Newsletter #6
June 1, 2008 
3 Comments
Hi everyone, welcome to this week’s newsletter. This is an exciting week as it is week 1 of my online continuing education program. If you missed out, I will likely repeat in January as the response was overwhelming. Let’s start this week off with a reader question.
Reader Question
Hi Mike,
Wanted to pick your brain on a patient I am treating. She is 7 weeks post-op (spur resection) secondary to elbow impingement. She is doing fine, has near full (lacking about 3-4 degrees of extension) ROM and is relatively pain free. She is a professional golfer and it is her trail arm that is involved. One last thing: she has a large carrying angle and her uninvolved elbow is hyperextended. Would you try to regain hyperextension or just shoot for full extension. Me and my partner disagree about this and would like your opinion. – Bob M., PT
Bob, good question. I would have to say that I agree with you and your partner! I would bet that the even if she restores her elbow to 0 degrees of extension, she will still feel as if it doesn’t go straight if she has significant hyperextension. I would recommend restoring some of the hyperextension with your techniques and then allow her to regain the rest on her own through functional activities. For example, if she has 8-10 degrees of hyperextension, I would restore ~5 degrees. If she has some laxity, which it sounds like she does, she will regain the motion. This will probably have a better outcome rather than you jamming it into hyperextension. By the way, same response for knee hyperextension following knee surgery.
Thanks for the question Bob, if anyone else has a question feel free to submit it in the contact form on the website.
Plays of the Week
- Interesting information on why we lose muscle as we age.
- An examination of the evidence behind treatment options for ilitotibial band syndrome from Physiospot.
- I agree with Michael Boyle, Coach Dos, and others – I’ve said this occasionally but the TV show “The Biggest Loser” is awful and concerns me every week, I find myself shaking my head every time I watch, as seldom as that is…
- Back to School Nutrition 101 by Brian St. Pierre who also has a nice review of the Real Truth about the Acai Berry.
- Good article on concussion injuries in young athletes from the Thrive pediatric blog by the Children’s Hospital in Boston.
- Received a nice email from Melissa Turnock from the blog Pilates Scene in Australia. Check out her blog for some info on Pilates.
- Chris Kolba’s blog has a nice article asking are year round sports bad for you? My answer is a huge “yes!” There is a reason that the professionals don’t play all year round, why would our children? Overuse is bad.
Video of the Week
Have you seen this video of the baby dancing to Beyonce??? Hilarious!
Does anyone have any input on whether I should do Blackburn exercises with fewer reps and a 5-6 second hold or for higher reps and only 1-2 second hold? As a practitioner, I've seen people do it both ways.
Marcus Holliday, MA, ATC, CES
Regarding Bob's case (elbow) would you recommend any type of splinting?
Dan McGovern PT,DPT,SCS,ATC,CSCS
@ Marcus – I dont ever want to "burn out the cuff" or work it to failure. would not recommend 5-6 second holds. Also, you should read my article in JOSPT from earlier in the year on shoulder exercises. If you are just doing "blackburn's" you are missing out on some important exercises.
@ Dan – I would bet she wouldnt need a splint, if she has that much hyperextension she likely has some type of laxity that will get it back. If she was more like a 10 deg lag etc, then yes. I really wouldnt want a splint to force her into excessive hyper either.