The Joint Ventures' Blog

Positional Fault

Tuesday, April 05, 2016

Could your "Tennis Elbow,” or other elbow pain, be caused by a Positional Fault? Many orthopaedic conditions affecting the elbow, such as “tennis elbow” or “little league elbow” can, at least in part, be attributed to imbalances between certain muscles’ flexibility and strength.  Muscles operate best when they are at the correct length, and muscles that are either too short/tight or too long/weak can create problems

Certain muscles are prone to overuse and therefore are very strong and tight (Example: the chest or pec muscles). In physical therapy, we treat this muscular tightness with mobility techniques such as self stretching and manual techniques, such as Active Release Technique (ART), Graston Technique, and various other methods of manual therapy.

Other muscular problems are caused by certain muscles being over stretched and becoming weak (think of your abdominals and glutes/buttock muscles). These muscles will only get better if we strengthen them with the proper corrective exercises.

So while a lot of elbow conditions can be treated with various self stretching and strengthening procedures, I still have a large variety of people who come to me and say, “I have looked up and tried every tennis elbow stretch and strengthening exercise on the internet. They help a little but I am still having tons of pain when I grip things."

If this person truly has taken care of the muscle imbalance with a proper corrective exercise prescription for their problem, the muscular imbalance may be the result of an underlying joint dysfunction. A world famous Physical Therapist from New Zealand, Brian Mulligan, describes this as a “Positional Fault."  Many joints in the body, but especially the elbow, are analogous to a hinge on a door. In order for a door to move, you need the door (forearm bones) to swivel smoothly on the hinge (elbow joint) of the door frame (the upper arm bones). If the door is not on its hinge properly, the door will not open smoothly. The body improperly interprets this abnormal movement about the elbow as pain. It does not matter how strong and flexible the muscles are, if they are trying to move a faulty hinge, they will not operate smoothly.




Mulligan and other manual therapists trained in his technique (using a mobilization strap as pictured here) place the joint in the optimal place (put the door back on the hinges) to reduce your pain. The perform a mobilization with movement, where you move through a previously painful motion with the joint now realigned with the mobilization strap and force applied by your PT.  The muscle imbalance that you were working on before probably is what caused the joint to "come off its hinge,” but stretching and strengthening without proper alignment will not resolve the problem entirely.


If you have a chronic elbow dysfunction and you have tried stretching and strengthening without the success you desire, you should contact Joint Ventures and see a physical therapist to see if a positional fault is causing your elbow pain.


For more information on Mulligan manual therapy, elbow dysfunctions or positional faults anywhere in the body, please contact Brent at.

Brent.Butler@JointVenturesPT.com.

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