By Hongying Chen
I. Description of Motion
Forearm pronation is a rotational movement where the hand and upper arm are turned inwards.1 (Fig. 1)
During pronation, the radius rotates around the ulna along an axis from the radial head through the fovea of the distal ulna.2 Pronation is used in almost all hitting and throwing wrist and hand actions, such as base ball pitching, football throwing, baseball and softball batting, racquet sports forehands and overheads, and in the golf swing.3
Fig 1. Pronation and supination
(image from http://groundupstrength.wdfiles.com/local--files/training%3Ahook-grip-versus-alternated-grip-for-deadlifts/forearm-supination-pronation.jpg)
Pronation occurs by the action of the pronator quadratus and pronator teres. The pronator teres is a more effective pronator when the elbow is extended. The normal range of forearm pronation is 75-85 degrees.2,4 Median nerve (C6,C7) and anterior interosseous nerve from median nerve (C8,T1) innervate pronator teres and pronator quadratus respectively.5
– Increasing forearm pronation6,7,8
Exercise 1 Active pronation-start with elbow tucked against your side, slowly turn forearm so palm of hand is face down.
Exercise 2 Start with a hand-shake position, and the other hand grasp the wrist and slowly turn to a face down
Exercise 3 Start with holding stick in arm to be stretched, elbow bent by side, turn palm down and apply pressure on stick to move further into the stretch.
Exercise 4 Passive pronation-start with elbow tucked against your side. Hold onto a light weight hammer. Slowly turn your hand so palm is face down.
For each exercise, patient should feel a stretch at the forearm. Each exercise needs hold for 30-40 seconds, repeat 4 times
III. Indications for Stretching
Any causes that lead to limited range of pronation, e.g. after long time immobilization such as radial, ulnar fracture or dislocation2; tight supinator etc.
Rest your forearm on a stable surface with your wrist hanging over the edge of the surface, make sure that your elbow is bent to 90 degrees and forearm is parallel to the ground. With light resistance (no more than 1 pound), rotate your hand so your palm is facing the ground, and then rotate your palm so your palm is facing the ceiling. Use a slow and controlled motion to perform the exercise.
Start with 2 sets of 10 repetitions and work your way up towards 3 sets of 15 repetitions.9
Sit and secure the ends of the band under your feet, creating a loop in the middle. With your elbows bent, stabilize your forearms on your thighs. Grasp the middle loop of the band with palm up. Turn your wrist downward, hold and slowly return.
TIP: Keep your elbow in one position during the exercise; don’t use your elbow to complete the exercise.10
Start with yellow color, gradually progress to red, green and black color band according to patients’ improvement.
Isometric forearm pronation. Resist downward rotation of hand with opposite hand. Hold 10 seconds. Relax. Repeat 10 to 15 times. Do 2 sessions per day.11 Gradually progress to 15 to 20 times, 4 sessions per day.12
V. Potential Clinical Syndromes or Etiologies
Pronator teres syndrome: A compression neuropathy of the median nerve at the elbow.
Anterior interosseous syndrome: a medical condition in which damge to the anterior interosseous nerve, a motor branch of the median nerve, causes pain in the forearm and a characteristic weakness of the pincer movement of the thumb and index finger.
1. http://en.wikipedia.org/wiki/Anatomical_terms_of_motion Accessed November 5, 2014.
2. LaStayo PC, Lee MJ. The forearm complex: anatomy, biomechanics and clinical considerations. J Hand Ther. 2006 ;19:137-144.
3. https://www.kinxlearning.com/supination_pronation Accessed November 5, 2014.
4. Richards RR. Chronic disorders of the forearm. J Bone Joint Surg Am. 1996;78:916-930.
5. Keith L. Moore, Arthur F. Dalley. Upper limb. Clinically oriented anatomy. In: 5th ed. Baltimore, MD; 2006:804-805.
6. http://www.orthoassociates.com/_pdfs/Forearm_ROM_exercises.pdf Accessed November 5, 2014.
7. http://www.cyberpt.com/cptvid55.asp Accessed November 6, 2014.
8. http://www.therapeuticexchange.com/body-region/elbow-wrist-hand/elbow-wrist-hand-lengthening/forearm-pronation-stretch/ Accessed November 6, 2014.
9. http://www.doctoramit.com/home-exercise-program/wrist-a-elbow/1104-forearm-pronationsupination.html Accessed November 6, 2014.
10. http://www.thera-bandacademy.com/tba-exercise-program/Thera-Band-Arm--Forearm-Exercises Accessed November 6, 2014.
11. http://www.gngpoems.com/pdfs/Wrist%20Exercises1.pdf Accessed November 6, 2014.
12. Linda S. Pescatello. General principles of exercise prescription. ACSM’s guidelines for exercise testing and prescription. In:9th ed. Baltimore, MD; 2014:185