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102 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 6 technique MYOSKELETAL ALIGNMENT TECHNIQUES An Alternate Approach to Tennis Elbow Articular Stretching for Neural Mobilization By Erik Dalton A primary part of being human is the ability to use our hands in extraordinary ways. This effective and skillful hand use requires stable and painless movement of all upper extremity joints, including the elbows. Since the elbow bends and straightens much like a basic door hinge, it is referred to as a hinge joint (Image 1). However, the interaction of the elbow with the forearm and wrist is far from basic. When this complex interaction is fully understood, it's easy to see how dysfunctional elbow mechanics could be a major contributor to forearm and hand pain. EPICONDYLALGIA While the humeral and ulnar bones flex and extend similar to a door hinge, the humeral and radial articulations are much more complex. Shaped like a contoured knob with a cup at the end, the elbow's radial head smoothly rotates around the ulnar bone, causing the radiohumeral and radioulnar joints to efficiently turn the palm up (supination) or down (pronation) (Image 2). Sports—and occupations that involve repetitive lifting, forceful forearm maneuvers, and recurrent vibration—may, in time, damage the elbow's extensor tendons and degrade the joint's articular cartilage. In the presence of altered joint mechanics, the brain may decide to layer the area with protective spasm, resulting in radial nerve symptoms that resemble lateral epicondylalgia, or tennis elbow. Famed hand surgeon Emanuel Kaplan, MD, was the first to suspect radial nerve denervation as a possible cause for some epicondylalgia cases. In dissection studies, he noted constriction of the radial nerve by adhesions to the capsule of the radiohumeral joint and the short extensor muscle of the wrist. 1 A study published in Manual Therapy Journal found that a significant percentage of double-blind subjects presenting with tennis elbow demonstrated a favorable response to articular stretching techniques to restore optimal extension, pronation, and supination. 2 A similar study on computer users found immediate reduction in lateral elbow pain after radial nerve mobilization. 3 The researchers concluded that mobilization with movement appears to be a promising alternative treatment for clients with tennis elbow. But why? TENDINOSIS OR NERVE PAIN? Most of us who treat athletes are keenly aware that repetitive gripping can strain elbow tendons, leading to palpable maladaptions in tendon structure. During clinical examination of tennis elbow, clients often report tenderness over the common forearm extensor tendon insertion at the lateral epicondyle. Pain is reproduced with resisted wrist and 1 2 The humeroulnar is the only true elbow hinge joint. Adapted from Dreamstime. The elbow's radial head smoothly rotates around the ulnar bone. Adapted from McGraw-Hill Education with permission. Humeroulnar hinge joint

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