\u00a9 2022 wikiHow, Inc. All rights reserved. 1. I have been seeing Doctor Jake for a few years and I highly recommend him!! At LifeClinic, our approach to treatment is centered on helping you maintain, restore, and optimize your bodys overall function. By treating your aching shoulder or elbow, youll be able to move freely and perform activities like normal again. A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose elbow impingement. Repeat this stretch on your left elbow 2 to 3 times. Step 2. (2013). DOI: Dy CJ, et al. 13. It can occur both at the medial and lateral epicondyle with medial epicondylitis occurring less frequently than lateral epicondylitis. How-to Elbow Back Stretch Drawing one arm across the chest with the elbow fully extended, the exerciser will pull their other arm inwards as it bends over the front of this opposite extended arm. Trigger points around the chest and shoulder blade refer pain to the medial forearm and hand. Side-Lying External Rotation YouTube Steps Lie down on the unaffected side. Ulnar nerve entrapment at the elbow sometimes causes an aching pain on the inside of your elbow. Its an effective technique for sciatic nerve pain and nerve pain in the arms. Tingling in the hands and feet can be caused by a number of factors or conditions. It is not medical advice. Repeat exercise times, times per day. . Jacob failed PT multiple times, inspiring him to become a physical therapist and improve the profession. Healthcare professionals use two tests to assess for ulnar nerve pain. Let the weight of the dumbbell help rotate your arm outward, turning your palm up. Were committed to providing the world with free how-to resources, and even $1 helps us in our mission. But in some cases, you can experience elbow pain because of a sprain, stress fracture, or throwing injury. Bending your wrist using this method is referred to as the wrist flexor stretch. Shoulder impingement, or swimmers shoulder, is a musculoskeletal condition that causes shoulder pain. Understanding the source of pain and developing an effective treatment plan is rarely simple. Physiotherapy for elbow impingement Physiotherapy is important to hasten the healing process and ensure an optimal outcome in all patients with this condition, regardless of whether their condition is managed conservatively or surgically. With repeated extension (straightening of the elbow), the olecranon tip is repeatedly jammed into the fossa at the back of the elbow, which results in inflammation of the joint lining (synovium), proceeding to injury to the cartilage and bone. Dont worry if you cant reach your hand down your back. Repeated neck motions have zero effect in cases of ulnar nerve entrapment at the cubital tunnel (elbow) or Guyons canal (wrist). Ulnar nerve pain causes numbness and tingling in the arm and hand. Absolutely the best Chiro service available in Las Vegas or anywhere. Clinical Representation. I heard all the stretching myths. Bend your wrist slowly towards you, and then slowly release. This is often done by a hand surgeon in an outpatient setting. You will also want to hold the stretch on your left arm for 15 to 30 seconds. Wrist lift (palm down) Bend your elbow at a right angle. Too much pressure on the elbow or prolonged elbow bending inflames the ulnar nerve. Shoulder Impingement Phase 2. Clinical evaluation included range of motion and Disabilities of the Arm, Shoulder, and Hand score. Range-of-Motion Exercises. Regime in the initial phase of injury. wikiHow is where trusted research and expert knowledge come together. When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. Select a dumbbell weight that is comfortable for you. Squeeze the soft object over and over again for 10 to 15 minutes. Ulnar nerve entrapment sometimes goes by other names, depending on where the entrapment occurs: Cubital tunnel syndrome is one of the most common types of ulnar nerve entrapment. As the cyst grows, it can put increasing pressure on the nerve. Reach down as far as you can while keeping your elbow pointed towards the ceiling. Recent research suggests that an open procedure without nerve transposition (in situ) produces the best outcomes and lowest complication risk (6). Bring the unaffected arm and place on the inside of the forearm at wrist level. Its commonly compressed at the cubital tunnel, where the ulnar nerve runs behind the medial epicondylethe bony bump on the inside of the elbow. Overuse is the most common cause of shoulder impingement. 2. (2013). Treatment UMedication - pain relief: You may wish to try Outcomes of rigid night splinting and activity modification in the treatment of cubital tunnel syndrome. This may occur during sports, such as overhead racket sports, throwing, swimming and boxing. However, it might take a full year for you to recover from severe shoulder impingement. After surgery, however, it generally takes around 08-12 weeks with elbow physiotherapy to go back to work / regular living In the early stages, ulnar nerve irritation is predictable and worsens with aggravating activitieslike frequent elbow bending and wrist compression. Then, the space between the rotator cuff and acromion constricts, creating more pressure. Physical Therapy Exercises: Phase II. Pain may also travel down to the elbow and forearm. Step 3 At the end of your passive range of motion, hold stretch for 6 seconds. Repeat 10-15 times into a gentle stretch. regime involves resting from aggravating activities (this may include the use of a brace or protective tape), regular icing, the use of a compression bandage and keeping the arm elevated. Keeping your elbow bent for prolonged periods of time can also aggravate the ulnar nerve. Repeat the exercise slowly 5 times. Execution: Return to erect position while performing scapular retraction with elbow flexion. Lower Trapezius Exercises Due to the commonality of anterior hip impingement, and the location of pain in the front of the hip being a common symptom associated with it, a hip flexor or groin stretch can be very beneficial for pain relief. Hold for the position for 5 seconds and then relax. Work with your doctor to figure out the most effective treatment plan for you. But if the pain persists, getting proper care is imperative. The Strange Study Results, Sleep for Weight Loss: The Emerging Connection, Problems with Stretching (and 3 Superior Alternatives). As the condition progresses (particularly in the throwing athlete), pain may increase during activity and can eventually prevent activity performance. Entrapment at the wrist usually only causes symptoms in your hand, including: It can also cause muscle weakness or wasting in advanced cases. In some cases, theres no clear cause. Aleksenko D, et al. This exercise allows you to take your shoulder blades through a full range of motion while stabilizing them against resistance. The main symptoms of triceps tendonitis are sensitivity and pain lengthwise of the tendon or sensitivity and localized pain in the insertion into the olecranon. This condition is closely related to shoulder bursitis and rotator cuff tendinitis. Impingement occurs when soft tissues are painfully trapped and compressed under the boney parts of the shoulder (specifically the acromion and the coracoacromial ligament), often occurring during overhead shoulder movements. Shoulder Impingement Phase 1. Shoulder Impingement & Elbow Pain Treatment. Other elbow pain treatment methods include over-the-counter pain relievers, physical therapy, and steroid injections. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Scapular Dyskinesis Exercises. Place a rolled up towel under your armpit of the sore arm. 7 Knee Pain Myths You Have Definitely Heard, Overcome Your Fear Of Movement (Or Anything Else), How to Create Your Perfect Workout in 5 Simple Steps, Household Chores for Exercise? I highly recommend you meet the staff and get your next treatment there. This often occurs at night. If you look at the knee, the knees end up being at mercy to the hip. You grasp a band between the hands and keep it slightly. Use your other hand to extend your fingers and wrist back. Severe symptoms include progressive muscle weakness, hand muscle atrophy, permanent sensation changes, and constant pain. You can also change up this stretch by holding out your arm in front of you while looking at the back of your hand, like you just got a manicure. Sleeping with bent arms and leaning on flexed elbows also aggravate cubital tunnel symptoms. Im 44 years old and have not been this pain free in decades. In fact, it can aggravate the ulnar nerve when its done too early in the healing process. Follow this step-by-step guide to create your perfect workout from start to finish. Instead, opt for a headset or use the speakerphone to mitigate stress on the elbow. Use it to try out great new products and services nationwide without paying full pricewine, food delivery, clothing and more. Keep your elbows in contact with the side of your body. I was not a believer in chiropractic until going to Dr Alverez. For office workers, desk ergonomics can make or break the recovery process. DOI: Giladi AM, et al. Bend your elbow to 90 degrees of the sore arm. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Download 7 Secrets to a Fast Recovery and join our free weekly newsletter, There are a host of knee pain myths. Bend your elbows 90 degrees, and tuck your arms against your sides. Your email address will not be published. Musculoskeletal conditions like arthritis, tendinitis, tennis elbow, and bursitis can also lead to an aching elbow. DOI: Keener JD (2015). Your doctor may order diagnostic studies such as EMG and nerve conduction studies to assess the extent of nerve damage. Extreme symptoms include constant numbness and visible hand muscle loss (atrophy) on the pinky side. It occurs when your rotator cuff catches or rubs against the acromion, or the topmost part of your shoulder. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms. Impingement syndrome is a common condition affecting the shoulder and is often seen in aging adults. Ball squeezes work hand and wrist muscles that become weak with ulnar nerve injury. Trigger points in these 3 muscles cause referred pain on the inside of the forearm: the latissimus dorsi, the pectoralis major, and the pectoralis minor. Occasionally, bony spurs may develop within the elbow joint contributing to the problem. Most ulnar nerve compression at the wrist is usually caused by a growth at the wrist that must be removed. However, numbness and tingling are not golfers elbow symptoms. The content of this site is intended for informational and educational purposes only. Repeat 10 times. I am the current benchpress world champion for the lightweights and this clinic has literally saved my career! When the elbow is straightened fully (figure 2), soft tissue is compressed at the back of the joint. I feel so much better after every visit! Once youve completed this stretch on both arms with your palm facing down, repeat the steps with your palm facing up. Eat Better Because the extensor mechanism must heal back to the ulna, active elbow extension, such as using the arm to assist . Ulnar nerve entrapment can be painful and get in the way of everyday activities. Pain may also increase on firmly touching the affected area. Patients with this condition typically experience pain at the back of the elbow that increases with forced hyperextension of the elbow. The first exercise will be for shoulder internal rotation. Repeat the exact same stretch with your left arm. Outcomes of these studies guide treatment decision-making. Non-surgical interventions alleviate many cases of mild to moderate pain. Now put your hands on the wall as if you are going to do a push-up. This assessment will help them develop a multi-modal treatment approach that is individualised to the specific problems and contributing factors found in the assessment. By using our site, you agree to our. It is a condition caused by repetitive forced extensions and overuse of the elbow. Treatment may comprise: exercises to improve flexibility and strength, a graduated return to activity program. Last Updated: September 23, 2021 Then, slacken the nerve at both locations (below). Shoulder Extension with Resistance Band Move your arm up while keeping your elbow against your body. After that, youll begin physical therapy exercises to restore your range of motion. Internal impingement is a cause of shoulder pain in overhead athletes caused by repetitive impingement between the undersurface of the rotator cuff and the posterosuperior glenoid. encouraged to perform daily stretching exercises to preserve motion. A vital aspect of treatment is that the patient rests sufficiently from any activity that increases their pain (a brace or protective taping may be required). Bend your elbow to 90 degrees so your thumb is touching the opposite shoulder. Elbow Bend to Straighten For some perspective, bending your elbow puts about 20 times more pressure on the area than keeping it at rest. The pain can be so excruciating that you dont even want. (2010). He completed an orthopedics residency program and he is a certified Orthopedic Clinical Specialist (OCS). Resting from aggravating activities ensures the body can begin the healing process in the absence of further tissue damage. As you may know, Im not a fan of stretching just for the sake of stretching. I never feel rushed and always look forward to my maintenance appointments. Passive Forearm Rotations. Many conditions can cause pain, numbness, and tingling on the inside of your elbow. The elbow joint primarily comprises of the articulation of two bones, the humerus (upper arm bone) and the ulna (inner forearm bone - figure 1). Compression at the elbow is called cubital tunnel syndrome. These splints may be removed for exercise and hygiene. Several things can increase your risk of ulnar nerve entrapment in either your elbow or wrist. Repeat 20 times. + Jacob's academic background includes a Bachelor of Science in Exercise Science and Doctor of Physical Therapy. You will learn exercises and stretches to help your shoulder and shoulder blade move . Elbow Impingement Exercises 19,356 views Apr 5, 2017 332 Dislike Share Performance Place Sports Care & Chiropractic 85.8K subscribers This is one exercise for DECREASING ELBOW IMPINGEMENT. Exercise has a mind-boggling placebo effect. You doctor can give you a better idea of what to expect from the procedure. Sign up for my free weekly newsletter and get instant access to 7 Secrets to a Fast Recovery! Dramatic differences between arms indicate adverse neural tension (an irritated or tight nerve). It often causes pinched muscles, tendons, or soft tissues in your shoulder. Shoulder impingement, or swimmer's shoulder, is a musculoskeletal condition that causes shoulder pain. The R.I.C.E. Like this: It can even prevent elbow flexion contractures, where the elbow won't straighten. Elbow impingement typically occurs due to activities that excessively or repetitively straighten the elbow (hyperextension Figure 2) often in combination with a sideways (valgus) force. Immediate, appropriate treatment in patients with elbow impingement is essential to ensure a speedy recovery. As a result, the new bone growth impinges joint movement, eventually leading to deformity. Before surgery, Dr McLean will guide you through the process and address any concerns you have. Using ice on the affected area before you exercise may be helpful. In a few visits he resolved my neck pain that several others could not address and we have moved on to other issues. Expert Interview. Wrist Flexor Stretch Bending your elbow stretches your ulnar nerve. Injuries to your elbow or lower arm, such as tennis elbow, or regular sports activities, such as martial arts, may require regular elbow stretches. Surgery is the best treatment for severe symptoms. an impingement. Our shoulder and elbow pain treatments will restore, maintain, and optimize your bodys function. But other things can also cause it. You can also try out heat therapy. Posterior Capsule Tightness. Curl your wrist and fingers toward your body. Our website services, content, and products are for informational purposes only. Then, the space between the rotator cuff and acromion constricts, creating more pressure. Neuropathy in the feet can make walking and being active challenging. This article was co-authored by Jonathan Frank, MD. (2). His passions include golf, powerlifting, and empowering clients to overcome pain. For example, you can do this stretch while watching TV, talking on the phone, or reading a book. The cubital tunnel is located in the elbow and encases the ulnar nerve. Bend your elbows to 90 degrees. Pinch the blades of the shoulder together. Bend your left elbow and raise it above your head. Rotate . Avid golfer. procedure for their elbow: rest, ice, compression, and elevation. Move your shoulders back while lifted so that you squeeze your shoulder blade muscles together. The cause of elbow impingement varies depending on age. The goal of surgery is to relieve ulnar nerve compression at the inner aspect of the elbow. Patients with elbow impingement should follow the. Hold a soft object, like a rubber ball or stress ball, in one hand. Keeping your elbow bent, use your "good" hand to gently rotate your forearm further. Similarly, nerve sliders smooth the nerves path through the arm. Most myths reflect the belief that knees are fragile and need to be coddled. For patients with mild symptoms, immobilizing the elbow at night can promote healing and prevent nerve irritation during sleep. I love that we can do PT on the fitness floor. You wont need your son to open jars for you anymore! You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. The exercises overleaf may stop the tendons and bursa being pinched and the pain may resolve. If gentle exercises and nonsurgical treatments arent helping, your doctor might recommend considering surgery. We use cookies to make wikiHow great. Once you've squeezed the soft object in one hand, switch and squeeze the soft object in your other hand. There are a number of different reasons why you may need to stretch your elbow. Unlock expert answers by supporting wikiHow, https://www.versusarthritis.org/about-arthritis/conditions/elbow-pain/#exercises-for-elbow-pain, https://www.healthlinkbc.ca/health-topics/zm2512, https://www.sportsinjuryclinic.net/rehabilitation-exercises/stretching-exercises/elbow-arm-stretching, https://medlineplus.gov/ency/imagepages/19488.htm, https://www.aafp.org/afp/2007/0915/p849.html. Raise the affected arm and rest your palm on your forehead. Exercises for ulnar nerve entrapment at the wrist Exercise 1 Stand straight with your arms. The ulnar nerve runs from the neck, down the inside of the arm, to the pinky side of the wrist. Dr. Frank's practice focuses on minimally invasive, arthroscopic surgery of the knee, shoulder, hip, and elbow. Research source. Ulnar tunnel syndrome is less common. Physical therapy can be part of your shoulder impingement treatment plan, too. Constantini L. (n.d.). Shah CM et al. Exhale and lower your shoulders. Cause Rotator cuff pain is common in both young athletes and middle-aged people. Ever had a day like this? Ulnar nerve entrapment causes pain, numbness, and tingling in the arm and hand. This article presents the best shoes for neuropathy to help you choose. 3. Regain your range of motion with natural, effective remedies for your impinged shoulder or achy elbow. See our disclaimer for more information. Hold your hand there for a few seconds and then bring your hand down slowly. This can strengthen your shoulder blades up fosho. The following interventions are the best nonsurgical treatments to decrease ulnar nerve pain and promote recovery. You can learn more about how we ensure our content is accurate and current by reading our. Bend the elbows 90 degrees. This may occur during sports, such as overhead racket sports, throwing, swimming and boxing. Correction of throwing technique is particularly important in those cases where faulty throwing biomechanics have contributed to the development of the condition. Guidelines recommend bracing the elbow at 45 of flexion for up to 3 months (3) Multiple studies found the Hely & Weber elbow brace was effective. DOI: Osma-Rueda JL, et al. First, stretch the ulnar nerve at the hand while slackening at the neck (above). Ive used many chiropractors over the years but none are as skilled as Dr Evan. For a simple stretch to improve your extension, simply put your upper arm flat on a table and let gravity pull your elbow straight. Figure 1 - Anatomy of Elbow (Lateral) Injury Mechanism: Snapping/rapid full extension of elbow repetitively - Triceps snaps, press-ups, chest press, dips, throwing. We provide relief with the following treatments. The dental floss slides side to side, clearing debris from its path. The nerve slides side to side but doesnt stretch or lengthen. Repeat 2-3 times. Sleep for weight loss sounds too good to be true. Using your "good" hand, grasp the wrist of your of your. I am extremely grateful to Dr Evan and its so convenient to have it in LTF. This makes it more vulnerable to compression. Feel free to be doing some other activity while youre squeezing the soft object in your hand. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of a poor outcome. Tweak your exercise routine and try some lower-body moves instead. Elbow pain originates from the spine 44% of the time! Hold 20-30 seconds for up to 3 times. Alexander A. Movements that contribute to ulnar nerve entrapment at the elbow include: The most frequent cause of entrapment at the wrist is a benign cyst on your wrist joint. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. using your phone on speakerphone or with headphones, avoiding resting your elbow on the door while driving or riding in a car. Many cases are caused by doing repetitive movements with your arm or hand. C8 radiculopathy and cubital tunnel syndrome present with overlapping symptomsnumbness and tingling in the pinky, pain along the inside of the forearm, and hand weakness. Ulnar nerve irritation is common in baseball pitchers and long-distance cyclistsnerve irritation at the wrist is called handlebar palsy. A lot of times when there are: All of that ends up harming the knees. Specific exercises are listed below: Nerve entrapment syndromes of the elbow, forearm, and wrist. . Our blog covers everything related to pain management, arthritis, fibromyalgia, migraines, and other musculoskeletal conditions. STRENGTH Shoulder, External Rotation, Isometric 1. That's one rep. 2. Are you currently a Life Time Fitness Member? In this section, we are going to work on the lower traps and the serratus anterior. For entrapment at the wrist, try using a wrist splint to keep your wrist in a neutral position while still allowing for use of your fingers. Postoperative Lysis of Adhesions and Manipulation. They control everything from your facial expression to, Alcohol-related neurologic disease refers to a range of conditions that affect the nerves and nervous system. Stay on the right path toward recovery. Make sure your hands are placed a little wider than the width of your shoulders, your hands are turned out slightly and your elbows are below your shoulders. Nerve flossing refers to a type of gentle exercise that can help soothe your compressed nerves and regain range of motion. A skilled clinician will determine the exact cause of your symptoms and work with you to develop a customized treatment plan. The ulnar . Step 2 With the help of your other arm, rotate the upper arm (external rotation) as far back as possible. The treatment recommended by your doctor will depend on your symptoms and the underlying cause. Shoulder Range of Motion. If your stretching due to an injury, continue these stretches even when your injury heals. Conservative interventions dont always solve cubital tunnel syndrome. The ulnar nerve travels from your shoulder to your pinky finger. Patients sometimes hold the affected elbow in a bent, guarded position. You should be receiving an order confirmation from Paypal shortly. If you have a sports injury or other elbow condition, act now to make an appointment. Straightening the elbow and gently stretching the wrist flexors promotes normal range of motion at the elbow. Once the patient can perform these activities pain free a gradual return to these activities is indicated provided there is no increase in symptoms. It improves with rest and non-aggravating positions. Over the counter medications, such as ibuprofen or naproxen can also help with inflammation and tenderness. Patients may also experience a loss of elbow movement, in particular, an inability to fully straighten the elbow due to stiffness and pain. Its like flossing your teeth. Miller TT, et al. You may also want to shake out your arm in between stretches. (2017). Strengthening is indicated once nerve healing begins and sensation returns. . Ulnar nerve entrapment at the wrist is fairly rare, so there isnt much data about success rates and recovery periods. The ulnar nerve is one of three main nerves in the upper limbs, along with the median nerve and the radial nerve. Proceed to rotated your arm outwards/inwards. Posterior Elbow Impingement Rehabilitation Exercises and Throwing - YouTube 0:00 / 13:49 MICHIGAN Posterior Elbow Impingement Rehabilitation Exercises and Throwing 6,116 views Premiered Jun. In minor cases of elbow impingement (whether traumatic or due to overuse), patients may be able to continue activity only to experience an increase in pain, swelling and stiffness in the elbow after activity with rest (particularly first thing in the morning). C. Wall Exercises For Scapula Stabilisation If you have shoulder blade instability or winged scapula exercises against the wall can really help. Kinetic chain exercises for shoulder impingement syndrome. I am pain free and strength is at its ALL TIME BEST! Entrapment of the ulnar nerve in cubital tunnel by free intra-articular body A case report. This one isnt complicated. Ive came in with lower back pain several times but leave every time without any!! In most mild elbow posterior impingement cases, patients can usually return to their normal activities within 6 weeks following conservative management (which includes elbow physiotherapy ). They can send pain to nearby body regions. However, chin tucks change symptoms at the elbow, forearm, and hand when theres referred pain from the neck, cervical radiculopathy, or double crush syndrome. We address various pain symptoms including acute pain, chronic pain, and pain caused by an injury or underlying condition. Step 4 Slowly lower the hand and arm. Our bodies' nerve cells are important for transmitting electrical and chemical information between different parts of the brain and the nervous system. Share This Section. If you want to roll up a small towel and place it between your side and your elbow, this will keep your arm close to your side through out the exercise. Anatomy. Did you know you can get expert answers for this article? Whether you can do household chores for exercise depends 100% on your expectations. As these stretches can take 10 to 15 minutes on each hand, you can repeat these stretches during the same time period or you can complete the stretches at different times throughout the day. ouh.nhs.uk/patient-guide/leaflets/files/5021Pcubital.pdf, osmosis.org/answers/ulnar-nerve-entrapment, assh.org/handcare/hand-arm-conditions/cubital-tunnel, orthoinfo.aaos.org/en/diseases--conditions/ulnar-nerve-entrapment-at-the-elbow-cubital-tunnel-syndrome/, nyulangone.org/conditions/ulnar-nerve-compression-in-adults/prevention, orthoinfo.aaos.org/en/diseases--conditions/ulnar-tunnel-syndrome-of-the-wrist/, ncbi.nlm.nih.gov/pmc/articles/PMC3453029/pdf/12593_2009_Article_20.pdf, Cubital Tunnel Syndrome Exercises to Relieve Pain, Top Shoes for Neuropathy with Comfort and Walking in Mind, loss of feeling in your ring and pinky fingers, claw-like deformity of ring finger and pinky, driving with a bent elbow resting on an open window, holding a phone up to your ear for long periods of time, leaning on your elbows at your desk for long periods, fluid buildup and swelling after an injury, repetitive activity at work, such as using a jackhammer or a hammer, repetitive activity in sports, such as pressing your hand against bicycle handlebars or swinging a golf club. In order to advance to the second phase of shoulder impingement rehabilitation your active shoulder range of motion should be full and pain-free. {"smallUrl":"https:\/\/www.wikihow.com\/images\/thumb\/8\/81\/Stretch-Your-Elbow-Step-1-Version-2.jpg\/v4-460px-Stretch-Your-Elbow-Step-1-Version-2.jpg","bigUrl":"\/images\/thumb\/8\/81\/Stretch-Your-Elbow-Step-1-Version-2.jpg\/aid11476536-v4-728px-Stretch-Your-Elbow-Step-1-Version-2.jpg","smallWidth":460,"smallHeight":259,"bigWidth":728,"bigHeight":410,"licensing":"