I have a client who, about 20 years ago, had a problem with his right bicep tendon, and he was told his only chance for a complete recovery was through surgery. He opted out of surgery and has since been keeping the muscles strong around it and has aggressive physio on it for 30 minutes a week. He finds it very hard, if not impossible, to push upwards with his arm extended out to the side with the palm face down. He also has weakness in shoulder press. He is a tennis coach and is unable to perform a proper serve, and he has recently started having symptoms of golfers elbow. I have been advised by his physio to work with his posture, which I am doing, but I wonder if there is anything else I can do. Also, is it possible that the bicep injury years ago and his occupation could be causing the latest golfers elbow symptoms?
Thank you for your question. Due to the chronic nature of this situation, try not to get caught in the “golfers elbow” symptom trap. What you’re dealing with is a movement impairment that has manifested into “golfers elbow.” The key is to assess your client’s needs and where he is currently and then strategize a plan to get him closer to the need. Be objective and be careful not to use pain as the only guide. Of course, this is heavily dependent on knowledge of movement. To help you, here are three of many strategies founded from movement science principles:
- Position your client relative to the chosen task and gravity. In other words, to understand the problem, you must be specific. If he hurts standing in extension, you must assess in standing!
- To get to the desired motion, you must load first (before explode). For example, if you want to flex the shoulder, extend first. Think of a tennis serve. Before you hit the ball, what direction do you load? Opposite to the intended direction. This is a key powerful strategy!
- Find his success. We are three dimensional and move through many different angles, Find where your client CAN move and move him knowing you will have an effect on the problematic angles of motion. If you feed one plane, you will have an effect on the other planes and therefore positively use his known success to help the injured region. It is important to remember that motion and stability (and posture) are integrated, NOT separated. The human movement system MUST have motion to exhibit stability. Therefore, do not allow one segment to “stay still” while the others move (traditional rehab commonly does this).
And YES, his injury years ago is part of his current problem. Why I can say this with confidence is the fact that we as humans do not regenerate, we remodel. Therefore, no wound is ever perfect! No surgery ever “fixes” the problem back to the original. A study of connective tissue adaptation will easily prove this comment. Our goal is always to assess ALL prior injuries and hope we can break chronic cycles of dysfunction, often caused from compensations post acute trauma (even if it happened years ago). As a reference to your client’s problem and many techniques, I would strongly suggest looking at the Gray Institute's Functional Video Digest Series DVD on the elbow.