Skip to main content

Rehabilitation of the Elbow

  • Chapter
  • First Online:
Elbow and Sport
  • 1598 Accesses

Abstract

Injuries to the elbow are relatively common in sport. They occur as a consequence of repetitive microtrauma during the acts of throwing and serving or as a result of direct blows or falls. Rehabilitation following injury or surgery is vital to restore normal athletic function and to return an individual to sport as quickly and as safely as possible. Rehabilitation follows a phased approach, to ensure vulnerable tissues are protected, whilst avoiding complications of immobilisation. The aims of rehabilitation are to restore full motion with strength and neuromuscular control. Programmes must be tailored so they are specific to the individual and their chosen sport. Rehabilitation focuses not only on the upper limb but also on the whole kinetic chain.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Crotin RL, Ramsey DK. Injury prevention for throwing athletes part I: baseball bat training to enhance medial elbow dynamic stability. Strength Cond J. 2012;34(2):79–85.

    Article  Google Scholar 

  2. Ellenbecker TS, Nirschl R, Renstrom P. Current concepts in examination and treatment of elbow tendon injury. Sports Health Multidisc Appro. 2012;5(2):186–94. 1941738112464761.

    Article  Google Scholar 

  3. Conte S, Requa RK, Garrick JG. Disability days in major league baseball. Am J Sports Med. 2001;29(4):​431–6.

    CAS  PubMed  Google Scholar 

  4. Posner M, Cameron KL, Wolf JM, Belmont Jr PJ, Owens BD. Epidemiology of major league baseball injuries. Am J Sports Med. 2011;39(8):1676–80.

    Article  PubMed  Google Scholar 

  5. Priest JD, Jones HH, Nagel DA. Elbow injuries in highly skilled tennis players. Am J Sports Med. 1974;2(3):137–49.

    Article  Google Scholar 

  6. Priest JD. Tennis elbow. The syndrome and a study of average players. Minn Med. 1976;59(6):367–71.

    CAS  PubMed  Google Scholar 

  7. Wilson FD, Andrews JR, Blackburn TA, Mccluskey G. Valgus extension overload in the pitching elbow. Am J Sports Med. 1983;11(2):83–8.

    Article  CAS  PubMed  Google Scholar 

  8. Dillman CJ, Smutz P, Werner S. Valgus extension overload in baseball pitching. Med Sci Sports Exerc. 1991;23:S135.

    Google Scholar 

  9. Cain EL, Dugas JR, Wolf RS, Andrews JR. Elbow injuries in throwing athletes a current concepts review. Am J Sports Med. 2003;31(4):621–35.

    PubMed  Google Scholar 

  10. Wilk KE, Macrina LC, Cain EL, Dugas JR, Andrews JR. Rehabilitation of the overhead athlete’s elbow. Sports Health Multidisc Appro. 2012;4(5):404–14.

    Article  Google Scholar 

  11. Ellenbecker TS, Mattalino AJ, Elam EA, Caplinger RA. Medial elbow joint laxity in professional baseball pitchers a bilateral comparison using stress radiography. Am J Sports Med. 1998;26(3):420–4.

    CAS  PubMed  Google Scholar 

  12. Wright RW, Steger-May K, Wasserlauf BL, O’Neal ME, Weinberg BW, Paletta GA. Elbow range of motion in professional baseball pitchers. Am J Sports Med. 2006;34(2):190–3.

    Article  PubMed  Google Scholar 

  13. Ellenbecker TS. A total arm strength isokinetic profile of highly skilled tennis players. Isokinet Exerc Sci. 1991;1(1):9–21.

    Google Scholar 

  14. Ellenbecker TS, Roetert EP, Riewald S. Isokinetic profile of wrist and forearm strength in elite female junior tennis players. Br J Sports Med. 2006;40(5):​411–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Laudner KG, Wilson JT, Meister K. Elbow isokinetic strength characteristics among collegiate baseball players. Phys Ther Sport. 2012;13(2):97–100.

    Article  PubMed  Google Scholar 

  16. Kovacs MS, Ellenbecker TS. A performance evaluation of the tennis serve: implications for strength, speed, power, and flexibility training. Strength Cond J. 2011;33(4):22–30.

    Article  Google Scholar 

  17. Wilk KE, Arrigo C, Andrews JR. Rehabilitation of the elbow in the throwing athlete. J Orthop Sports Phys Ther. 1993;17(6):30.

    Google Scholar 

  18. Ellenbecker TS, Paul Roetert E. Isokinetic profile of elbow flexion and extension strength in elite junior tennis players. J Orthop Sports Phys Ther. 2003;33(2):​79–84.

    Article  PubMed  Google Scholar 

  19. Ruivo R, Pezarat-Correia P, Carita AI. Elbow and shoulder muscles strength profile in judo athletes. Isokinet Exerc Sci. 2012;20(1):41–5.

    Google Scholar 

  20. Wilk KE, Reinold MM, Andrews JR. Rehabilitation of the thrower’s elbow. Clin Sports Med. 2004;​23(4):765–801.

    Article  PubMed  Google Scholar 

  21. Bring DKI, Reno C, Renstrom P, Salo P, Hart DA, Ackermann PW. Joint immobilization reduces the expression of sensory neuropeptide receptors and impairs healing after tendon rupture in a rat model. ​J Orthop Res. 2009;27(2):274–80.

    Article  CAS  PubMed  Google Scholar 

  22. Martinez DA, Vailas AC, Vanderby Jr R, Grindeland RE. Temporal extracellular matrix adaptations in ligament during wound healing and hindlimb unloading. Am J Phys Regul Integrative Comp Physiol. 2007;​293(4):R1552–60.

    Article  CAS  Google Scholar 

  23. Eliasson P, Andersson T, Aspenberg P. Rat Achilles tendon healing: mechanical loading and gene expression. J Appl Physiol. 2009;107(2):399–407.

    Article  PubMed  Google Scholar 

  24. Ross G, McDevitt ER, Chronister R, Ove PN. Treatment of simple elbow dislocation using an immediate motion protocol. Am J Sports Med. 1999;27(3):308–11.

    CAS  PubMed  Google Scholar 

  25. Armstrong AD, Dunning CE, Faber KJ, Duck TR, Johnson JA, King GJ. Rehabilitation of the medial collateral ligament-deficient elbow: an in vitro biomechanical study. J Hand Surg. 2000;25(6):1051–7.

    Article  CAS  Google Scholar 

  26. Wolff AL, Hotchkiss RN. Lateral elbow instability: nonoperative, operative, and postoperative management. J Hand Ther. 2006;19(2):238–44.

    Article  PubMed  Google Scholar 

  27. Lee AT, Schrumpf MA, Choi D, Meyers KN, Patel R, Wright TM, Hotchkiss RN, Daluiski A. The influence of gravity on the unstable elbow. J Shoulder Elbow Surg. 2013;22(1):81–7.

    Article  PubMed  Google Scholar 

  28. Page C, Backus SI, Lenhoff MW. Electromyographic activity in stiff and normal elbows during elbow flexion and extension. J Hand Ther. 2003;16(1):5–11.

    Article  PubMed  Google Scholar 

  29. Jones V, Stanley D.

    Google Scholar 

  30. Monument MJ, Hart DA, Salo PT, Befus AD, Hildebrand KA. Posttraumatic elbow contractures: targeting neuroinflammatory fibrogenic mechanisms. J Orthop Sci. 2013;18(6):869–77.

    Article  CAS  PubMed  Google Scholar 

  31. Bisset LM, Hing W, Vicenzino B. The efficacy of mobilisations with movement treatment on musculoskeletal pain: a systematic review and meta-analysis. In: 16th international congress of the world confederation for physical therapy. 2011. http://www.wcpt.org/wpt11.

  32. Bernas GA, Thiele RAR, Kinnaman KA, Hughes RE, Miller BS, Carpenter JE. Defining safe rehabilitation for ulnar collateral ligament reconstruction of the elbow a biomechanical study. Am J Sports Med. 2009;37(12):2392–400.

    Article  PubMed  Google Scholar 

  33. O’Driscoll SW, Jupiter JB, King GJ, Hotchkiss RN, Morrey BF. The unstable elbow*†. J Bone Joint Surg. 2000;82(5):724.

    Article  Google Scholar 

  34. Basmajian JV, GRIFFINJR W. Function of anconeus muscle an electromyographic study. J Bone Joint Surg. 1972;54(8):1712–4.

    CAS  PubMed  Google Scholar 

  35. Bergin MJG, Vicenzino B, Hodges PW. Functional differences between anatomical regions of the anconeus muscle in humans. J Electromyogr Kinesiol. 2013;23(6):1391–7.

    Article  PubMed  Google Scholar 

  36. Molinier F, Laffosse JM, Bouali O, Tricoire JL, Moscovici J. The anconeus, an active lateral ligament of the elbow: new anatomical arguments. Surg Radiol Anat. 2011;33(7):617–21.

    Article  PubMed  Google Scholar 

  37. Misra G, Paris TA, Archer DB, Coombes SA. Dose–response effect of isometric force production on the perception of pain. PLoS One. 2014;9(2):e88105.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Koltyn KF, Umeda M. Contralateral attenuation of pain after short-duration submaximal isometric exercise. J Pain. 2007;8(11):887–92.

    Article  PubMed  Google Scholar 

  39. Kosek E, Ekholm J. Modulation of pressure pain thresholds during and following isometric contraction. Pain. 1995;61(3):481–6.

    Article  CAS  PubMed  Google Scholar 

  40. Kosek E, Lundberg L. Segmental and plurisegmental modulation of pressure pain thresholds during static muscle contractions in healthy individuals. Eur J Pain. 2003;7(3):251–8.

    Article  PubMed  Google Scholar 

  41. Lannersten L, Kosek E. Dysfunction of endogenous pain inhibition during exercise with painful muscles in patients with shoulder myalgia and fibromyalgia. Pain. 2010;151(1):77–86.

    Article  PubMed  Google Scholar 

  42. Staud R, Robinson ME, Price DD. Isometric exercise has opposite effects on central pain mechanisms in fibromyalgia patients compared to normal controls. Pain. 2005;118(1):176–84.

    Article  PubMed  Google Scholar 

  43. Ellenbecker TS, et al. Current concepts in rehabilitation following ulnar collateral ligament reconstruction. Sports Health Multidis Appro. 2009;1(4):​301–13.

    Article  Google Scholar 

  44. Lin F, et al. Muscle contribution to elbow joint valgus stability. J Shoulder Elbow Surg. 2007;16(6):​795–802.

    Article  PubMed  Google Scholar 

  45. Otoshi K, et al. The proximal origins of the flexor–pronator muscles and their role in the dynamic stabilization of the elbow joint: an anatomical study. Surg Radiol Anat. 2014;36(3):289–94.

    Article  PubMed  Google Scholar 

  46. Park MC, Ahmad CS. Dynamic contributions of the flexor-pronator mass to elbow valgus stability. J Bone Joint Surg. 2004;86(10):2268–74.

    PubMed  Google Scholar 

  47. Perry J, Jobe FW. Functional anatomy of the flexor pronator muscle group in relation to the medial collateral ligament of the elbow. Am J Sports Med. 1995;23(2):245–50.

    Article  PubMed  Google Scholar 

  48. Pienimäki TT, Tarvainen TK, Siira PT, Vanharanta H. Progressive strengthening and stretching exercises and ultrasound for chronic lateral epicondylitis. Physiotherapy. 1996;82(9):522–30.

    Article  Google Scholar 

  49. Stasinopoulos D, Stasinopoulou K, Johnson MI. An exercise programme for the management of lateral elbow tendinopathy. Br J Sports Med. 2005;39(12):944–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Svernlöv B, Adolfsson L. Non‐operative treatment regime including eccentric training for lateral humeral epicondylalgia. Scand J Med Sci Sports. 2001;11(6):​328–34.

    Article  PubMed  Google Scholar 

  51. Ng G. The effects of forearm brace tension on neuromuscular performance in subjects with lateral humeral epicondylosis: a review: review article. Int SportMed J Elbow Injury Sport Part 2 Biomech Elbow Sport. 2005;6(2):124.

    Google Scholar 

  52. Fusaro I, Orsini S, Kantar SS, Sforza T, Benedetti MG, Bettelli G, Rotini R. Elbow rehabilitation in traumatic pathology. Musculoskelet Surg. 2014;98(1):​95–102.

    Article  Google Scholar 

  53. Carpenter JE, Blasier RB, Pellizzon GG. The effects of muscle fatigue on shoulder joint position sense. Am J Sports Med. 1998;26(2):262–5.

    CAS  PubMed  Google Scholar 

  54. Guskiewicz KM, Schneider RA, Prentice WE. Proprioception and neuromuscular control of the shoulder after muscle fatigue. J Athl Train. 1999;34(4):362.

    PubMed  PubMed Central  Google Scholar 

  55. Myers JB, Ju YY, Hwang JH, McMahon PJ, Rodosky MW, Lephart SM. Reflexive muscle activation alterations in shoulders with anterior glenohumeral instability. Am J Sports Med. 2004;32(4):1013–21.

    Article  PubMed  Google Scholar 

  56. Voight ML, Hardin JA, Blackburn TA, Tippett S, Canner GC. The effects of muscle fatigue on and the relationship of arm dominance to shoulder proprioception. J Orthop Sports Phys Ther. 1996;23(6):​348–52.

    Article  CAS  PubMed  Google Scholar 

  57. Shanley E, Rauh MJ, Michener LA, Ellenbecker TS, Garrison JC, Thigpen CA. Shoulder range of motion measures as risk factors for shoulder and elbow injuries in high school softball and baseball players. Am J Sports Med. 2011;39(9):1997–2006.

    Article  PubMed  Google Scholar 

  58. Wilk KE, Macrina LC, Flensing GS, Aune KT, Porterfield RA, Harker P, Evans TJ, Andrews JR. Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers a prospective study. Presented at the 39th annual meeting of the AOSSM, Chicago, July 2013.

    Google Scholar 

  59. Dines JS, et al. Glenohumeral internal rotation deficits in baseball players with ulnar collateral ligament insufficiency. Am J Sports Med. 2009;37(3):566–70.

    Article  PubMed  Google Scholar 

  60. Cools AM, Johansson FR, Cagnie B, Cambier DC, Witvrouw EE. Stretching the posterior shoulder structures in subjects with internal rotation deficit: comparison of two stretching techniques. Shoulder Elbow. 2012;4(1):56–63.

    Article  Google Scholar 

  61. Wilk KE, Obma P, Simpson CD, Cain EL, Dugas J, Andrews JR. Shoulder injuries in the overhead athlete. J Orthop Sports Phys Ther. 2009;39(2):38–54.

    Article  PubMed  Google Scholar 

  62. Reinold MM, Macrina LC, Wilk KE, Fleisig GS, Dun S, Barrentine SW, Andrews JR. Electromyographic analysis of the supraspinatus and deltoid muscles during 3 common rehabilitation exercises. J Athl Train. 2007;42(4):464–9.

    PubMed  PubMed Central  Google Scholar 

  63. Reinold MM, Wilk KE, Fleisig GS, Zheng N, Barrentine SW, Chmielewski T, Cody RC, Jameson GG, Andrews JR. Electromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises. J Orthop Sports Phys Ther. 2004;34(7):385–94.

    Article  PubMed  Google Scholar 

  64. Escamilla RF, Ionno M, ScottdeMahy M, Fleisig GS, Wilk KE, Yamashiro K, Mikla T, Paulos L, Andrews JR. Comparison of three baseball-specific 6-week training programs on throwing velocity in high school baseball players. J Strength Cond Res. 2012;26(7):​1767–81.

    Article  PubMed  Google Scholar 

  65. Alizadehkhaiyat O, Fisher AC, Kemp GJ, Vishwanathan K, Frostick SP. Upper limb muscle imbalance in tennis elbow: a functional and electromyographic assessment. J Orthop Res. 2007;25(12):​1651–7.

    Article  PubMed  Google Scholar 

  66. Seroyer ST, Nho SJ, Bach BR, Bush-Joseph CA, Nicholson GP, Romeo AA. The kinetic chain in overhand pitching: its potential role for performance enhancement and injury prevention. Sports Health Multidis Appro. 2010;2(2):135–46.

    Article  Google Scholar 

  67. Kibler WB, Chandler J. Baseball and tennis. In: Griffin LY, editor. Rehabilitation of the injured knee. St. Louis: Mosby; 1995. p. 219–26.

    Google Scholar 

  68. Hannon J, Garrison JC, Conway J. Lower extremity balance is improved at time of return to throwing in baseball players after an ulnar collateral ligament reconstruction when compared to pre‐operative measurements. Int J Sports Phys Ther. 2014;9(3):356.

    PubMed  PubMed Central  Google Scholar 

  69. Burkhart TA, Andrews DM. Kinematics, kinetics and muscle activation patterns of the upper extremity during simulated forward falls. J Electromyogr Kinesiol. 2013;23(3):688–95.

    Article  PubMed  Google Scholar 

  70. Lo J, McCabe GN, DeGoede KM, Okuizumi H, Ashton-Miller JA. On reducing hand impact force in forward falls: results of a brief intervention in young males. Clin Biomech. 2003;18(8):730–6.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rob Tamminga MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 ESSKA

About this chapter

Cite this chapter

Tamminga, R., Jones, V. (2016). Rehabilitation of the Elbow. In: Pederzini, L., Eygendaal, D., Denti, M. (eds) Elbow and Sport. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48742-6_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-48742-6_17

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-48740-2

  • Online ISBN: 978-3-662-48742-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics