fbpx
0%

NASM CES Chapter 15: Corrective Strategies for the Wrist and Elbow 1

Post Content

    Chapter Goals:

    • Know the basic functional anatomy for the wrist and the elbow.
    • Find the mechanisms that are common for the wrist and elbow injuries.
    • Be able to discuss the influence of alterations in elbow and wrist movement in the kinetic chain. 
    • Find the strategies for appropriate systematic assessment in the wrist and elbow. 
    • Find the right corrective exercise strategies for the wrist and elbow. 

    Introduction

    The elbow joint is the link between the shoulder and the wrist, and it works to give a great amount of stability and motion.

    The elbow joint is not simply a hinge joint, as it also works to give pronation and supination.

    Force transmission in the forearm is a complex interaction between the radius, ulna, and the interosseus membrane.

    The wrist affects the force transmission to the elbow. 

    The wrist is one of the most complex joints that we have in the body. it has many bones, ligaments, connective tissues, nerves, and muscles.

    It allows for us to have a large amount of movements and fine motor skills.

    We have a total of 37 bones in the wrist and hand. 

    Review of Elbow and Wrist Functional Anatomy

    The elbow and wrist, like the shoulder, provide us with the ability to do limitless amounts of movements in the upper body.

    The elbow is similar to the knee in the lower extremities, except it is not as robust due to less force traveling through it. 

    Bones and Joints

    The elbow is seen as simple and only really made up of three bones. These are the humerus, ulna, and the radius.

    The humerus and ulna will form the humeroulnar joint.

    This joint is mainly for flexion and extension.

    It is considered to be the pure elbow joint.

    The radius and the humerus coming together works to make up the humeroradial joint. 

    In the wrist we have the radius and ulna making the distal radioulnar joint, and it works to interact with the carpal bones.

    It is important to look at the diagram and know the bones of the hand. 

    Muscles

    The muscles in the elbow, forearm, and the wrist may be divided into the following 6 categories: 

    • Forearm flexor- the pronator group
    • Forearm extensor – the supinator group
    • Wrist flexors
    • Wrist extensors
    • Wrist ulnar deviation
    • Wrist radial deviation

    Some of the other key muscles to know that have involvement with the elbow and wrist are the:            

    Exclusive PTP Offers


    Gold Standard Cert
    Save 25%
    Most Popular Cert
    3 Certs for 1
    A Good Option
    50% off
    Best Study Materials
    See MVP discount
    Best online PT course
    $100 Off
    The Top PT Software
    Get Free Trial
    • Biceps brachii, brachialis, brachioradialis, pronator teres, triceps brachii, and then the ones that make up those previous six categories. 

    Altered Wrist and Elbow Movement

    Musculoskeletal injuries in the elbow, forearm, and wrist make up a third of workday illnesses.

    Elbow pain has been found to affect 1 – 3 percent of the population and 25% of the athletic sports related injuries are in the wrist and hand. 

    Static Malalignments

    Common malalignments of the elbow cause us constant elbow flexion, which results from overactivity in the biceps brachii and the brachialis and underactivity of the triceps.

    This may or may not be affected by instability of the shoulder.

    Excessive flexion of the elbow has shown restriction of range of motion for the wrist.

    These static malalignments in the wrist show up usually as chronic wrist extension and flexion. 

    Abnormal Muscle Activation Patterns

    It has been shown that many people with elbow and wrist impairments have less than optimal stability and range of motion along with alterations in muscle activation patterns at the shoulder joint.

    Repeated use of the wrist and elbow motion may lead to overusing the extensors of the wrist or to injuries to tendons. 

    Dynamic Malalignments

    A lack of wrist and elbow movement can lead to alterations in the shoulder girdle patterns of activation since more movement may be needed to compensate for a reduction in distal mobility.

    These changes may lead to increased strain for the elbow muscles, tendons, and the rotator cuff. 

    Wrist and Elbow Dysfunction and the Regional Interdependence Model

    Proper function of the elbow and wrist depends on the proper structures of the upper extremities.

    The proper mobility of the thoracic spine, stability of the scapula, and position of the shoulder can play a large part on dysfunctions and injuries of the wrist and elbow.

    The length tension relationships of the upper body may be compromised due to having poor posture, repetitive activities, or when it is immobilized in some form of brace or cast. 

    Influence on the Wrist

    Considering that the upper extremity joints are linked functionally in a chain and one joint impacting the function of the others, the shoulder and the elbow influence the wrist.

    It is important to take this into account when we are relating all of the things found throughout our assessments in this chapter and the one on the shoulder and thoracic spine. 

    Assessment Results for the Elbow and Wrist

    The elbow and the wrist need to be looked as an extension of the shoulder and rest of the upper body.

    Essentially, any time there is dysfunction of the shoulder, there is likely some form of dysfunction to be found in the elbow or the wrist.

    One specific common one is overactivity of the biceps that lead to rounding of the shoulders in the static posture, or the arms falling forward as a movement compensation like in the overhead squat.

    Pay attention to the various results of the different forms of assessments. 

    Static Posture

    Fitness professionals will see that there is no mention of elbow and wrist problems in the syndromes and spinal postures that we initially started to look at in the book.

    But, due to the regional interdependence model, we are able to relate some of these dysfunctions to the syndromes that we have.

    Rounded shoulders can show up in various ways in the elbow and wrist, and this usually evolves around the biceps brachii being overactive.

    Transitional Movement Assessments

    The overhead squat and the overhead press movements will shine spotlights on the imbalances that may be present in the arms. 

    Overhead Squat Assessment

    Because doing the overhead squat means that we need full mobility in the upper body, shoulders, and elbows, and many of these common compensations can be found with the overhead squat pattern.

    Exclusive PTP Offers


    Gold Standard Cert
    Save 25%
    Most Popular Cert
    3 Certs for 1
    A Good Option
    50% off
    Best Study Materials
    See MVP discount
    Best online PT course
    $100 Off
    The Top PT Software
    Get Free Trial

    This is another reason the overhead squat is such a valued assessment. 

    Loaded Movement Assessment

    The overhead squat assessment gives a strong estimation of possible dysfunctions of the arms, predictions for limitations in the range of motion in the wrist can be made by looking at the client when they are doing pushing, pulling, and overhead press exercises. 

    Mobility Assessments

    The elbow and the wrist are a functional extension of the shoulder. When movement impairments are found in the shoulder and thoracic spine, there is likely to be some muscle overactive in the arm.

    There should be tests done for the elbow and wrist flexion and extension. 

    Corrective Strategies for the Elbow and Wrist

    The Sample corrective Exercise Program for the Elbow and Wrist Impairments includes these phases:

    We start by inhibiting the brachialis, biceps brachii, wrist flexors or extensors, through the use of SMR. Make sure to look at the acute training variables for this phase of corrective exercise in the appropriate chapter. 

    Next is the lengthening phase where static stretching is implemented on the biceps brachii and the wrist extensors or flexors. Make sure to look at the acute training variables for this phase of corrective exercise in the appropriate chapter. 

    Activation is the third phase and it has us using isolated strengthening in the form of elbow extension, wrist flexion or extension, and wrist supination and pronation. Make sure to look at the acute training variables for this phase of corrective exercise in the appropriate chapter. 

    Integrated dynamic movements are implemented in the final stage of integration in the exercises of standing latissimus dorsi pulldowns, standing cable press, and prone ball triceps extension with cobra. Make sure to look at the acute training variables for this phase of corrective exercise in the appropriate chapter. 

    Make sure to go through the steps and pictures so you cannot how everything should look for these four steps mentioned.  And look into the specific for elbow flexion and non-neutral wrist. 

    Common Issues Associated with the Elbow, Wrist, and Hand

    Wrist and elbow injuries have a significant impact on the daily life activities of everyone.

    Pain will limit simple tasks that we do. 

    Lateral Epicondylitis

    We also call this tennis elbow. This is a common issue related to overuse injuries of the forearm extensors.

    It is more specifically from the repeated wrist and elbow motions and can also lead to injuries of the wrist extensors and tendons. 

    Medial Epicondylitis

    This is also known as golfer’s elbow. It is a very common overuse injury to the flexors of the forearms.

    It is just like tennis elbow, where certain sports and occupations are more at risk due to chronic movements. 

    De Quervain’s Tenosynovitis

    This is inflammation of the sheath, or the synovium, that surrounds the two tendons running between the wrist and the thumb.

    There is no one specific cause, but really any activity relying on constant hand or wrist motions. 

    Carpel Tunnel Syndrome

    This is a neural entrapment condition that affects around 3 – 6 percent of all adults in the US. It causes numbness, tingling, weakness, and other symptoms in the hand. 

    NASM CES Chapter 15: Corrective Strategies for the Wrist and Elbow 2
    NASM CES Chapter 15: Corrective Strategies for the Wrist and Elbow 3
    NASM CES Chapter 15: Corrective Strategies for the Wrist and Elbow 4

    About The Author

    Leave a Comment

    Your email address will not be published.

    Get The Sectret Cheat Sheet For The ACSM Exam

    18749

    Get The Sectret Cheat Sheet For The CSCS Exam

    18749

    Discover Your Cert:

    Get the top 5 Tips for Passing the ACE CPT

    18749

    Get the top 5 Tips for Passing the NASM CPT

    18749

    Get The Sectret Cheat Sheet For The NSCA CPT Exam

    18749

    Get The Sectret Cheat Sheet For The ACE Exam

    18749

    Get The Sectret Cheat Sheet For The NASM Exam

    18749

    Get The Sectret Cheat Sheet For The ISSA Exam

    18749
    Scroll to Top
    }});}});