1. The elbow is an integral part of the Chain Reactionin ...1. The elbow is an integral part of the...

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©2002 Functional Design Systems 1. The elbow is an integral part of the Chain Reaction in all three planes of motion. 2. Understanding that training and conditioning is consistent with what we would do in rehabilitation. 3. To fully understand elbow function and elbow dysfunction we have to know what is going on with the rest of the body. 4. A Chain Reaction description of how the “varus knee” reaction to the loading of the hip could possibly influence the entire Chain Reaction and ultimately the elbow. 5. The elbow gets loaded by the “intention of our task”. 6. We have to functionally know and understand how the big toe relates to the elbow. 7. The elbow takes a tremendous amount of stress off the shoulder when functioning properly. 8. Understanding feeding the “other side” of the painful plane, then to the other planes, and finally to the painful plane of motion as a treatment strategy. 9. In function, the power should not come from “close to the elbow”. 10. Pump & Praise provides a multitude of opportunities to experience function. 11. Elbow exercises should look like total body exercises . . . progressing to integrated isolation which logically takes away friends of the elbow. 12. If the elbow gets out of sync in the Chain Reaction the opposite effect occurs. 13. In golf as in most other activities, the elbow is a transmitter of force. 14. The foot reacts to the ground . . . the hand reacts mostly to intention.

Transcript of 1. The elbow is an integral part of the Chain Reactionin ...1. The elbow is an integral part of the...

Page 1: 1. The elbow is an integral part of the Chain Reactionin ...1. The elbow is an integral part of the Chain Reactionin all three planes of motion. 2. Understanding that training and

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1. The elbow is an integral part of the Chain Reaction in all three planesof motion.

2. Understanding that training and conditioning is consistent with what we would do in rehabilitation.

3. To fully understand elbow function and elbow dysfunction we have toknow what is going on with the rest of the body.

4. A Chain Reaction description of how the “varus knee” reaction to theloading of the hip could possibly influence the entire Chain Reactionand ultimately the elbow.

5. The elbow gets loaded by the “intention of our task”.

6. We have to functionally know and understand how the big toe relatesto the elbow.

7. The elbow takes a tremendous amount of stress off the shoulder when functioning properly.

8. Understanding feeding the “other side” of the painful plane, then to the other planes, and finally to the painful plane of motion as a treatmentstrategy.

9. In function, the power should not come from “close to the elbow”.

10. Pump & Praise provides a multitude of opportunities to experience function.

11. Elbow exercises should look like total body exercises . . . progressing to integrated isolation which logically takes away friendsof the elbow.

12. If the elbow gets out of sync in the Chain Reaction the opposite effect occurs.

13. In golf as in most other activities, the elbow is a transmitter of force.

14. The foot reacts to the ground . . . the hand reacts mostly to intention.

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v2.3 THE ELBOWHinge Reaction

By: Gary Gray, PT

OBJECTIVES FOR THE ELBOW FUNCTIONAL GUIDETo assimilate up-to-date information and knowledge of the hinge reaction of the elbow.

To learn how to apply effective functional techniqueswhen testing, training and rehabilitating the elbow.

To understand and appreciate the tri-plane ChainReaction principles as they apply to the elbow.

HOW TO USE THIS FUNCTIONAL GUIDEThis functional guide can be used as a convenientsummary of the program’s contents to take with youafter viewing. You can also use this guide as a notebook; space has been provided so that you canmake notes on relevant tracts as you watch them.

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It is a huge blessing being able to play your son in golf, basketball or paddleball.

It is even a greater blessing getting your butt whipped by your son.

STRATEGY 1Strategically appreciating the CChhaaiinn RReeaaccttiioonn function of the elbow in relationship

to the rest of the body.

STRATEGY 2Strategically understanding that the elbow is a transmitter of force and dependent

for most activities of daily living.

STRATEGY 3 Strategically analyzing the hip, scapula and wrist, integrated with the rest of the

body to fully analyze the elbow.

STRATEGY 4Strategically revealing the force redistribution principle.

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STRATEGY 5Strategically realizing the similarities as well as the differences between the elbow

and the knee.

STRATEGY 6Strategically taking advantage of what we do for the elbow in training and

conditioning is what we do for the elbow in rehabilitation.

STRATEGY 7Strategically comprehending the cocking of the wrist and the cocking of the

shoulder in order to effectively load the elbow.

STRATEGY 8Strategically transforming our understanding of research into enhanced clinical

abilities.

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Life would be at “arm’s length” without the elbow.

The elbow takes a tremendous amount of stress off the shoulder when functioningproperly.

The elbow is an integral part of the CChhaaiinn RReeaaccttiioonn in all three planes ofmotion.

The elbow is, as all the other joints, a reactor.

We have to functionally know and understand how the big toe relates to theelbow.

The elbow is much more than just a sagittal plane joint.

As we look at the muscles of the elbow we realize there is a significant rotaryblend of the musculature.

The question for the elbow, when in pain, is this “Who put me at risk?”

In function, the power should not come from “close to the elbow”.

Review the planes of motion of the elbow.

The elbow gets loaded by the “intention of our task”.

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•Same side hip loading for the sagittal plane•Opposite side hip loading for the frontal plane•Same side hip loading for the frontal plane•Opposite side hip loading for the transverse plane•Same side hip loading for the transverse plane

Exploding from the ground up for an effective elbow.

Static sitting causing ineffective loading and exploding.

Dancing with a squeeze gun versus isolating out the elbow.

The wisdom of loading the rest of the body.

Elbow exercises should look like total body exercises. . . progressing to integratedisolation which logically takes away friends of the elbow, progressively isolatingthe elbow while still integrated within the rest of the body.

Understanding what feeds the elbow, therefore what loads the elbow, to allowthe elbow to unload and function.

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CASE PRESENTATION - Thanking Jim Brown for his valuable assistance in analysis, rehabilitation,training and conditioning in reference to the elbow.

Adding to traditional techniques to evaluate the elbow.

To fully understand elbow function and elbow dysfunction we have to know whatis going on with the rest of the body.

Realizing the failure of just an “isolated strategy” of elbow evaluation.

Assessing the hip loading relationship to the elbow•Single leg balance, same side upper extremity anterior reach at knee height•Single leg balance, same side upper extremity posterior reach at knee height•Single leg balance, same side upper extremity overhead posterior reach•Single leg balance, opposite side upper extremity lateral reach at waist height•Single leg balance, same side upper extremity overhead medial reach

The real question we are asking is: “In all three planes do the hips load effectivelyto efficiently load the elbow?”

•Single leg balance, opposite side upper extremity same side rotational reach at shoulder height•Single leg balance, same side upper extremity same side rotational reach atshoulder height

A CChhaaiinn RReeaaccttiioonn description of how the “varus knee” reaction to the loading of the hip could possibly influence the entire CChhaaiinn RReeaaccttiioonn and ultimately the elbow.

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Assessing scapular load and its relationship to the elbow•Sagittal plane scapula motion and loading with same side hip loading in flexionand extension•Frontal plane scapula motion and loading with opposite side and same side hipadduction loading•Transverse plane scapula motion and loading with opposite side and sameside hip internal rotation loading.

Assessing wrist loading and its relationship to the elbow•Sagittal plane wrist motion and loading with same side hip loading into flexionand extension•Frontal plane wrist motion and loading with opposite side and same side hipadduction loading•Transverse plane wrist motion and loading with opposite side and same sidehip internal rotation loading

Assessing the hips and legs, trunk, scapula, humerus and wrist in allthree planes of motion to fully understand the elbow

How does Jim’s body configure loading and unloading to get the elbow to workeffectively?

Understanding feeding the “other side” of the painful plane, then to the otherplanes, and finally to the painful plane of motion as a treatment strategy.

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ANALYSIS AND REHABILITATION DEBRIEF WITH BOB WIERSMA, P.T.

Discussing the wisdom of looking at the elbow as well as the rest of the body in the functional CChhaaiinn RReeaaccttiioonn..

More specific elbow exam strategies including palpation and elbow range ofmotion three dimensionally.

Strategies of treating the elbow . . . Where can I go for success of the elbow?

Revealing the redistribution strategy.

Understanding the initial eccentric loading to create the lengthening andstrengthening for appropriate elbow structures.

Questioning a certain amount of “deja vu” between the elbow and the knee.

The foot reacts to the ground . . . the hand reacts mostly to intention.

The elbow as the knee concept . . . caught in the middle with few places to go and no place to hide.

Understanding how and why the elbow takes the hit.

Singing the “deja vu song” between the elbow and the knee.

Understanding the differences between the elbow and the knee.

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Brad Gray, Director of PEAK PEPEAK PE - Promoting Encouragement and Athleticism in Kids of all ages

Pump and Praise is an exciting functional workout.

Pump and Praise is a major component of PEAK PE.

Pump and Praise is a functional circuit training workout driven by music andstructured by three dimensional functional exercise opportunities

Pump & Praise provides a multitude of opportunities to experience function.

Pump & Praise can be done literally anywhere.

Pump & Praise can be done with or without functional equipment.

Pump & Praise takes advantage of the reaction of the elbow and the wrist andthe elbow and the shoulder and the rest of the body to effectively train and condition the elbow.

Pump & Praise is based on the same functional principles as our rehabilitation,training and conditioning exercises.

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TAKING THE ELBOW THROUGH A FUNCTIONAL WORKOUT

Understanding that the training and conditioning is consistent with what wewould do in rehabilitation, knowing that we would use rehabilitative strategies with significant tweaking to facilitate the reaction we desire.

Feed certain “things” to the elbow and see how the elbow deals with it.

Dumbbell ExercisesHolding the dumbbell to get a wrist load•Sagittal plane loading and exploding•Frontal plane loading and exploding•Transverse plane loading and exploding

Let the weights be passive, let the hips do the work.

Kettleball ExercisesIt is the same game . . . let the hips and the trunk do the work.•Sagittal plane loading and exploding•Frontal plane loading and exploding•Transverse plane loading and exploding

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Bungee Cord Exercises Concentrate working on transformation with a bungee cord. Let the wrist come along for the ride Let the bungee load the hip first“Power the hip”•Sagittal plane loading and exploding•Frontal plane loading and exploding•Transverse plane loading and exploding

Lever Arm Exercises•Sagittal plane loading and exploding•Frontal plane loading and exploding•Transverse plane loading and exploding

Discussion of tweaks such as changing the load, changing the speed, andchanging the stability.

A special thanks to Jim Brown for his excellent efforts and the opportunityto workout with him.

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In golf as in most other activities, the elbow is a transmitter of force.

There is a transmission of our core power to the club in order to hit the ball far.

With a right handed golfer, the right elbow is part of the back side upper extremity CChhaaiinn RReeaaccttiioonn.

With the right handed golfer, the left elbow is part of the front side upperextremity CChhaaiinn RReeaaccttiioonn.

The back side elbow undergoes a cocking loading motion along with the shoulder and the wrist.

The front side elbow undergoes a loading through a firm left side with loadingthrough the wrist and the shoulder.

Elbow hinge drill with Dr. Dave Tiberio

Let the cocking and the loading of the wrist talk to the elbow.

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Drill #1 Back side right elbow hinge drill

Drill #2 Front side left elbow hinge drill(opposite side for left handed golfer)

Loading of the golf swing occurs at both ends of the golf swing.

The golf drill is proprioceptively designed to train the elbow.

“Switch clubs and switch sides”. G. Gray

Drill #3 Back side elbow hinge drill

Drill #4 Front side elbow hinge drill

Golf drills should ultimately help our golf swing

Getting the hips to talk to the elbow

The “most funnest” thing of golf is to be able to play golf with the ones you love.

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RESEARCH ROUNDTABLE WITH DR. DAVID TIBERIOLooking at motions and torques in the lower extremity as well as the upperextremity.

Intention driven subconscious reactions of the upper extremity.

This “function stuff” makes sense.

The body takes advantage of the reactive forces and only uses the active internaldriven forces to compliment and mold those external forces.

Movement and motor control concepts to guide our practices.

How do you do that? . . .I don’t think about it.

The elbow’s effect on the wrist and the wrist’s effect on the elbow

Discussion of research articleJ.D. Cooke, N. Virji-Babul. Reprogramming of muscle activation patterns at thewrist in compensation for elbow reaction torques during planar two-joint armmovements. Exp. Brain Res. 1-6 (1995); 177-180.

N. Virjo-Babul. J.D. Cooke. Influence of joint interactional effects on the coordinationof planar two-joint arm movements. Exp. Brain Res 103 (1995); 451-9.

The elbow as a driver for the wrist.

Understanding muscles and their tendons that cross more than one joint.

We have to get away from the “minutia”.

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We need to evaluate motion as well as the timing of motion in all three planesof motion.

Ingrained Proprioception

It is really the same old song . .. “the foot bone is connected to the knee boneand the knee bone is connected to the hip bone . . . “

If the elbow gets out of sync in the CChhaaiinn RReeaaccttiioonn the opposite effect occurs.

Understanding functional biomechanics is the ability to isolate while the isolatedsegments are still integrated.

“It should smell like function”. - G. Gray

Understanding a wrist up (bottom up) load.

What is their function and am I utilizing a strategy consistent with their functionto allow them to improve.

A special thanks to Dave for his ongoing exceptional efforts in bringingpertinent research articles to the table.