PT on the Net Research

Poor Flexibility in Elbows


Question:

I have a client who is unable to straighten out his arms due to sub par flexibility in his elbows. He has progressed wonderfully in all aspects of our fitness program and experiences no pain in his elbows. I was curious about the cause of this. Can it be remedied with training?

Answer:

In order to get a clearer handle on your client, a few assessments have to be done including range of motion and checks for spring and end feel. There are a couple of possibilities why your client is unable to straighten his arm. These include the following:

Fascial and Trigger Point Build Up

Fascial build up in the area in question can present with tightness and lack of mobility and flexibility and, in most cases, results from the chronic performance of a movement pattern. Pattern overload usually results in injury, and the lack of flexibility is a precursor to that. The muscle tissue may be overdeveloped and hypertonic, resulting in tightness.

Anatomy of Connective Tissue

The elbow is a major junction with tendons and thick connective tissues surrounding the area. Connective tissue is naturally firmer than muscle tissue and less mobile to provide stability to the joint. This makes it more difficult to work with as there is less pliability and less blood flow. Connective tissues take longer to heal, and mobilizing the area can prove to be tough because of the increased tightness of the area for reasons mentioned above.

Atrophy and Sarcomere Loss

This is the other side of the spectrum where the tightness is due to the inactivity and atrophy or a chronic postural fault. If a muscle is chronically tight and in a shortened position, the muscle fibers tend to drop sarcomeres, tightening the tissue even further. This is very common in individuals who are hospitalized and experience paralysis or some type of trauma that impedes movement. Usually a nurse or physical therapist will come in to assist the patient and move his or her joints through a range of motion to increase stimulation and get some blood flow and circulation.

Scar Tissue and Injury Trauma

If your client has had any history of injury to the elbows, there may be old scar tissue build up in the area, which will reduce mobility and flexibility. Deep tissue work, neuromuscular therapy, Heller work or a Rolfer can help break up the scar tissue and aid in mobilizing the arm a little better.

Bicep Tightness

In my experience, any client who presented with inability to straighten his arm always was related to bicep tightness. A tight bicep will shorten the arm and pull it up, giving you the “gorilla” effect. Most people have their biceps in a somewhat shortened position most of the day (i.e., eating, driving, typing on the computer, talking on the phone, sitting). Remember, a shortened muscle will drop sarcomeres over time, which shortens the muscle fiber. And many times, most guys want to come in and hammer away at their biceps doing curls, which can make it even worse.

Systemic Hyper/Hypo Mobility

Everyone has a natural or systemic flexibility that is developed early in life. Some people are naturally tight and some naturally loose. There are several tests you can perform to assess the systemic mobility of a person, but you can pretty much tell after working with a client if he gets tight just by looking at a weight or if he can stretch and be loose as a noodle. Your client may be one of those guys who is extremely tight and needs to have a regular stretching program to balance out his systems.

These are some ideas you can think about when trying to find out the origin of the tightness of a muscle or joint. Use this information and see if you can come up with any more clues as to the root of the problem. If both of his arms are unable to straighten, you’re probably looking at a chronic case of improper training, work/lifestyle postural faults or just a tight person. Stretching, deep tissue work, full range of motion exercise and multi-planar exercises should aid in getting your client to straighten out. Training can remedy the problem, but you have to do it properly. If the client can't straighten his arms because he has been annihilating them for years, more of the same will give him just that. Stimulation is the approach to take.