A Multimodal Chiropractic Approach to the Treatment and Management of Medial Elbow Injuries in Elite Javelin Throwers: A Case Series.

Background: Sports chiropractors are increasingly being consulted in the assessment, treatment and rehabilitation of athletes. The purpose of this case series was to describe a multimodal chiropractic treatment approach to address medial elbow injuries in amateur/elite javelin throwers.

Case descriptions: Five javelin throwers (3 Males & 2 Females) aged 15-24 years presented to two chiropractic clinics with signs/symptoms including pain, instability, postural dysfunction, and dysfunctional range of motion of the glenohumeral and elbow joints. Diagnoses included tear/rupture of the ulnar collateral ligament, medial epicondylitis, valgus extension overload syndrome (posteromedial impingement), reactive bone formation of the olecranon fossa, avulsion fracture of the medial epicondyle/sublime tubercle, distal triceps tendinopathy, scapular dyskinesis, glenohumeral internal rotation deficit, anterior glenohumeral capsulitis, instability of the glenohumeral joint, rotator cuff pathology, and subacromial impingement.

Interventions and outcomes: A multimodal treatment approach was utilized for all five athletes which included; soft tissue therapy (active release techniques [ART]), ischemic pressure, cross-friction massage, dry needling, low level laser therapy (LLLT)/Photobiomodulation (PBM), spinal and peripheral joint manipulation/mobilization and a rehabilitation program that included proprioceptive and postural retraining, strength and Javelin specific technical retraining. Numeric rating scale (NRS), Conway scale, activities of daily living (ADL's) and sport specific functions were used to assess change. All javelin throwers returned to above pre-injury performance 12-26 weeks post injury presentation. At six and 12 month follow up all patients continued to be symptom free, performing normal ADL's and sport specific functions.

Conclusions: This case series presents results which demonstrate positive outcomes after using a multimodal chiropractic treatment and management approach in five javelin throwers with medial elbow injuries.

Level of evidence: 5 (case series).