Joint Manipulation in the Management of Lateral Epicondylalgia: A Clinical Commentary

Abstract Lateral epicondylalgia or tennis elbow is a prevalent musculoskeletal disorder that is characterized by lateral elbow pain often associated with gripping tasks. The underlying pathology remains to be fully elucidated; however, evidence indicates that the disorder does not involve an inflammatory process but rather impairments of the pain and motor systems as well as morphological changes in the structure of both the extensor carpi radialis brevis muscle and tendon. Although the most efficient management approach remains controversial, there is a growing body of literature reporting the effects and underlying mechanisms of joint manipulation in the management of lateral epicondylalgia. Evidence exists demonstrating that joint manipulation directed at the elbow and wrist as well as at the cervical and thoracic spinal regions results in clinical alterations in pain and the motor system. In addition to presenting this evidence, this paper describes proposed underlying physiological mechanisms of joint manipulation associated with the observed clinical effects. We propose that this information will be useful for the physical therapist in making clinical decisions regarding the selection of treatment technique for the management of patients with lateral epicondylalgia.

[1]  L. Bouter,et al.  Lateral epicondylitis in general practice: course and prognostic indicators of outcome. , 2006, The Journal of rheumatology.

[2]  L. Bisset,et al.  tennis elbow : randomised trial corticosteroid injection , or wait and see for Mobilisation with movement and exercise , 2006 .

[3]  L. Arendt-Nielsen,et al.  Effects of a manual therapy technique in experimental lateral epicondylalgia. , 2006, Manual therapy.

[4]  H. Alfredson,et al.  Extensor origin vascularity related to pain in patients with Tennis elbow , 2006, Knee Surgery, Sports Traumatology, Arthroscopy.

[5]  I. Stasinopoulos,et al.  Comparison of effects of Cyriax physiotherapy, a supervised exercise programme and polarized polychromatic non-coherent light (Bioptron light) for the treatment of lateral epicondylitis , 2006, Clinical rehabilitation.

[6]  L. Simon.  Hyperbole, innuendo, and fact: the strange case of COX-2 selective inhibitors. , 2006, The Journal of rheumatology.

[7]  J. Cleland,et al.  Incorporation of Manual Therapy Directed at the Cervicothoracic Spine in Patients with Lateral Epicondylalgia: A Pilot Clinical Trial , 2005 .

[8]  L. Bisset,et al.  A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia , 2005, British Journal of Sports Medicine.

[9]  E. Waugh.  Lateral epicondylalgia or epicondylitis: what's in a name? , 2005, The Journal of orthopaedic and sports physical therapy.

[10]  M. Johnson,et al.  Cyriax physiotherapy for tennis elbow/lateral epicondylitis , 2004, British Journal of Sports Medicine.

[11]  J. Cleland,et al.  Effectiveness of manual physical therapy to the cervical spine in the management of lateral epicondylalgia: a retrospective analysis. , 2004, The Journal of orthopaedic and sports physical therapy.

[12]  K. Khan,et al.  Tendinopathies in the upper extremity: a paradigm shift. , 2004, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[13]  S. Forsgren,et al.  Neurokinin 1‐receptors and sensory neuropeptides in tendon insertions at the medial and lateral epicondyles of the humerus Studies on tennis elbow and medial epicondylalgia , 2004, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[14]  B. Vicenzino,et al.  Naloxone fails to antagonize initial hypoalgesic effect of a manual therapy treatment for lateral epicondylalgia. , 2004, Journal of manipulative and physiological therapeutics.

[15]  G. Tomlinson,et al.  Factors associated with prognosis of lateral epicondylitis after 8 weeks of physical therapy. , 2004, Archives of physical medicine and rehabilitation.

[16]  K. Sluka,et al.  Joint manipulation reduces hyperalgesia by activation of monoamine receptors but not opioid or GABA receptors in the spinal cord , 2003, Pain.

[17]  B. Vicenzino,et al.  Hypoalgesia induced by elbow manipulation in lateral epicondylalgia does not exhibit tolerance. , 2003, The journal of pain : official journal of the American Pain Society.

[18]  L. Blankevoort,et al.  Manipulation of the wrist for management of lateral epicondylitis: a randomized pilot study. , 2003, Physical therapy.

[19]  B. Vicenzino,et al.  Lateral epicondylalgia: a musculoskeletal physiotherapy perspective. , 2003, Manual therapy.

[20]  B. Vicenzino,et al.  Hypoalgesic and sympathoexcitatory effects of mobilization with movement for lateral epicondylalgia. , 2003, Physical therapy.

[21]  A. Dogra,et al.  Effectiveness of a Specific Physiotherapy Regimen on Patients with Tennis Elbow , 2002 .

[22]  B. Vicenzino,et al.  A pilot study of the manual force levels required to produce manipulation induced hypoalgesia. , 2002, Clinical biomechanics.

[23]  J. Cleland,et al.  Effects of Slump Long Sitting on Peripheral Sudomotor and Vasomotor Function: A Pilot Study , 2002 .

[24]  P. Kannus,et al.  Time to abandon the “tendinitis” myth , 2002, BMJ : British Medical Journal.

[25]  L. Bouter,et al.  Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial , 2002, The Lancet.

[26]  P. Bijur,et al.  Prospective validation of clinically important changes in pain severity measured on a visual analog scale. , 2001, Annals of emergency medicine.

[27]  S B Bird,et al.  Clinically significant changes in pain along the visual analog scale. , 2001, Annals of emergency medicine.

[28]  B. Vicenzino,et al.  Specific manipulative therapy treatment for chronic lateral epicondylalgia produces uniquely characteristic hypoalgesia. , 2001, Manual therapy.

[29]  B. Vicenzino,et al.  Characterisation of chronic lateral epicondylalgia using the McGill pain questionnaire, visual analog scales, and quantitative sensory tests , 2001 .

[30]  J. Abbott.  Mobilization with movement applied to the elbow affects shoulder range of movement in subjects with lateral epicondylalgia. , 2001, Manual therapy.

[31]  J H Abbott,et al.  The initial effects of an elbow mobilization with movement technique on grip strength in subjects with lateral epicondylalgia. , 2001, Manual therapy.

[32]  G. Jull,et al.  Cervical mobilisation: concurrent effects on pain, sympathetic nervous system activity and motor activity. , 2001, Manual therapy.

[33]  J. Rompe,et al.  Chronic lateral epicondylitis of the elbow: A prospective study of low-energy shockwave therapy and low-energy shockwave therapy plus manual therapy of the cervical spine. , 2001, Archives of physical medicine and rehabilitation.

[34]  Ariana M. Kelly.  The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain , 2001, Emergency medicine journal : EMJ.

[35]  R. Lorentzon,et al.  In vivo investigation of ECRB tendons with microdialysis technique--no signs of inflammation but high amounts of glutamate in tennis elbow , 2000, Acta orthopaedica Scandinavica.

[36]  J. Fridén,et al.  Substance P and Calcitonin Gene-related Peptide Expression at the Extensor Carpi Radialis Brevis Muscle Origin: Implications for the Etiology of Tennis Elbow , 2000 .

[37]  B. Vicenzino,et al.  No Influence of Naloxone on the Initial Hypoalgesic Effect of Spinal Manual Therapy , 2000 .

[38]  P. Croft,et al.  Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care , 1999, BMJ.

[39]  B. Vicenzino,et al.  The displacement, velocity and frequency profile of the frontal plane motion produced by the cervical lateral glide treatment technique. , 1999, Clinical biomechanics.

[40]  J. Fridén,et al.  Substance P and calcitonin gene‐related peptide expression at the extensor carpi radialis brevis muscle origin: Implications for the etiology of tennis elbow , 1999, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[41]  J. Fridén,et al.  Wrist Extensor Muscle Pathology in Lateral Epicondylitis , 1999, Journal of hand surgery.

[42]  R. Ling,et al.  The influence of weight-bearing on the measurement of polyethylene wear in THA , 1999 .

[43]  B. Vicenzino,et al.  An investigation of stress and pain perception during manual therapy in asymptomatic subjects , 1999, European journal of pain.

[44]  B. Kraushaar,et al.  Current Concepts Review - Tendinosis of the Elbow (Tennis Elbow). Clinical Features and Findings of Histological, Immunohistochemical, and Electron Microscopy Studies* , 1999 .

[45]  Kraushaar Bs,et al.  Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. , 1999 .

[46]  R P Nirschl,et al.  Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. , 1999, The Journal of bone and joint surgery. American volume.

[47]  A. Kelly,et al.  Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain? , 1998, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[48]  M Feuerstein,et al.  Occupational upper extremity disorders in the federal workforce. Prevalence, health care expenditures, and patterns of work disability. , 1998, Journal of occupational and environmental medicine.

[49]  B. Vicenzino,et al.  Cardiovascular and respiratory changes produced by lateral glide mobilization of the cervical spine , 1998 .

[50]  B. Vicenzino,et al.  An investigation of the interrelationship between manipulative therapy-induced hypoalgesia and sympathoexcitation. , 1998, Journal of manipulative and physiological therapeutics.

[51]  T. Souvlis,et al.  The tolerance effect: its relevance to analgesia produced by physiotherapy interventions , 1997 .

[52]  B. Vicenzino,et al.  The influence of an anteroposterior accessory glide of the glenohumeral joint on measures of peripheral sympathetic nervous system function in the upper limb. , 1997, Manual therapy.

[53]  B. Vicenzino,et al.  The initial effects of a cervical spine manipulative physiotherapy treatment on the pain and dysfunction of lateral epicondylalgia , 1996, Pain.

[54]  H. Vanharanta,et al.  Progressive Strengthening and Stretching Exercises and Ultrasound for Chronic Lateral Epicondylitis , 1996 .

[55]  B. Vicenzino,et al.  Lateral epicondylalgia I: epidemiology, pathophysiology, aetiology and natural history , 1996 .

[56]  A. Wright,et al.  To compare the effects of different rates of application of a cervical mobilisation technique on sympathetic outflow to the upper limb in normal subjects. , 1996, Manual therapy.

[57]  H. van Mameren,et al.  Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. , 1996, The Journal of bone and joint surgery. British volume.

[58]  B. Vicenzino,et al.  Effects of a novel manipulative physiotherapy technique on tennis elbow: a single case study. , 1995, Manual therapy.

[59]  H. Potter,et al.  Lateral epicondylitis: correlation of MR imaging, surgical, and histopathologic findings. , 1995, Radiology.

[60]  D. Mulligan,et al.  Manual Therapy: "Nags", "Snags", "Mwms" Etc. , 1995 .

[61]  B. Vicenzino,et al.  Cervical mobilisation techniques, sympathetic nervous system effects and their relationship to analgesia , 1995 .

[62]  M. Cawley,et al.  Abnormal microvascular responses in a lateral epicondylitis. , 1994, British journal of rheumatology.

[63]  P. Stratford,et al.  Assessing Valid Change over Time in Patients with Lateral Epicondylitis at the Elbow , 1994 .

[64]  B. Vicenzino,et al.  Sudomotor Changes Induced by Neural Mobilisation Techniques in Asymptomatic Subjects , 1994 .

[65]  B. Vicenzino,et al.  Hyperalgesia in Tennis Elbow Patients , 1994 .

[66]  Patricia J Cyriax,et al.  Cyriax's Illustrated Manual of Orthopaedic Medicine , 1993 .

[67]  B. Morrey,et al.  Microscopic histopathology of chronic refractory lateral epicondylitis , 1992, The American journal of sports medicine.

[68]  H. Labelle,et al.  Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow. An attempted meta-analysis. , 1992, The Journal of bone and joint surgery. British volume.

[69]  T. Sculco,et al.  Salvage and reinfusion of postoperative sanguineous wound drainage. A preliminary report. , 1992, The Journal of bone and joint surgery. American volume.

[70]  A. Wright,et al.  An evaluation of mechanical and thermal hyperalgesia in patients with lateral epicondylalgia , 1992 .

[71]  L Dimberg,et al.  The prevalence and causation of tennis elbow (lateral humeral epicondylitis) in a population of workers in an engineering industry. , 1987, Ergonomics.

[72]  D. G. Lee.  "Tennis Elbow": A Manual Therapist's Perspective. , 1986, The Journal of orthopaedic and sports physical therapy.

[73]  R. Elvey.  Treatment of arm pain associated with abnormal brachial plexus tension. , 1986, The Australian journal of physiotherapy.

[74]  M. Zusman.  Spinal manipulative therapy: review of some proposed mechanisms, and a new hypothesis. , 1986, The Australian journal of physiotherapy.

[75]  P. Kivi.  The etiology and conservative treatment of humeral epicondylitis. , 1983, Scandinavian journal of rehabilitation medicine.

[76]  R. Nirschl,et al.  Tennis elbow. The surgical treatment of lateral epicondylitis. , 1979, The Journal of bone and joint surgery. American volume.

[77]  C. Gunn,et al.  Tennis elbow and the cervical spine. , 1976, Canadian Medical Association journal.