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Follow this log as I take John Cortiliet, Amateur strongman, through his PRs therapy program. John is currently recovering from a complete avulsion of the biceps long head at the elbow insertion.
John is currently dealing with some elbow flexion, shoulder extension, and internal rotation in extension issues. This stems from scar tissue build up, poor mobility, and stability. The following Is a documentation of his treatment on 6/22/2017. This information is used for educational purposes only and is not meant to treat, cure, or diagnose any medical issue. Please see a health professional for any medical problems.
I started Johns treatment with my initial assessment. This included a basic movement assessment (range of motions global and local), palpation for tissue health and tonicity, and then graded manual muscle testing. Every clinicians assessment process is different. As I have developed mine over 8 years, I wont go into it.
After completion of the assessment we went into some soft tissue mobilization including active release technique, graston and joint mobilizations of the shoulder (IR), Anterior to Posterior humeral glides, and humeral radial anterior posterior glides. Post soft tissue treatment and joint mobilizations we went into our performance portion. Here we worked on passive Shoulder extension with internal rotation(not shown), Self Administered Shoulder extension with KB (shown), Wrist distraction in extension using PAILS/RAILS, and lastly some controlled articular wrist rotations to capture the new range of motion.
Exercise 1: SA graded shoulder extension w KB. I chose this exercise mainly because it captures the ROM he needs based on his restrictions. We worked active internal and external rotation with the kb in wrist extension (also limited). He is able to grade the intensity of shoulder extension by increasing or decreasing his torso position. We will progress this to b/l over the course of his treatment.
Exercise 2: Wrist extension with distraction using progressive angular isometric loading and regressive angular isometric loading (PAILS/RAILS). Johns bicep reattachment and lack of previous physical therapy left him with severe wrist range of motion restrictions mainly in extension due to over active flexors. This mobilization is one of my top choices for increased wrist extension. The PAILS/RAILS addition adds an isometric load to help activate tissues and then progressively lengthen them by regressively closing the opposite joint angle. The mobilization still works without the PAILS/RAILS and might be to intense for beginning wrist extension for some.
We needed to take that new range of motion and control it. For this we used controlled articular rotations (CARS). It's essentially taking your end ranges of motion into rotations, depending on the joint, and aggressively owning the entire range. This will light up the small extensors and flexors of the wrist and forearm when done correctly.
That was the end of his session. He has a pre-determined frequency he needs to come in but I will stay on top of his progress via this log so you can hopefully take some things away.
This was after treatment and as you can see a much more improved front rack position for the right arm. Increasing position for overhead log clean and press.