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Elastic Band Exercises for elbow treatment

PHASE 2: MOBILIZE AND STABILIZE

What is Rehabilitation? 

Rehabilitation is the process or action of restoring something after it has been damaged back to normal condition. After an injury, the body has a fundamental physiological process for how it restores itself back to health. Sometimes that restoration is quick and returns to normal, other times it returns to become functional but now has a new baseline or what normal is. There are ways that as an athlete, we can improve and enhance this process to increase our rate of return and manipulate the new baseline. This process in musculoskeletal injuries includes the additional steps of primarily mobilization and stabilization following the recovery and pain-relieving phase. 

Mobilize 

Stabilize 

During the rehabilitation phase, it is important for any athlete or individual to become more self-aware to what their body is feeling. Here at the elbow athlete, we focus on the education for each of these topics. Our goal is to educate and increase your awareness of what you are feeling so you can determine if you are ready for the next phase or progression. This is the most significant component of training and returning from injury. The ability to find the edge, riding the line of giving the body enough stimulus to improve and heal, but not too much to become overloaded and delay rehabilitation. 

A general rule of thumb is soreness a good thing because the body needs some overload of stress to get stronger. This soreness should go away within 24 hours or with a little bit of movement.  However, if the soreness does not go away after movement or after 24 hours then you DID TOO MUCH. Scale it back, by about 25%! If the soreness or pain lasts more than 48 hours, then you did WAY TOO MUCH!! And need to scale back the amount you did by about 50%!

Rehabilitation is a process that is ever changing. It is a balancing act of giving the body some, but not too much. At the elbow athlete, we have broken down the rehabilitation process into these two topics: mobilization and stabilization. Continue to become more aware and let’s restore your elbow back to normal!

Phase 2: Mobilize & Stabilize: About
Fitness Video

MOBILIZATION

What is mobilization? Why is it important? 

More specifically defined as soft tissue mobilization is the process of improving range of motion by elongating the muscle tissue, fascia, tendons, and other connective tissues in the body.  This can be achieved in a multitude of ways, but the general theme is to increase blood flow. Increased blood flow creates a warming up of the tissue, so it has greater elasticity or extensibility. This often results in a temporary elongation of the tissue, allowing an increase in range of motion and movement with a reduction in pain. This reduction in pain is also due to the improvement in the tension of the nervous and musculoskeletal system.  Following soft tissue mobilization, the body often interprets this increased motion as the new baseline for that movement pattern. Therefore, mobilization should occur daily and is one of the fundamentals to every proper daily routine and training day. It is through this repetition; an individual can improve their mobility and functional movement long term by then introducing stabilization. But first, we need to keep it simple and mobilize. 

When can I start with mobilization? 

Mobilization can begin right away in most cases specifically relating to tendinopathy, arthritis, and even carpal tunnel. It is important to not have any severe swelling like in bursitis or an acute trauma before starting with mobilization. If large amounts of swelling exist, continue with Phase 1: Relief and Recover, until the skin is not tender to touch. 

How is mobility achieved? 

Mobility is achieved in a variety of ways including passive mobility, sustained stretching, dynamic mobility, or pressure manipulation which is usually hands on approach and may require a licensed professional. We will focus on the aspects of mobility that you can perform without seeking out a professional first. Then we will provide some education on what other types of manual therapy exist and how those can be achieved as well. A thorough and complete program has components of all of these in their weekly structure. Think of it all as part of your checklist to maintain health. 

The four components of individualized mobility are passive trigger point, dynamic trigger point, sustained stretching and lastly, dynamic mobility. Continue to ready to find out how each of these can be implanted into your return to health.

Passive Trigger Point Mobility 

The first part of any mobilization routine should include some type of passive mobility. Primarily using a piece of equipment that can affect larger muscle groups to release some tension. The goal of this type of mobility is to increase blood flow and warm the tissue up! Passive refers to your body just being along for the ride. The muscle length or tissue being worked on is not changing, even if you are moving. The important concept throughout the mobilization phase is to remember YOU ARE IN CONTROL of the amount of pressure and how aggressive you take it. REMEMBER MORE IS NOT ALWAYS BETTER! Start light and then increase the pressure you feel. Think of it as causing acute trauma to increase blood flow. TOO MUCH PRESSURE CAN DO MORE DAMAGE THAN GOOD. 

Treatment: For best results we recommend performing 2 x 30-60 seconds using one of the devices below to the major areas of the body. Smaller areas require less time and larger areas will require more time. Focus on the elbow muscular from LEARN, but feel free to explore the shoulder, back, and neck muscles as well.  Muscles we recommend exploring are the anterior forearm muscles, posterior forearm muscles, triceps, latissimus dorsi and pectoralis muscles. Remember the goal is to just warm up the tissue and increase blood flow. The specificity of breaking down the adhesions and trigger point come in the next phase during our dynamic trigger point mobility. 


Ways to perform passive trigger point mobility is by using equipment like a Theragun, foam roller, lacrosse ball, or even an elbow trigger point roller. Here is a list of some of our favorite products for this phase of mobility. As well as videos of how to utilize the equipment.

Total Time: 5-10 min

For more specific routines, regarding elbow routines see our lacrosse ball elbow routine here!

  • VIDEO OF USING THERAGUN DEVICE

  • VIDEO OF USING LACROSSE BALL ROUTINE

Dynamic Trigger Point Release

Once blood flow has been initiated in larger areas. It is always good to be more hyper focused on spots of adhesions and/or specific acupressure sites. For Golfer’s elbow, this is the medial forearm and for Tennis elbow this is the backside of the forearm. But utilize the areas that were more tender during Passive Mobility and then go back and utilize the Tac/Move Method.

In The Tac/Move Method, the focus is on improving the length of the tissue by attacking where this is a buildup of scar tissue and adhesions from overloading. This dynamic approach is about tacking down the tissue and elongating it through movement to create new extensibility and pliability of the tissue. Thus, through repetitions the adhesions can reduce and encourage more flexibility. Through consistency over time, the body can elongate and create a new baseline of range of motion for the next steps of stabilization.

Treatment: Using one of the below devices stated in passive trigger point mobility or listed here!. Find a sensitive spot that is sensitive and tender when you roll on it. Then once you find a spot, STOP on it. This is how we TAC IT! This should increase the pressure felt and be uncomfortable, almost to the point of making you go cross eyed! Next, comes the fun part. We call it the HURT SO GOOD! Once you have pinned down a tender spot, we need to move the extremity that elongates the tissue. This is basically the action of that muscle group. When this happens the pressure again should intensify and be a little uncomfortable initially. After we repeat the movement a few times the pressure should reduce and we should be able to go a little farther into the movement. The goal and focus of dynamic trigger point mobility is DO A LITTLE FIRST and THEN SLOWLY INCREASE. Allow the body to adapt to the stimulus.

Perform 2 x 10 reps at the tender muscle spots, and then move to a new spot and repeat. This can be the wrist, arm, back, neck, etc.

Total Time: 5-10 min

LACROSSE BALL ROUTINE DYNAMIC (VIDEO)

Sustained Stretching 

Sustained stretching is like what you commonly think of when it comes to stretching with subtle improvements. Recent research shows static stretching is not beneficial to changing tissue length for prolonged periods of time and if anything has been shown to increase the risk of injury if performed before a workout or game. We focus our mobility sequence instead as it has been able to reduce injuries in the athletes and special forces we train. The process of starting with passive and dynamic trigger point mobility allows for the tissue to warm up and improve the tissue flexibility. Once that has been achieved, we implement some sustained stretching to further elongate the tissue and activate the smaller stabilizing muscles so we can turn the tissue ON. This is known as the stretch and activation phase. This is the prep work that must happen before we can work on dynamic movements and stabilization. If we do not activate certain intrinsic muscles before we train, then we are continuously working in the same patterns that got us injured in the first place. While performing sustained stretching, think of the focus as spending time under tension to slowly create the change in our posture and tone. Rather than focusing on the reps, focus should be on breathing and the process of elongation occurring over time through activation. Remember consistency over time is what creates change. Below we have listed our 4 favorite sustained stretches to improve Upper Body Neural Tension and ways to improve resting posture. The great thing about these stretches is they will focus on improving the tendinopathy of your elbow, but also feel these throughout the body.  Wherever then tension is felt in these stretches keep doing them, as this tension may shift as you perform these more. The tighter spots will be exposed first, but again this is a whole-body approach. They can be performed in various settings, but the concept is the same. Focus on the cadence of your breathing and turning the ON through sustained stretching. 

Technique for best results:

Focus on a slow 5 second inhale through your nose, try to expand your upper chest as you breathe in. Perform a 5 second hold. Then as you begin to exhale out of your mouth, focus on breathing out through your rib cage. This creates a “scooping” sensation of your pelvis. The exhale phase should last about 5-7 seconds and you should begin to feel your core muscles activate. Hold this new position and repeat for 5 total breaths. Feel free to repeat these exercises 2 x 5 breaths.

Total Time: 5-10 minutes 

Exercise 1: Hanging Lat Stretch (Chin Up/ Pull Up Position) 

** Variation Squat Bar Sit Back *** 

Exercise 2: Quadruped Sit Back (Wrist Flexion/Wrist Extension

Exercise 3: Quadruped Rock Forward (Wrist Flexion)

Exercise 4: Quadruped Reach Through Plus Rotation

Dynamic Mobility 

The final component of mobility is called Dynamic Mobility. For us at Elbow Athlete, we refer to this as the total body mobility routine or a more specific type of dynamic warm up that activates your entire body. In this component of mobility, we are implementing more dynamic movements to improve the neural tension throughout the entire body. This is necessary to complete if you are about to workout, race, or have a game day, but also a great routine to perform in the mornings to get you ready for the day. 

Treatment: These routines should not take more than 5-15 minutes. If this is for a warm-up, it should be completed once. If you are using this as a cool down for total body stretching routine, then you can go through them 2-3 times. We encourage people to do a full body routine 3-5 times a week, to really make that long lasting change. 

Dynamic Warm-Up Workout Focus 

Dynamic Total Body Stretching Routine 

Dynamic Upper Body Stick Routine 

How often should mobilization occur? 

These mobilization techniques can be part of your daily routine to improve your status. However, it is important to remember you are causing acute trauma by creating micro tears in the tissue. Therefore, it is important to start 2-3 times a week and then progress as you see fit.

Remember the rule of thumb: If soreness persists following some passive movement or more than 24 hours you did too much! If this is you, reset, take the day off, and come back and try again tomorrow. Recovery and rehabilitation from an injury is a MARATHON, IT IS NOT A SPRINT!

What are other options I can do to improve my mobility?

Other ways you can improve your soft tissue and mobility are by seeking out licensed professions. In some cases, you may need a referral from your primary care physician.  This can be conducted by seeking a massage therapist, physical therapist, chiropractor or even an acupuncturist. They will use different acupressure techniques to alter and manipulate soft tissue to improve pain relief, elasticity, and improve tissue healing and elongation. They may utilize different techniques like manual therapy, Graston, cupping, acupuncture, and even dry needling, 

Here is some information on the following techniques: 

  • Massage Therapy 

  • Graston 

  • Cupping 

  • Acupuncture 

  • Dry Needling 

Ways to assess if ready to move to the next step? 

If your pain was acute and you have waited 2-3 weeks and are no longer in pain, then you can begin STEP 2: STABILIZE of the Rehabilitation process. 

If you have waited 4-6 weeks for a more chronic issue and are no longer in pain, then you are also ready to progress to the next step of rehabilitation. 

If you are still in daily pain, then go back and reread recovery and mobilization and continue to alter your approach. If you have any questions, feel free to reach out to us and we will provide you with some feedback. Or if you would like to set up a consultation with our licensed physical therapist, contact us as well.

Phase 2: Mobilize & Stabilize: Text
Phase 2: Mobilize & Stabilize: Video Player
Workout Lesson

STABILIZATION

What do we mean by stabilize? 

Once the tissue has been mobilized, the next step is to create some stabilization.  Now that the tendons, muscular junctions, and fascia have been manipulated; it is important to create a new baseline for movement patterns and ways of support. This process is called the stabilization. Stabilization is the process of creating stability in the body, so movements can be performed in a controlled way. The correct movement pattern over time with the proper amount of load will repair the injured tendons and muscles allowing for the body to return to normalcy. When we talk about movement patterns, we mean the way that different muscles in the body will contract or relax depending on what actions need to happen. 

What is the goal of this step? 

The goal of the stabilization phase is to educate or re-educate the body how to contract and relax certain muscle groups, while repairing the tissue that has been damaged or worn down. Over time, through a proper progression, you will be able to load the elbow with more and more force/tension without the return of pain. This load can be through weight, time, or repetitions. Depending on the long-term goal, all different types of loads may be necessary in your return to pain free activities. Stabilization exercises are used to focus on tendon health and longevity. 

How to achieve stabilization?

Since the common elbow injury is a result of an overloaded tendon, it is vital in the rehabilitation phase to improve tendon health and tolerance to activity. This can be accomplished in a multitude of ways, but the general concept needs to be the same. Start slow and slowly build into more. When it comes to movements and exercises, think small and then progress to larger or more dynamic. Often there is a motor control deficit. Essentially the firing of the muscle and time is off so we must isolate and start with fine motor movements, and then progress to multiple muscles at a time and larger dynamic movements. 

For this to be achieved, rehabilitation must start with isometric and eccentric exercises. Isometric exercises are those that do not change the muscle length while it is under tension, ie. Plank or wall sits. Eccentric exercises are those that isolate the tendon more than the muscle bulk so the focus is maintaining load while the negative movement is happening, ie. the lowering part of a pull up of bench press. This is different than what most strength exercises are composed of which is the shortening of the muscle as people lift the weight, commonly known as concentric exercises. 

Another component, other than time under tension, is focusing on the rep scheme of the exercises. In training and exercise there are four primary types of strengthening: endurance, hypertrophy, strength, and power. As we are focusing on stabilization, the first two parts of strength will help us achieve the stabilized force in the elbow tendons.

This is implementing an endurance, > 15 reps, rep scheme and a hypertrophy, 10 to 15, rep scheme. Initially it is imperative to start with the endurance exercises to increase the tolerance to activity and time under tension to maintain a quality of movement in our activities. Endurance will allow for us to focus on activities in our day to day and reduce the quality of pain we feel. Once the pain in our day to day has improved, we can then focus on improving the hypertrophy of the muscles and tendon. Hypertrophy means increasing the size and bulk of the muscle fibers. As we encourage hypertrophy, our body will be able to tolerate increased activity and load without pain. 

During the stabilization stage, it is important to improve tendon health by endurance and hypertrophy before trying to focus on true strength and power so that the elbow pain does not continue to come back. 

When can I begin with stabilization exercises? 

Stabilization exercises are best to introduce once you have completed the first two steps at the Elbow Athlete: Recovery and Pain Relief, as well as Mobilization. Before implementing stabilization exercises into your program, it is essential to be pain free and reduce the adhesions in the tissues through mobilization. This is because the primary focus at the Elbow Athlete, is to increase self-awareness in your body, so injuries do not become chronic and return time and time again. Altering the way you approach the rest of your life. By being pain free first and altering the tight tissue, you can have a better understanding of how to properly load your muscles and tendons based on the feedback you get after your exercises. Remember the rule of thumb stated in previous sections… Pain is the body communicating that you are doing too much. 

That is why we recommend starting the Stabilization phase, once you have been pain free and performed mobilization exercises for two weeks. 

How long is the stabilization phase? 

The stabilization phase should be a routine of exercises that follows the mobilization for about 4-12 weeks, or 1-3 cycles of our routine. At Elbow Athlete, we have a group of exercises that we have developed to improve your tendon health. This program will help regain and establish your tolerance to activity, while you can continue to be aware of how your body is progressing with the increase in load. 

Remember the rule of thumb: If soreness persists following some passive movement for more than 24 hours you did too much! If this is you, reset, take the day off, and come back and try again tomorrow. Recovery and rehabilitation from an injury is a MARATHON, IT IS NOT A SPRINT!

The stabilization routine can be a starting block for some of you, but it can also be a training program for many of you. The idea behind it, is that you are doing the little things, you are improving the smaller intrinsic and stabilizing muscles of the elbow, shoulder, back, and core. Feel free to progress to Phase 3: Strengthen and Sustain, as you see fit or when this routine becomes easy. But there is always a way to increase timing during the exercise or increase in weight to make these exercises for your needs. 

What other things can I focus on during the stabilization phase?

As you begin to increase your activity level, remember that progression takes time. It will take about 4-6 weeks for your elbow to start to feel stronger again during these exercises. While we monitor and increase our tolerance, this is a perfect opportunity to look at the bigger picture and see what postural things may have impacted your shoulder. Yes, that is right!! Your elbow pain could be a result of your rounded shoulder, your forward head posture, or even your anterior pelvic tilt in your hips. The body is interconnected. It is a machine that looks at how to complete a task in an efficient manner. Well sometimes efficient is not always effective. At Elbow Athlete, we see the body as a bigger picture, as a complete unit. 

That is why in this stabilization routine you will also see results that improve your sitting posture, the activation of your core, and even improvements in your overhead movement pattern. That is why we have developed a weekly checklist to make sure you are doing the little things to treat the whole body and not just the isolated injury.  The only time where it is valid to treat the isolated injury location, the elbow, is following a blunt trauma to that area. Other than that, improve your elbow as well as your body. This is Elbow Athlete Phase 2. 

Stabilization Programs here!

  • Phase 1 (6 weeks) 

  • Phase 2 (4 weeks) 

Exercise examples

Perform 2-3 sets of these exercises for 15-20 reps to begin to improve stabilization and endurance of tendon tolerance. Try to perform these exercises 1-2 times a week initially, and progress to 3-4 times a week.

  • Sand Bucket

  • DB Wrist Tendon Exercises 

    •  Golfers Elbow Focus: Eccentric Extension and Supination 

    • Tennis Elbow Focus: Eccentric Flexion and Pronation 

  • Tabletop or Tabletop Shoulder Taps 

  • 90 90 Banded Isometric Hold + Heel Taps 

  • Side Plank on Elbow 

Exercise progression and regression chart (for purchase) 

Stabilization program

  • Phase 1 (6 weeks)

  • Phase 2 (4 weeks)  

Ways to assess if ready to move onto next step:

Repeats programs with new weights, if more time is needed before progressing to strength phase. 

Phase 3: Strengthen and Sustain will focus on return to play movements and functional training, while educating on how to sustain recovery and health as the intensity increases. 

Continue to apply what you have learned from step 1 throughout step 2. For products to assist with these mobilize and stabilize clock here!

Phase 2: Mobilize & Stabilize: Welcome

EQUIPMENT

We used the equipment below 2-4x per week during our 4 week elbow rehab period. Try them out and let us know if they give you the same great results.

Phase 2: Mobilize & Stabilize: Text
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THERABAND FLEXBAR

Great exercise tool...

Must have. Watch the Youtube video and use this every 2-4x days.

Phase 2: Mobilize & Stabilize: About

THERABANDS

Inexpensive, versatile, and perfect for variety of rehab exercises

Extremely versatile and light resistance. The light resistance is key at this point to avoid overtraining and re-injuring or aggravating the elbow tendonitis.

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Phase 2: Mobilize & Stabilize: About
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LIGHTWEIGHT DUMBBELLS

Keep it light

We recommend 4-6lbs at this point in the recovery process for the exercises demonstrated in video above 2-3x per week.

Phase 2: Mobilize & Stabilize: About

RESISTANCE BANDS

Great for shoulder and back stability exercises

We found amazing elbow relief by strengthening our shoulder and back muscles with these bands using techniques in Youtube tutorials above.

We recommend buying a 5lb and 10lb band first, and then get heavier if 25 reps feels easy.

Resistance band.jpg
Phase 2: Mobilize & Stabilize: About
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ELBOW FLOSSING

Elastic compression technique

Some Elbow Athlete team members love this and feel tremendous elbow relief with it. We recommend only doing this 1x per week and watching the instructions that come with the purchase of this tool.

Phase 2: Mobilize & Stabilize: About

PULL UP BAR

A great tool to no only get strong but stretch as well

Fat bar grip to provide less stress on the elbow. Easy installation.

Pull Ups
Phase 2: Mobilize & Stabilize: About
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