January 31, 2015

Why Won’t My Elbow Straighten?

elbow stretching for gradual straightening
On one occasion while playing basketball, I was knocked off of my feet, and I landed onto my left elbow. Thankfully, my elbow was not fractured, although it did bruise up substantially.

In addition to some swelling, I soon noticed an inability to straighten out my elbow. For many months my elbow remained unable to completely straighten. I ended up consulting an orthopedist and a physical therapist, and their advice was invaluable…

Elbows respond to slow and gentle stretching.

Elbow fractures, elbow surgeries, and general elbow trauma all can have the unfortunate consequence of “contractures,” or lags in range of motion. I have found that the soft tissue of the elbow does not respond favorably to aggressive stretching. Aggressive pushing of the ranges of motion will actually cause the elbow to become more inflamed, and in many cases, the contracture will worsen.

The soft tissue of the elbow tends to agree with a slower, gentler stretch imposed over a longer period of time. If you cannot fully straighten your elbow, try this simple exercise. (See photo above)

1. Lie on the floor “face upwards” and place a pillow under your forearm so that your arm may rest with a slight amount of stretch. Make sure that your shoulder does not lift off the floor as you lie in this position. Adjust the amount of support under the forearm if necessary.

2. Allow your elbow to rest into extension over ten to fifteen minutes. Gently press your forearm down into the pillow for ten seconds every minute by contracting your triceps muscles.

3. As your range of motion improves, use less of a support under your forearm.

4. The level of stretch imposed on your shoulder during this exercise should be a “one or two” out of a scale of ten. If you are encountering too much stretch, adjust the pillow under your forearm to allow a more comfortable amount of flexion.

About Dan Baumstark, MSPT, CHT

Dan is a physical therapist who specializes in sports medicine & upper extremity rehabilitation. He is certified by the American Society of Hand Therapists, and he has extensive continuing education in manual therapy from the Michigan State University School of Osteopathic Medicine. Google+

Comments

  1. I’m a woman in my late 50’s. A month ago, I fell and fractured my left elbow – radial head fracture, Type II. Supposedly (according to the description in the medical report of the x-rays taken the same day), the humerus and ulna are intact.

    I consulted an orthopedic surgeon 4 days later (at one of the top hospitals in the U.S., where I have all my medical care), who said I would not need surgery. He thought I would probably regain most, though not necessarily all, of my range of motion, and sent me to physical therapy. My first session was gentle, and I was sent home with instructions for exercises (blended Elbow Flexion and Elbow Extension, and Forearm Supination). My next P/T session was scheduled 2 weeks (13 days) later, with a different therapist (the first therapist suggested I might like to go to one who was a few miles closer to me, at another highly ranked hospita). When the latter began to work with me, she told me that I had done the exercises improperly. I have seen her 4 times since; each time she manipulated my left arm in a way that caused me such intense pain that I could not endure it for very long. I have continued to do the exercises at home, and done them properly; usually 4 times per day, though a few times only 3. Manual dexterity in my left hand and fingers have increased, but my elbow extension and bending are, I believe, unchanged (there was measured improvement on 1/7, but it worsened on 1/9). My physical therapist told me on 1/13 that she could no longer work with me, after more of the torturous manipulation (not without result, I was able, with her forcing down the left forearm, to touch my left hand to my shoulder), that it was too difficult; perhaps she was tired of my needing to stop after a certain amount of time. I tried to endure the pain, but could not. She has also told me that she does not understand why I am in so much pain during the P/T sessions, and said there was no reason for it.

    I see my orthopedic surgeon again later today (1/14). I am afraid that he will tell me that he cannot authorize any future P/T, or even surgery. I am wondering if I’ve wasted 4 weeks out of the 6 week window, and am annoyed that I didn’t find out about the 6 week window (before the elbow stiffens) until 2 weeks had passed (when my questions prodded my P/T to tell me about it).

    Is it normal for P/T for a type II radial head fracture to the elbow to involve such intense pain? I was prepared for some pain and discomfort, but not for pain too extreme to endure for more than 10 or 20 seconds (and it was often longer than that). Am I just being too sensitive?

    I am very worried that I will not be able ever to bend or extend my arm to a greater degree, or be cleared to drive. I want to try P/T again with a different therapist who might cooperate more with me (I had asked my P/T to at least tell me how long the painful manipulation would last, if I’d known, I might have been able to withstand the pain; but she refused to tell me). Is a stronger painkiller (I’ve been taking Tylenol extra strength 500 mg) that might help?

    I’d appreciate any tips, insights or opinions you might have.

    • Pat let me preface this response by saying that I cannot actually feel what your elbow’s range feels like over the internet. Having said that, it sounds like the therapist that you are using is a bit too aggressive. Ditch her.

      I would go with gentle and slow stretching to tolerance. Maybe try another PT, or you could ask the doctor to prescribe you a “JAS” brace for the elbow. The JAS brace will apply a light stretch that you can control by turning a dial. The brace goes home with you as well so you can fit it in to your day.

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