstring pain, I had given up hope.  Two courses of PT and multiple trips to my primary and orthopedic specialist brought little relief.  WalkWell changed all that!  Throughout the entire process of evaluation and treatment, I believed from the start that I would one day be painfree.  Today, I have never felt better!”
Chad Konecky, Program Manager for ESPN

ART gets you better – QUICKER!!

Active Release Technique or ART is a patented and proven manual therapy technique that can speed recovery from injury or surgery. ART can alleviate symptoms that have been unresponsive to other treatments. Certified practitioners for the NBA, NFL, PGA Tour, and Ironman events utilize Active Release Technique. It is a hands-on system that allows the practitioner to diagnose and treat soft tissue injuries and peripheral nerve entrapments. ART uses the fundamentals of anatomy and biomechanics to determine and to treat dysfunction in the system. The “touch” is developed through a comprehensive certification process. At OrthoWell/WalkWell, we are certified in Active Release Technique.

So how does it work? As repetitive injury or cumulative stress occurs to soft tissue, the normal longitudinal arrangement of fibers can become disrupted via the haphazard and erratic formation of scar tissue. Stretching a muscle with scar tissue only stretches the area above and below the “knot”. Hence, more stress occurs at the point of dysfunction. ART entails the application of specific pressure via one’s thumbs or hands on an area of fibrosis or adhesion as the patient actively or passively moves through a specific, guided range of motion. The “knot” will release through the applied tension.

SO WHAT DO OUR PATIENTS THINK ABOUT ACTIVE RELEASE?

After 13 months of suffering through debilitating left hamstring pain, I had given up hope. Two courses of PT and multiple trips to my primary and orthopedic specialist brought little relief. WalkWell changed all that! Throughout the entire process of evaluation and treatment, I believed from the start that I would one day be painfree. Today, I have never felt better!”
Chad Konecky, Program Manager for ESPN