Tips on Elbow Joint Mobilization to Relieve Lateral Elbow Pain



Support@

September 2021

No. 23

Tips on Elbow Joint Mobilization to Relieve Lateral Elbow Pain

by Karol Young, OTD, OTR/L, CHT & Jerry Ditz, DPT, Dip. Osteopractic, Cert. SMT, Cert. DN

Joint mobilization of the elbow has been shown

to decrease pain and improve functional grip in patients with lateral elbow pain. (1) Although there are

many treatment approaches for lateral tendinopathy, we are focusing on some preferred elbow joint

mobilization techniques which we have found helpful. Only therapists with appropriate training should

perform manual mobilization techniques.

FROM KAROL YOUNG, OTD, OTR/L, CHT

I instruct patients in a self-administered Mobilization with Movement (MWM) program that allows

them to actively contribute to their recovery. MWM

provides a subtle manual joint position correction

which biomechanically decreases pain. (2,3)

IF PATIENT HAS ELBOW PAIN WITH GRIPPING:

Item/s needed: Wall corner and two small towels.

Starting Position: While standing parallel to one

wall, place the lateral elbow area against one towel

on the wall near the outside corner. The upper arm

is resting next to the side of the body and is against

the wall. The elbow is flexed to 90 degrees and the

forearm is fully supinated. Place the other rolled towel in the hand for gripping. See Figure 1. Place the

uninvolved hand distal to the elbow flexion crease

on the proximal forearm as shown in Figure 2.

Sequence:

1. Apply a lateral glide force to the forearm with the

uninvolved hand.

2. While maintaining the lateral glide pressure, grip

the towel.

3. Release grip.

4. Release the lateral glide pressure on the forearm.

Parameters: Perform the MWM only if pain free: 6

to 10 repetitions, 3-5 times daily.

IF PATIENT HAS ELBOW PAIN WITH WRIST

EXTENSION:

Item/s needed: Wall corner and one small towel.

Starting Position: While standing parallel to one

wall, place the lateral elbow area against one towel

on the wall near the outside corner. The upper arm

is resting next to the side of the body and is against

the wall. Elbow is flexed to 90 degrees and the forearm is fully pronated. See Figure 3. Place the uninvolved hand distal to the elbow flexion crease on the

proximal forearm. See Figure 4.

Figure 3: Starting position Figure 4: Lateral glide with

for wrist extension

wrist extension

Figure 1: Starting position for gripping

Figure 2: Lateral elbow

glide with gripping

Sequence:

1. Apply a lateral glide force to the forearm with the

uninvolved hand.

2. While maintaining lateral glide pressure, extend

? BraceLab 2021; all rights reserved

Disclaimer: BraceLab Clinical Clues are intended to be informal sharing of practical clinical ideas; not evidence-based conclusions of fact.

Tips on Elbow Joint Mobilization to Relieve Lateral Elbow Pain

- continued -

the wrist with fingers relaxed.

3. Relax wrist.

4. Release lateral glide force to the forearm.

Parameters: The patient is instructed to perform

the MWM only if pain free: 6 to 10 repetitions, 3-5

times daily.

Access the patient¡¯s pain level before and after

the maneuver and modify if necessary to ensure

pain free performance. Possible modifications are:

1) move the position of the hand providing the glide

to a more proximal or distal position, 2) decrease

the amount of gripping

force or 3) decrease the

range of wrist extension.

The patient progresses

by performing the self

MWM first with the elbow

flexed and then with the

elbow extended. See

Figure 6: Lateral elbow

Figure 6.

glide with full elbow extension

FROM JERRY DITZ DPT, Dip. Osteopractic,

Cert. SMT, Cert. DN

My preferred mobilization technique for this patient population is a Grade 5 mobilization, called

the Mills Manipulation which was first described in

1928 by G. Percival Mills. (4,5) Because it is difficult to learn a therapist-directed manual technique

by briefly reading about it, I encourage you to review

the Mills references below for specifics about positioning, hand placement, and thrust velocity and to

seek mentorship to learn this technique.

WHEN TO USE THIS TECHNIQUE

Mills noticed his patients had full elbow motion

when he examined joints individually. But with combined, complex movements there was a loss of

range of motion. Specifically, he noted the inability to completely extend the elbow when the forearm was fully pronated, and the wrist and fingers

flexed. The limited complex movements were not

painful, and the motion was full on the uninvolved

side. When a patient with lateral tendinopathy has

limited range of complex motions, consider using

the Mills technique.

HOW TO EXPLAIN THIS TECHNIQUE TO YOUR

PATIENT AS YOU LEARN IT

When learning new manual techniques, therapists

may struggle with deciding when to apply them to

patients. As a younger therapist, I was afraid patients would be upset if I told them I just learned a

new technique and wanted to try it on them. This

was far from the truth. Patients enjoyed being part

of my learning experience. I would explain I had attended a course or read a review article about their

condition and had thought about their case and had

practiced this technique. I discussed my thoughts

with them, asking if we could try the mobilization

their next visit. I also alerted the patient to expect

an audible pop and explained that is normal.

A SUCCESSFUL PATIENT EXPERIENCE

The Mills Manipulation is a one-time use technique that, if successful, will have a significant response. When performed effectively, the technique

elicits a snap, pop, or cavitation as the patient experiences an immediate 60-80% reduction in pain.

(4,5) If the patient does not respond to the Mills

Manipulation, move to a different treatment. Do not

try it repeatedly.

As with all joint mobilization techniques, only

certain patients will respond positively. Since joint

mobilization is always only one part of our patient

treatment, a successful response to the Mills technique helps us know when it is of value.

References

1.

Lucado A, Dale RB, Vincent J, Day, J. Do joint mobilizations assist in the recovery of lateral elbow tendinopathy? A systematic review and meta-analysis. J of Hand Ther.

2018; 32:262-276. 10.1016/j.jht.2018.01.01

2.

Reyhan AC, Sindel D, Dereli EE. The effects of Mulligan¡¯s mobilization with movement technique in patients

with lateral epicondylitis. J Back Musculoskelet Rehabil.

2020;33(1):99-107. doi: 10.3233/BMR-181135.

3.

Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzin B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: Randomised trial. Br Med J. 2006; 333(7575): 939. doi: 10.1136/

bmj.38961.584653.AE

4.

Mills GP. The treatment of ¡°tennis elbow¡± Br Med J

1928; 1(12). doi:10.1136/bmj.1.3496.12

5.

Mills GP. Treatment of tennis elbow Br Med J 1937;

2(212). doi:10.1136/bmj.2.3995.212

? BraceLab 2021; all rights reserved

Disclaimer: BraceLab Clinical Clues are intended to be informal sharing of practical clinical ideas; not evidence-based conclusions of fact.

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