Your Patient,a 19-Year-Old College Student,sustained a Nondisplaced Fracture of the Distal

Your patient,a 19-year-old college student,sustained a nondisplaced fracture of the distal humerus,which was managed by closed reduction and 6 weeks of immobilization in a cast.Yesterday the cast was removed and the patient is to begin exercises to improve ROM and strength of the elbow.Your examination reveals significant limitation of elbow flexion/extension and forearm pronation/supination as well as reduced joint play at the elbow.The patient describes her elbow as feeling "very stiff," but pain occurs only when overpressure is applied at the end of the available ranges.One of the goals in this patient's treatment plan is to increase elbow ROM.Which of the following techniques should you begin with to increase ROM?

A) Cross-fiber massage of the tendons inserting at the elbow
B) Joint-mobilization techniques to stretch the restricted joints (grade III sustained glide or grade IV oscillation techniques) after evaluating the reactivity of the elbow joints with grade II sustained glides
C) Manual passive stretching to lengthen muscles that cross the elbow
D) Passive ROM within pain-free ranges