By Matthew Barrick
I. Description of Motion:
Elbow extension is the straightening of the arm at the elbow. It occurs in the open chain when the concave proximal end of the ulna rolls and slides posteriorly on the convex distal end of the humerus. In closed chain extension, the distal end of the convex humerus rolls and slides in opposite directions on the concave ulna. Full elbow extension is considered the closed packed position.
The primary muscle involved in producing elbow extension is the triceps brachii. It is innervated by the radial nerve (nerve roots C6, C7, C8).1 The secondary muscle involved in extension is the anconeus. It is also innervated by the radial nerve (nerve roots C7, C8, T1).1
Single Arm Wall Stretch:
With a sturdy wall to the side of the arm you are going to stretch, bring your arm up to a level of slightly lower than shoulder height. Put your palm on the wall with your fingers pointing directly behind you. Keeping your arm straight, slowly rotate your torso away from the wall until you feel a stretch in your upper arm or bicep area. Hold this stretch for 30 seconds and repeat 3 times.
Seated Bicep Stretch:
Begin sitting on the table with both knees bent in front of you and both feet flat. Put both hands on the table directly behind you, with the fingers facing away from your body. Keep the elbow pushed into extension. If you feel a stretch here, hold this position for 30 seconds and repeat 3 times. If you do not feel a stretch yet, move your butt towards your feet until you feel a stretch in your upper arm or bicep area. Hold for 30 seconds and repeat 3 times.
Banded Elbow Extension Stretch:
With a band anchored about a foot off of the floor, position yourself next to it on your hands and knees. Put the band around the arm (just above the elbow) that is furthest away from the anchor point. Your fingers should be pointing toward the anchor point. Move the hand away from the anchor point until there is reasonable tension in the band and you feel the band pull your elbow into extension. You may need to use your free hand to hold the involved hand in place. Let the band pull your arm into extension for 30 seconds and repeat 3 times. You may also benefit from slowly and gently mobilizing your elbow in and out of extension for the same time period.
You should feel a good stretch, but should not feel any pain during these mobilizations.
Increasing Elbow Extension Range of Motion
III. Indications for Stretching:
Mobilizing the elbow into extension is a good idea when one cannot bring the elbow into full extension. This could be due to tight flexor muscles such as the biceps brachii, brachialis, or the brachioradialis. Elbow flexion contractures, bicep tendonitis, elbow epicondylitis, elbow arthritis, and neural tension are common etiologies where mobilizing into extension would be beneficial.1
Tricep Kick Backs
Position yourself with the right knee and right hand supporting the body on the bench with your left foot planted on the ground. It is important to keep the spine in a neutral position. With the left hand, grab the dumbbell and position the upper arm parallel to the floor. Keeping the upper arm in a static position, kick the dumbbell back by extending the elbow into end range and straightening the arm. Squeeze at the top of the range for one second and then slowly lower the weight back into the starting position. Repeat this 10 times for 3 sets. To progress this exercise, increase the weight or number of repetitions.
Tricep Pull Downs with Band
With the band attached to an overhead anchor, grab the band with each hand in a neutral position. It is also important to keep the spine in a neutral position for this exercise. The starting position should be with the elbows bent at 90 degrees and the upper arms at your side. There should be a reasonable amount of tension in the band at this position. Pull the bands towards the floor, trying to bring your elbows into full extension without moving the rest of your body or upper arms. Squeeze at full extension for one second then slowly return to the starting position. Repeat this exercise 10 times for 3 sets. To progress this exercise, increase the tension of the band or increase the number of repetitions.
Overhead Tricep Extension
With the dumbbell in one hand, raise the arm above your head. The starting position is with the elbow bent, and the dumbbell behind your head. It is important to keep your spine in a neutral position during this exercise. If you need help holding the arm in the overhead position, you may use the uninvolved hand to apply a small pressure. The next step is to push the dumbbell towards the ceiling, trying to bring your elbow into full extension. Squeeze at the top of the movement for one second and then slowly bring the dumbbell back to the starting position. Repeat this for 3 sets of 10 repetitions. To progress this exercise, increase the weight or the amount of repetitions.
V. Potential Clinical Syndromes or Etiologies:
Strengthening the elbow extensors is a good idea for anyone with triceps brachii weakness or when one cannot actively bring the elbow into full extension. Strengthening the elbow extensors would be beneficial to people with elbow flexion contractures, extensor or flexor tendonitis, elbow epicondylitis, and elbow arthritis.1
VI. Additional Web Based Resources:
1.Moore KL, Dalley AF, Agur AMR. Chapter 6: upper limb In: Clinically Oriented Anatomy. 7th edition. Philadelphia, PA: Lippincott Williams & Wilkins; 2014:670-819.