Forearm stretch
This week we will see the two forearm stretches: i) volar or anterior forearm stretch for the flexor muscles, and ii) dorsal or posterior forearm stretch for the extensor muscles. The biceps and brachialis muscles insert on the anterior aspect of forearm, distal to the elbow joint. Another set of muscles which originates from the medial epicondyle of the humerus, traverses the front of the forearm and inserts at various points near the wrist and hand. These are the common flexors of the wrist/ hand/ fingers and the pronator teres. The triceps inserts on the olecranon process of the ulna (which is a forearm bone), just distal to the elbow joint. A set of muscles which originates from the lateral epicondyle of the humerus and inserts at various points near wrist and hand. These are the common extensors of the wrist/hand/fingers and the supinator. Any repetitive motion of the hand, wrist or turning of the forearm may lead to pain near the elbow usually due to inflammation of the common flexor tendons (golfers elbow) or the common extensor tendons (tennis elbow). Passive stretching and soft tissue mobilization One may very easily do self-mobilization for these muscle groups and follow up with gentle active stretches to release the muscles and perform eccentric muscle contractions to strengthen the muscles through the full released range of motion. * Sit upright in a chair with back rest and neutral spine with both feet supported on the floor. * Place a pillow on your lap and rest the right forearm on the pillow with palm facing upwards. This makes the volar or anterior forearm available for mobilization. * Bring the left thumb pad slightly distal to the inner/medial side of the right elbow, below the elbow crease. Begin by gently pressing the thumb into the soft tissue and move in small circles. Slide the thumb towards the wrist in small increments repeating the circles. You will distinctly detect tender points and can emphasize specific release by working locally over that area. Also you may slide the thumb side to side over the muscle bulk (proximal half of forearm) and hold mild pressure over detected tender points for 5-20 seconds(this should be to tolerance and not be painful). * * Now place the right forearm on the pillow across your lap with palm facing down. This makes the dorsal or posterior forearm available for mobilization. * * Bring the left thumb pad slightly distal to the outer /lateral side of the right elbow, below the elbow crease. Begin by gently pressing the thumb into the soft tissue and move in small circles. Slide the thumb towards the wrist in small increments repeating the circles. You will distinctly detect tender points and can emphasize specific release by working locally over that area. Similar to volar mobilization, the thumb may slide along the dorsal muscle bulk from side to side. Hold mild pressure for 5-20 seconds, to tolerance over detected tender points. Follow up the release obtained through soft tissue mobilizations with gentle stretches. i) Anterior forearm stretch: 1) In standing position, with elbow straight (extended), hold the right hand (distally around fingers) in your left hand. Passively extend the right wrist and fingers with the left hand to stretch the anterior forearm and hold position for 5-30 seconds and release. Repeat 2-3 times with 15-30 second rest break in between stretches. 2) Sit on the mat in vajrasana. Lean forward to bring both palms on the floor in front of the respective knees with fingers pointing forwards. Rotate the arms out by turning the hands on the mat till the wrist faces forward and the fingers back. In this position, the elbow crease is facing forward. Hold here for 5-30 seconds for anterior forearm stretch. When the tendon is not stretched in this position, deepen the stretch by gradually sliding the palms forwards , away from the knees while maintaining the heels of palm in contact with the floor as well as the kneel sitting with buttocks on the heels of feet. 3) Begin in vajrasana and progress to veerasana. Veerasana is a position in which you sit on the floor/mat with sit bones resting on the floor between the feet. This needs good mobility at the hip and knee joints as well as rotary movement of the leg (tibia and fibula) and should not be done in case of knee discomfort without guidance. Bring both hands in front and interlace the fingers. Slowly rotate forearm so the palms face forward, with fingers interlocked. Extend the elbows slowly, moving the palms away from body, and raise arms up overhead while stretching the entire arm upwards. At the end position, palms face upwards. Hold position for 5-30 seconds and slowly bring arms down, turning palms inwards and release the fingers. ii) Posterior forearm stretch: 1) In standing position, raise the arm up by flexing at the shoulder, palm facing the floor. With the left hand bend wrist downwards to stretch the posterior forearm and hold position for 5-30 seconds and release. Repeat 2-3 times with 15-30 second rest break in between stretches. Forearm stretch This week we will see the two forearm stretches: i) volar or anterior forearm stretch for the flexor muscles, and ii) dorsal or posterior forearm stretch for the extensor muscles. The biceps and brachialis muscles insert on the anterior aspect of forearm, distal to the elbow joint. Another set of muscles which originates from the medial epicondyle of the humerus, traverses the front of the forearm and inserts at various points near the wrist and hand. These are the common flexors of the wrist/ hand/ fingers and the pronator teres. The triceps inserts on the olecranon process of the ulna (which is a forearm bone), just distal to the elbow joint. A set of muscles which originates from the lateral epicondyle of the humerus and inserts at various points near wrist and hand. These are the common extensors of the wrist/hand/fingers and the supinator. Any repetitive motion of the hand, wrist or turning of the forearm may lead to pain near the elbow usually due to inflammation of the common flexor tendons (golfers elbow) or the common extensor tendons (tennis elbow). One may very easily do self-mobilization for these muscle groups and follow up with gentle active stretches to release the muscles and perform eccentric muscle contractions to strengthen the muscles through the full released range of motion. Sit upright in a chair with back rest and neutral spine with both feet supported on the floor. Place a pillow on your lap and rest the right forearm on the pillow with palm facing upwards. This makes the volar or anterior forearm available for mobilization. Bring the left thumb pad slightly distal to the inner/medial side of the right elbow, below the elbow crease. Begin by gently pressing the thumb into the soft tissue and move in small circles. Slide the thumb towards the wrist in small increments repeating the circles. You will distinctly detect tender points and can emphasize specific release by working locally over that area. Also you may slide the thumb side to side over the muscle bulk (proximal half of forearm) and hold mild pressure over detected tender points for 5-20 seconds(this should be to tolerance and not be painful). Now place the right forearm on the pillow across your lap with palm facing down. This makes the dorsal or posterior forearm available for mobilization. Bring the left thumb pad slightly distal to the outer /lateral side of the right elbow, below the elbow crease. Begin by gently pressing the thumb into the soft tissue and move in small circles. Slide the thumb towards the wrist in small increments repeating the circles. You will distinctly detect tender points and can emphasize specific release by working locally over that area. Similar to volar mobilization, the thumb may slide along the dorsal muscle bulk from side to side. Hold mild pressure for 5-20 seconds, to tolerance over detected tender points. Follow up the release obtained through soft tissue mobilizations with gentle stretches. i) Anterior forearm stretch: 1) In standing position, with elbow straight (extended), hold the right hand (distally around fingers) in your left hand. Passively extend the right wrist and fingers with the left hand to stretch the anterior forearm and hold position for 5-30 seconds and release. Repeat 2-3 times with 15-30 second rest break in between stretches. 2) Sit on the mat in vajrasana. Lean forward to bring both palms on the floor in front of the respective knees with fingers pointing forwards. Rotate the arms out by turning the hands on the mat till the wrist faces forward and the fingers back. In this position, the elbow crease is facing forward. Hold here for 5-30 seconds for anterior forearm stretch. When the tendon is not stretched in this position, deepen the stretch by gradually sliding the palms forwards , away from the knees while maintaining the heels of palm in contact with the floor as well as the kneel sitting with buttocks on the heels of feet. 3) Begin in vajrasana and progress to veerasana. Veerasana is a position in which you sit on the floor/mat with sit bones resting on the floor between the feet. This needs good mobility at the hip and knee joints as well as rotary movement of the leg (tibia and fibula) and should not be done in case of knee discomfort without guidance. Bring both hands in front and interlace the fingers. Slowly rotate forearm so the palms face forward, with fingers interlocked. Extend the elbows slowly, moving the palms away from body, and raise arms up overhead while stretching the entire arm upwards. At the end position, palms face upwards. Hold position for 5-30 seconds and slowly bring arms down, turning palms inwards and release the fingers. ii) Posterior forearm stretch: 1) In standing position, raise the arm up by flexing at the shoulder, palm facing the floor. With the left hand bend wrist downwards to stretch the posterior forearm and hold position for 5-30 seconds and release. Repeat 2-3 times with 15-30 second rest break in between stretches. (P.S: Anatomy pictures from Wikimedia Commons Version 8.25 from the Textbook OpenStax Anatomy and Physiology Published May 18, 2016)
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The biceps muscle is located in the front of the upper arm. It is the muscle that pops up when you flex your arm at the elbow- yeah, that one, that is used to display strength. Since the muscle fibers in this muscle are long and parallel, contracting them causes the biceps “bulge.” This muscle can be trained and hypertrophies significantly since the myofibrils which make up muscle cells enlarge due to increase in size and amount of the composing contractile proteins.
The biceps consists of the long head and the short head. The long head is intra-articular, that is it originates inside the capsule of the shoulder joint from the supra-glenoid tubercle of the scapula. The short head originates from the coracoid process of the scapula and is extra-articular (outside the shoulder joint). Both the heads meet to form a common tendon which inserts to the proximal radius. This muscle flexes the elbow and supinates the forearm and since it passes the shoulder joint, it contributes to flexion and abduction (when humerus is externally rotated) and horizontal adduction (when humerus is medially rotated) of shoulder joint. It is the main muscle enabling carrying of load in hands with the palm facing upwards (supinated forearm). Here are the various ways to stretch the biceps brachii. For ease of understanding, and consistency, description is for right sided stretch. Passive Stretch This is done by various manual techniques based on the examination of the shoulder joint and shoulder girdle. The trigger points maybe located in the muscle belly (front middle of upper arm), the upper back, the lateral shoulder joint, or down the front of upper arm towards the elbow joint. Myofascial release and transverse friction by a trained therapist to release proximal tendon of long head of biceps in the bicipital groove, improves the ROM. Beginning from a good upright seated posture with neutral spine and feet supported on the floor, the therapist may also passively stretch the biceps by externally rotating the shoulder so that the elbow crease is facing forward and extending the shoulder behind the back. Wrist extension further stretches the biceps via the distal insertion of this muscle. Active Stretch i) The easiest stretch in acute phase is done in supine with the arms resting by the side on the mat, palms facing up. Place a towel roll under the right upper arm and slowly extend the arm at the elbow joint so that the right wrist is extended and off the edge of the mat with gravity assisting elbow extension. Hold the position for 5-30 seconds as stretch is experienced in the front of upper arm. Repeat 2-3 times with rest breaks in between. ii) The stretch may be done standing with feet shoulder width apart and facing forward. The hands are clasped behind the back by interlocking fingers and turning the arm so that palms face down. Engage the transverse abdominals and hold spine neutral while slowly elevating the arms away from the back. Ensure the chest is open and shoulders pulled back with trunk upright. Hold when stretch is felt in the front of shoulder, upper arm for 5-30 seconds. Release and rest for the same time as the stretch is held. Repeat stretch 2-3 times. iii) Long sitting position is assumed with the hands palm down and resting on the mat behind the back, and arms externally rotated so that fingers are pointing away from the body. Shoulders should be neutral or slightly depressed (gently press the wrists into the floor/mat). Now start sliding the wrists back and away from the trunk. Hold when stretch is felt in the upper arm or front of shoulder along the biceps muscle/tendon. Mild downward pressure should be maintained at the wrist throughout. To release, slide hands towards the trunk. Repeat stretch 2-3 times with rest breaks in between. iv) Parsva Anjali Mudra or in other words Namaste or hands joined as in prayer behind the back is a great way to stretch the biceps. This is done with the Parsvottanasana, which is a forward bending posture, however may be done stand-alone in an upright seated posture for upper body benefits. The key here is to keep shoulders rolled back and to open the chest while bringing the hands behind the back in prayer position. It requires maximal shoulder internal rotation with extension and is not recommended in existing rotator cuff injuries without rehabilitation and guidance. Stretch with tools and equipment i) The biceps maybe released by using a tennis ball along the front of upper arm along the length of the biceps at the wall. Since these are parallel muscle fibers, they are best stretched by lengthwise movements along the muscle fibers. When a tight trigger point is detected, small, circling, motion of the ball over the specific area may help release the local tightness. The next muscle we will consider is the triceps. This muscle forms the bulk of the posterior upper arm and is an extensor muscle for the elbow joint and one of the shoulder joint extensors.
As the name suggests, this muscle originates with 3 heads- the long head (which starts from the infra- glenoid tubercle of the scapula) and the medial and lateral heads which originates from the posterior surface of the humerus. The three heads form a muscle belly and insert via a common tendon into the olecranon process of the ulna and the elbow joint capsule. The triceps muscle is an elbow joint extensor. The long head of triceps contributes to shoulder extension and adduction. The triceps is one muscle of the arm which is strengthened and hypertrophies when workouts target triceps such as push-ups, press downs, bench presses, bench dips, overhead extensions. However, it is important to maintain healthy length and flexibility of the muscle, and stretches for triceps should be incorporated in the exercise program. Passive stretch This may be done via manual techniques and release of trigger points along the triceps by a physical therapist. Passive manual stretching may be done in supine position by flexing the elbow joint completely with palm facing up. Once the forearm muscle bulk approximates the upper arm muscle bulk, stabilize the scapula downward and into the rib cage with one hand, while the other flexes the upper arm at shoulder with the elbow in flexed position as far as possible and hold for 5-30 seconds. It is important to keep the spine neutral and not extend the thoracic spine. Release by lowering upper arm and extending elbow to neutral. Repeat stretch 2-3 times. Active Static Stretch i) Initially this stretch is best done in supine as it eliminates need to stabilize the trunk and scapula as it is well supported on the mat. Similar to above passive technique, first begin by actively flexing the elbow with palm facing up. Next, flex the shoulder as far as possible while maintaining neutral thoracic spine. Stop the shoulder flexion as soon as you notice tilting of shoulder blade and mid to low thoracic spine arches upwards into extension. Hold the position and stabilize spine by activating transverse abdominals. See if you are able to flex the shoulder overhead a little further and hold for 5-30 seconds. With good flexibility, you should be able to slide the palm between the shoulder blades. Release and repeat 2-3 times. ii) With good scapula-thoracic and lumbar spine stabilization, this stretch may be done in seated or standing position. Sit upright in a chair without back support or stand with feet hip width apart and maintain neutral spine. First stabilize the spine through trunk corset activation (transverse abdominals, multifidi, and obliques) by 2-3 breathing cycles. Trunk and spine should be steady with no movement with inhalation/exhalation and notice movement of rib cage and abdomen only. Next, flex the right arm at elbow, and cup the shoulder with the hand. The upper arm is still in line with the trunk. Next, flex and elevate the arm at shoulder joint to overhead position and slide hand between shoulder blades, if possible. Stretch may be deepened by bringing the left hand to the right elbow and gently pulling right arm back and to left. Hold position for 5-30 seconds. Release and repeat 2-3 times. Active Dynamic Stretch: i) Gomukhasana: This is an advanced yoga pose and must be done with proper guidance. The starting position is Vajrasana. Initially come to sitting on the right side, with both feet pointing left. Keeping the legs bent at the knees, rotate the left hip outwards as you stack the left knee on top of the right so that you are now sitting on both the sit bones. The feet are resting on the floor. Bring the heels as close to the hips as possible. Trunk is stable in upright position. The left arm is rotated inward at the shoulder while bending the elbow and the back of the hand is placed between the shoulder blades from below. The right arm is rotated outwards at the shoulder while bending the elbow and the arm is lifted overhead placing the palm between the shoulder blades from above. Once the two hands are behind the back, the triceps stretch on the right side may be deepened by interlocking the fingers of both hands in hook grip behind the back and gently pulling downwards with the left hand. Trunk needs to be stabilized further as the pose is deepened, to prevent the thoracic spine from arching. Stretching with tools i) One may use a tennis ball for releasing the triceps brachii by placing it between the back of upper arm and wall or on a table and release trigger points by simply holding the pressure for few seconds and moving to a different point along the muscle. It may help to first palpate the muscle belly with the finger pads prior to employing the tennis ball to determine the areas needing release. Rolling the ball gently between the back of the upper arm and wall/table, is another way to identify trigger points and release by focusing rolling (small circles or up and down) over tender points. (P.S: Anatomy picture from Wikimedia commons) Page URL: https://commons.wikimedia.org/…/File%3A1120_Muscles_that_Mo… By CFCF (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons |
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AuthorAmi Gandhi is a licensed physical therapist in the state of California. She is the owner of StableMovement Physical Therapy, a small boutique practice in San Jose that offers patient centered, one-on-one, hands-on physical therapy. Archives
March 2018
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