Clinical Pearl: Biceps Transverse Release to Improve Forearm Supination
Her goals were to increased function of her left UE and hand, which is her non-dominant side. I had not seen an adult with CP and used OMPT for pure ROM/function purposes for the hand/arm solely, and it coincided nicely with this treatment I posted earlier.
She had ~ 20 degrees of supination and was lacking 35 degrees of elbow extension. I performed IASTM and functional release around the bony contours of her radius for 2-3 visits, which greatly increased her hand mobility and coordination. She also noticed significant decrease in her upper trap "tension" that she did not c/o about on the evaluation, but stated her DC noted during a monthly maintenance visit.
I was not making lasting improvements in her elbow extension and forearm supination, and I suspected it was more of a tone issue. On her last visit, I started working on her lateral upper arm, and found her biceps was very restricted, not parallel, but perpendicular to orientation of the muscle. I started some functional release with light lateral to medial pressure to improve transverse play (penpendicular to the fibers). The functional movement chosen was repeated elbow extension. This not only improved her elbow extension, but almost completely restored her supination from 20 degrees to about 75 degrees; this was after only 5-7 minutes of the treatment!
I had previously been performing IASTM along the anterior and posterior radius and functional release to her pronator teres, along with JM to the proximal and distal RU joints without much luck improving her supination. The mechanism behind this improvement is most likely a loss of biceps "folding" as it is a secondary supinator, with it being restricted, it was blocking elbow extension and forearm supination.