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Elbow Room

By Hunter Van Houten PT, DPT

Recently, the artist known as Bono of U2 commented on his recovery from his cycling accident, saying that “It is not clear that I will ever play guitar again”. What? Bono may not be able to shred with the Edge anymore? No! Bono was specifically talking about his injured elbow. Bono fractured his humerus distally near his elbow joint, requiring surgery and the use of several screws and metal plates to successfully repair the broken bone. Regaining the motions of flexion and extension (bending/straightening) at the elbow joint is of the utmost importance; especially if you are going to hold a guitar, strum chords, and finger the notes for “Desire”.

In the initial 4-6 weeks after surgery, Bono will most likely be immobilized at the elbow joint via a sling or cast. He cannot use his injured arm for any functional or daily activities. He would not be allowed to lift any amount of weight in order to decrease stress on the surgical hardware in his elbow. Usually x-rays would be taken to track the progress of the healing bone and he would begin to work with a physical therapist around weeks 4-6 to begin regaining the range of motion of his elbow joint.

Though Bono does appear superhuman at times, the beginning of his treatment will most likely cause him pain. The use of ice and electrical stimulation may help with pain management early on in treatment. Bono will certainly have restrictions in the soft tissues around his elbow from the lack of movement over 4-6 weeks. Specific muscles that would benefit from soft tissue mobilization include his biceps brachii, extensor and flexor tendon masses, tricep brachiii, brachioradialis, and brachialis musculature. Joint mobilizations to the humerus and both the radius and ulna (bones of the forearm) would be preformed for improved joint mechanics. Bono would have been able to perform grip strengthening at this stage if his hand was without injury.  However, Bono also sustained a fracture of one of his fingers, requiring a different course of treatment. Home exercises for Bono would focus on improving range of motion in all planes of the three joints of his elbow and self-stretching of his biceps, triceps, and forearm musculature.

After regaining the majority of range of motion of his elbow and forearm joints, he will begin to focus on regaining strength in his arm, forearm, and wrist musculature. Focusing on retraining and re-educating his entire upper extremity is extremely important, as weakness will develop in his scapular (shoulder blade), pectoralis major, lattissmus dorsi, and deltoid musculature. Strengthening can be performed with both “open chain” activities (think bicep curls or tricep kick back) and “closed chain” activities (think wall push up, hands and knees activities, or push up position).

As with any other patient at Lakeshore Sports Physical Therapy, if Bono were our patient, we would take his goals into mind when tailoring and designing his treatment. Our goal for Bono would be to improve the mobility and strength of his shoulder, elbow, wrist, and hand in order for him to straighten and bend his elbow completely to perform daily and functional activities first. Reaching overhead, reaching behind his back, holding objects with an outstretched arm, carrying, and lifting overhead would take precedence over finger-picked arpeggios and whammy bar abuse on the guitar. However, achieving the necessary range of motion in his elbow joint early on in treatment offers the best opportunity for Bono to hold a guitar in a seated position and return to jamming with the band, be it in a limited capacity. He may be limited with restrictions on how much he can lift or carry per his orthopedic surgeon initially, so while holding a guitar may not be an option, resting it on his lap could be a possibility.

Ultimately, a healthy left arm for Bono means U2 will be returning to bring epic rock to a stadium near you. Tune in for the last installment of all things Bono when we discuss the rehabilitation of his finger. Rock on!