Bent Out of Shape

Pain in the elbow is generally brought on by repetitive movements like throwing, swinging, or activities that involve gripping.  These tend to develop when someone is just using their arm for more than the tissues in the arm can handle at any given period of time.  An example is a baseball pitcher exceeding their pitch count on a weekly basis throughout the season or someone starting a new DIY project at home that involves several hours of hammering for a week or two.  Another common source of pain, especially with the elbow, is trauma, especially in the form of falls.

Falls are a more obvious source of pain and can lead to any number of issues, including fractures or sprains.  With regards to the elbow, a frequently used medical phrase is “falling on outstretched hand,” which is commonly abbreviated as FOOSH.  This is basically when someone falls onto their hand with their arm straightened out in front of them. Since the elbow is often “locked out” during a FOOSH, the muscles are unable to act as shock absorbers for the joints in the elbow.  This often leads to excessive force directly through the bones and/or ligaments of the elbow.

The biggest concern with a FOOSH is a fracture.  One of the best ways to rule out the possibility of a fracture is if you’re able to fully straighten your elbow immediately after the fall.  If you are unable to do so, there’s a 50% chance you have a fracture and you should seek out X ray imaging. If you can straighten your elbow but are still having pain after 7-10 days, you should consider seeking imaging to rule out a potential fracture. (1)

Everyone is at risk for falling, however adults with balance deficits or children are more at risk.  For children, elbow injuries are among the most common injuries because of the high rates of falls in younger children.  Certain activities also tend to lead to FOOSH injuries, such as bouldering, biking, volleyball, baseball/softball, and most contact sports.

Naturally it’s pretty hard to prevent a FOOSH injury as falling is typically not anticipated.  Improving one’s balance, strength, and mobility will go a long way, but that is going to take time, often months/years versus days/weeks.  If you aren’t working on your balance, strength, and mobility on a weekly basis, you definitely need to start, even if you’re healthy and otherwise active.

One skill that translates well into preventing FOOSH injuries, and injuries from falls in general, is learning how to roll.  If you watch videos of people doing parkour, you’ll notice that they roll quite often. The reason they roll is that it is efficient and much safer when dealing with high amounts of potential energy going through the body.  Rolling disperses the force over a larger area and over a longer period of time, which makes injury much less likely.

With regards to FOOSH injuries, rolling will disperse the force away from the elbow joint and into the muscles/tendons, which are much better at shock absorption.  Learning how to roll is a complex skill, however, and is potentially unsafe for most people. Anyone who has had a fractured bone, has osteopenia or osteoporosis, or anyone who generally has difficulty with balance needs to see their PCP or physical therapist before learning how to safely role.  Even if you don’t meet these criteria, it would be best that you consult with a physical therapist or coach/trainer who regularly teaches rolling – think karate/martial arts or gymnastics coaches.

Rolling can help prevent injury, but rolling does still constitute falling.  You’ll need a lot of padding, an open space, and likely guided instruction. If you don’t have those, find someone and somewhere that can supply those for you, like a physical therapist.

Got questions?  Feel limited in what you’re able to do?  The staff at Limitless Physical Therapy in Eugene, OR can show you how to discover your future without limits.

***The above information, including text, images, and all other materials, is provided for educational purposes only, and not as a replacement or supplement to professional medical advice.  Please contact a certified healthcare professional or your primary physician for any personal concerns.

1. Appelboam A, Reuben AD, Benger JR, et al. Elbow extension test to rule out elbow fracture: multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. BMJ. 2008;337:a2428. Published 2008 Dec 9. doi:10.1136/bmj.a2428

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