From Research to Practice: Post-Elbow Dislocation

It’s always the weekend warriors that stay with you the longest. Tara was a 32-year-old graphic designer with a quiet love for bouldering. On weekdays she sketched logos. On weekends, she scaled walls.

Until one fall changed everything.

During a casual climb indoors, she fell awkwardly, landing on her outstretched right arm. The result? A posterior elbow dislocation.

She self-reduced the dislocation on site, was later immobilized, and referred to me two weeks later with the usual prescription: “gradual return to activity, restore range of motion, avoid instability.”

But when Tara walked into the clinic, she wasn’t just worried about stiffness. She was afraid she might never climb again.

Subjective assessment: More than just pain

Tara reported mild pain, mostly at end-range extension, but her real concern was the vulnerability she felt around the joint. There was hesitance in her voice when she talked about returning to climbing. She hadn’t even tried pulling a door open with that arm.

Goals? “I just want to climb again. But I don’t know if I trust my elbow.”

Red flags were ruled out, no neural symptoms, no vascular compromise. Her immobilization had been under three weeks, which was reassuring. She had no prior elbow issues. But psychosocial yellow flags stood out: low self-efficacy, fear of reinjury, uncertainty around return-to-sport.

Objective assessment: Stiffness, but also self-doubt

Tara lacked about 25 degrees of extension and had some flexion tightness. Pronation and supination were close to full but felt stiff. No signs of gross instability or apprehension in mid-range loading, but she did avoid terminal positions.

Strength was mildly reduced globally, especially in grip and elbow flexors/extensors. What stood out wasn’t the weakness itself, but how protective she was. She overcompensated with her left arm constantly.

Navigating treatment: Letting research lead the way

Two recent Physio Network Research Reviews heavily influenced my approach.

The first Review, by Dr Val Jones explored psychological barriers in climbers post-elbow dislocation. It found that 10% of climbers quit altogether, with reduced self-efficacy being a key predictor of poor functional return. Tara wasn’t just a dislocated elbow – she was a case study in fear-avoidance. Addressing that from day one mattered just as much as regaining extension.

The second Review was an eye-opener: it broke down a cadaveric study that showed that active overhead elbow motion simulated near-normal kinematics even with Medial-and-Lateral Collateral Ligament injuries. This challenged my initial apprehension. Traditionally, clinicians worry about overhead activity being risky post-dislocation. But this study supported early movement in overhead planes (if loaded sensibly!).

Rehab plan: Research in action

Early phase (week 2–4)

Our first goal: reassurance and active movement. We ditched prolonged passive stretches and opted for controlled AROM in multiple planes, including overhead positions using pulleys and wall slides.

I explained to Tara that overhead movements weren’t dangerous – they were natural and even beneficial, especially for joint congruency and confidence. This reframe changed her posture, literally.

We also initiated light isometrics for flexors and extensors and included grip work. But our biggest win in this phase? Setting a graded exposure hierarchy: opening a jar, pulling a door, lifting a backpack.

Mid-stage (week 4–8)

With ROM nearly restored by week 5, we shifted focus to strength and dynamic stability. Drawing from the second Research Review, I incorporated overhead resistance band work (think: diagonals, kettlebell carries) and dynamic weight-bearing in quadruped. We also introduced light plyometric drills: ball tosses, reactive catch, and tapping tasks. These weren’t just about strength- they were about teaching Tara to trust her elbow again.

And we kept circling back to the psychological load. Every week, we reflected: What felt hard? What felt easier? How did her elbow respond after each session? This subjective journaling gave Tara ownership of the process.

Late stage (Week 8–12+)

Climbing was our north star, so we tailored our return-to-sport tests accordingly. Single-arm hangs (with progressive loading), TRX rows, and wall-based reach tasks helped simulate bouldering demands.

We didn’t rush. In fact, we rehearsed failure: what would she do if she slipped or had to land suddenly? Planning for relapse gave her confidence.

Tara did her first partial wall climb at week 10 and full boulder routes (easy grade) at week 12. At week 14, she was back to her pre-injury climbing grade.

Wrapping up

It was never just an elbow. Elbow dislocations may seem mechanical, but recovery is deeply psychological. Tara’s case reminded me that no amount of mobility drills can substitute for rebuilding self-belief.

Research Reviews gave me the green light to load her overhead early, and helped me spot the invisible barrier: fear of reinjury. Clinicians often look for instability in joints. But sometimes, it’s instability in identity we need to watch for.

So next time a climber walks into your clinic post-dislocation, treat the elbow- yes. But treat the fear too.

Because sometimes, the best outcome isn’t just restoring flexion. It’s finding your way back to the wall, one hold at a time.

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