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Šarčević Z, Stanković M, Tepavčević A. Lateral Epicondylalgia and Thoracic Kyphosis: A Study on Young Athletes. Clin J Sport Med 2024:00042752-990000000-00190. [PMID: 38810134 DOI: 10.1097/jsm.0000000000001232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 04/28/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE The etiology of lateral epicondylalgia (LE) remains unclear, although it has been linked to various factors. Recent theories suggest a potential connection between LE and impairments in the kinetic chain. In our study, we aimed to investigate the association between another factor influencing kinetic chain impairment, specifically an increased angle of thoracic kyphosis, and the presence of initial signs of LE in young athletes. DESIGN This study employed an observational, case-control design. SETTING The participants underwent examination during a routine preventive checkup conducted by a sports physician at Novi Sad Healthcare Center, Sports Medicine Center. PARTICIPANTS One hundred young athletes aged 10 to 15 years were included in the study. Half of the participants reported pain in the lateral aspect of the elbow during maximal hand grip, while the remaining athletes served as controls and did not experience any pain. ASSESSMENT OF INDEPENDENT VARIABLES Thoracic kyphosis inclination angles were measured using a digital inclinometer. MAIN OUTCOME MEASURES Pain was assessed using the pressure pain threshold at a specific point associated with lateral epicondylalgia, measured by a digital algometer. RESULTS Participants exhibiting initial signs of LE displayed significantly different angles of anteroposterior curvatures of the spine compared with the control group. Moreover, the angle of thoracic kyphosis was significantly associated with pain in the lateral aspect of the elbow. CONCLUSIONS Our findings confirm an association between initial signs of lateral epicondylalgia and the grade of thoracic kyphosis in young athletes.
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Affiliation(s)
- Zoran Šarčević
- Novi Sad Health Care Centre, Sports Medicine Centre, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; and
| | - Milan Stanković
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; and
| | - Andreja Tepavčević
- Faculty of Sciences, University of Novi Sad, Novi Sad, Serbia; and
- Mathematical Institute SANU, Belgrade, Serbia
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2
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Dunning J, Mourad F, Bliton P, Charlebois C, Gorby P, Zacharko N, Layson B, Maselli F, Young I, Fernández-de-Las-Peñas C. Percutaneous tendon dry needling and thrust manipulation as an adjunct to multimodal physical therapy in patients with lateral elbow tendinopathy: A multicenter randomized clinical trial. Clin Rehabil 2024:2692155241249968. [PMID: 38676324 DOI: 10.1177/02692155241249968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
OBJECTIVE The purpose of this study was to assess the effects of adding electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization, and ultrasound in patients with lateral elbow tendinopathy. DESIGN Randomized, single-blinded, multicenter, parallel-group trial. SETTING Thirteen outpatient physical therapy clinics in nine different US states. PARTICIPANTS One hundred and forty-three participants (n = 143) with lateral elbow tendinopathy were randomized. INTERVENTION Cervical spine manipulation, extremity manipulation, and percutaneous tendon electrical dry needling plus multimodal physical therapy (n = 73) or multimodal physical therapy (n = 70) alone. MAIN MEASURES The primary outcome was elbow pain intensity and disability as measured by the Patient-Rated Tennis Elbow Evaluation at baseline, 1 week, 4 weeks, and 3 months. Secondary outcomes included the Numeric Pain Rating Scale, Tennis Elbow Functional Scale, Global Rating of Change, and medication intake. RESULTS The 2 × 4 analysis of covariance demonstrated that individuals with lateral elbow tendinopathy receiving electrical dry needling and thrust manipulation plus multimodal physical therapy experienced significantly greater improvements in disability (Patient-Rated Tennis Elbow Evaluation: F = 19.675; P < 0.001), elbow pain intensity (Numeric Pain Rating Scale: F = 22.769; P < 0.001), and function (Tennis Elbow Function Scale: F = 13.269; P < 0.001) than those receiving multimodal physical therapy alone at 3 months. The between-group effect size was large for pain and disability (Patient-Rated Tennis Elbow Evaluation: standardized mean difference = 1.13; 95% confidence interval: 0.78, 1.48) in favor of the electrical dry needling and thrust manipulation group. CONCLUSIONS The inclusion of percutaneous tendon electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization and ultrasound was more effective than multimodal physical therapy alone in individuals with lateral elbow tendinopathy.Trial Registration: www.clinicaltrials.gov NCT03167710 May 30, 2017.
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Affiliation(s)
- James Dunning
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
- Montgomery Osteopractic Physical Therapy & Acupuncture, Montgomery, AL, USA
| | - Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute, Differdange, Luxembourg
| | - Paul Bliton
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
- William Middleton VA Hospital, Madison, WI, USA
| | - Casey Charlebois
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
| | - Patrick Gorby
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
- Gorby Osteopractic Physiotherapy, Colorado Springs, CO, USA
| | - Noah Zacharko
- Osteopractic Physical Therapy of the Carolinas, Fort Mill, SC, USA
| | | | - Filippo Maselli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Ian Young
- Tybee Wellness & Osteopractic, Tybee Island, GA, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Cátedra de Clínica, Investigación y Docencia en Fisioterapia, Terapia Manual, Punción Seca y Ejercicio, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Reuter S. [Physiotherapeutic therapy modalities for lateral epicondyopathy]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:359-364. [PMID: 37069354 DOI: 10.1007/s00132-023-04369-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 04/19/2023]
Abstract
Physiotherapy interventions can have a positive effect on the symptoms and relief of symptoms of lateral epicondylopathy (LE). However, there is currently no standard physiotherapy protocol for treating LE. Today, a multimodal treatment approach that focuses on progressive exercise therapy is recommended. While in the past, most treatment protocols were based on eccentric training, recent research shows that other forms of training can also improve pain and function in tendinopathies.
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Affiliation(s)
- Sven Reuter
- Campus Stuttgart, SRH Hochschule für Gesundheit, Nißlestr. 22, 70190, Stuttgart, Deutschland.
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Nambi G, Alghadier M, Verma A, Aldhafian OR, Alshahrani NN, Saleh AK, Omar MA, Hassan TGT, Ibrahim MNA, El Behairy HF. Clinical and radiological effects of Corticosteroid injection combined with deep transverse friction massage and Mill's manipulation in lateral epicondylalgia-A prospective, randomized, single-blinded, sham controlled trial. PLoS One 2023; 18:e0281206. [PMID: 36780557 PMCID: PMC9925075 DOI: 10.1371/journal.pone.0281206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/10/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The knowledge about the effective implementation of corticosteroid injection (CS) with deep transverse friction massage (DTFM) and Mill's manipulation (MM) on clinical and radiological changes (Magnetic resonance imaging-MRI and Ultra sound) in lateral epicondylalgia (LE) is lacking. Therefore, the objective of this study is proposed to find and compare the effects of corticosteroid injection (CS) DTFM and Mill's manipulation on clinical and radiological changes in lateral epicondylalgia. DESIGN, SETTING, PARTICIPANTS Randomized, single-blinded, controlled study was conducted on 60 LE participants at university hospital. The active MM group (n = 30) received corticosteroid injection with DTFM and active Mill's manipulation (MM) three sessions a week for 4 weeks and the sham MM group received corticosteroid injection with sham manipulation. The primary outcome was pain intensity, measured with the visual analog scale. The other outcome measures were percentage of injury measured by MRI and ultrasound, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life which were measured at 4 weeks, 8weeks and at 6 months follow up. RESULTS The between-group difference in pain intensity at 4 weeks was 1.6 (CI 95% 0.97 to 2.22), which shows improvement in the active group than sham group. The similar effects have been noted after 8 weeks and at 6 months 2.0 (CI 95% 1.66 to 2.33) follow up in pain intensity. Similar improvements were also found on percentage of injury, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life (p = 0.001). CONCLUSION Corticosteroid injection with DTFM and Mill's manipulation was superior to sham group for improving pain, percentage of injury, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life in people with lateral epicondylalgia. TRIAL REGISTRATION Clinical trial registration: CTRI/2020/05/025135 trial registered prospectively on 12/05/2020. https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2020/05/025135.
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Affiliation(s)
- Gopal Nambi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
- * E-mail:
| | - Mshari Alghadier
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Anju Verma
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
- Faculty of Medicine and Health, Department of Exercise and Sports Sciences, School of Health Sciences, University of Sydney, New South Wales, Australia
| | - Osama R. Aldhafian
- Department of Surgery, College of Medicine, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Naif N. Alshahrani
- Orthopedic Surgery Department, King Fahad medical city, Ministry of Health, Riyadh, Saudi Arabia
| | - Ayman K. Saleh
- Department of Surgery, College of Medicine, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
- Faculty of Medicine for Girls, Department of Orthopedic Surgery, Al-Azhar University, Cairo, Egypt
| | - Mohamed A. Omar
- Faculty of Medicine for Girls, Department of Orthopedic Surgery, Al-Azhar University, Cairo, Egypt
| | - Tohamy G. T. Hassan
- Faculty of Medicine for Girls, Department of Orthopedic Surgery, Al-Azhar University, Cairo, Egypt
| | | | - Hassan Fathy El Behairy
- Faculty of Medicine for Girls, Al-zhraa University Hospital, Al-Azhar University, Cairo, Egypt
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Savva C, Kleitou M, Efstathiou M, Korakakis V, Stasinopoulos D, Karayiannis C. The effect of lumbar spine manipulation on pain and disability in Achilles tendinopathy. A case report. J Bodyw Mov Ther 2020; 26:214-219. [PMID: 33992247 DOI: 10.1016/j.jbmt.2020.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 07/08/2020] [Accepted: 08/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND/PURPOSE Cervical and thoracic spine manipulation has been found to reduce tendon pain and disability in lateral epicondylalgia and rotator cuff tendinopathy. Based on these findings, the application of lumbar spine manipulation may also provide similar improvements in Achilles tendinopathy (AT). Therefore, the purpose of this study was to evaluate the effect of lumbar spine manipulation on pain and disability in a patient experiencing AT. CASE DESCRIPTION A 44 years old male ex-football player presented with a 20-year history of persistent Achilles tendon pain (ATP) consistent with AT diagnosis. The patient attended 12 treatment sessions receiving a high-velocity, low amplitude lumbar spine manipulation. Outcome measures were collected at baseline, 2 weeks, 4 weeks, 3 months and 6 months and included pain in visual analogue scale, the American Orthopedic Foot and Ankle Score, the 36-Item Short Form Health Survey and the Victorian Institute of Sport Assessment-Achilles questionnaire. Pressure pain threshold was also assessed using an electronic pressure algometer. OUTCOMES Improvement in all outcome measures was noted 6-months post intervention. Outcome measures indicated substantial improvements in both the patient's pain and disability. The patient was able to perform activities of daily living without difficulties, suggesting higher level of function and quality of life at 6-months post initial evaluation. CONCLUSION These findings have demonstrated the positive effects of lumbar spine manipulation on ATP and disability. Further studies, specifically clinical trials investigating the effect of lumbar spine manipulation or combining this technique with exercises and functional activities are suggested.
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Affiliation(s)
- Christos Savva
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus.
| | - Michalis Kleitou
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus
| | - Michalis Efstathiou
- Department of Life and Health Science, 46 Makedonitissas Avenue, Engomi, University of Nicosia, Cyprus
| | | | - Dimitris Stasinopoulos
- Department of Physiotherapy, 11521, Aleksandras Avenue, University of West Attica, Athens, Greece
| | - Christos Karayiannis
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus
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A global view on how local muscular fatigue affects human performance. Proc Natl Acad Sci U S A 2020; 117:19866-19872. [PMID: 32753385 DOI: 10.1073/pnas.2007579117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
There is a growing interest in scientific literature on identifying how and to what extent interventions applied to a specific body region influence the responses and functions of other seemingly unrelated body regions. To investigate such a construct, it is necessary to have a global multivariate model that considers the interaction among several variables that are involved in a specific task and how a local and acute impairment affects the behavior of the output of such a model. We developed an artificial neural network (ANN)-based multivariate model by using parameters of motor skills obtained from kinematic, postural control, joint torque, and proprioception variables to assess the local fatigue effects of the abductor hip muscles on the functional profile during a single-leg drop landing and a squatting task. Findings suggest that hip abductor muscles' local fatigue produces a significant effect on a general functional profile, built on different control systems. We propose that expanded and global approaches, such as the one used in this study, have great applicability and have the potential to serve as a tool that guarantees ecological validity of future investigations.
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Young SW, Young TW, MacDonald CW. Conservative management of De Quervain's tendinopathy with an orthopedic manual physical therapy approach emphasizing first CMC manipulation: a retrospective case series. Physiother Theory Pract 2020; 38:587-596. [PMID: 32478626 DOI: 10.1080/09593985.2020.1771800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
De Quervain's tendinopathy (DQT) is a musculoskeletal disorder that limits hand function of affected individuals. Management of DQT can include splinting, activity modification, medications, corticosteroid injections, physical therapist management, and surgery. There is limited evidence to support the combination of manual therapy and exercise interventions within an Orthopedic Manual Physical Therapy (OMPT) approach when managing patients with DQT. Three patients identified with DQT underwent a multi-modal treatment regimen including carpometacarpal (CMC) thrust and non-thrust manipulation, end range radiocarpal mobilization, mobilization with movement (MWM), strengthening exercises, and grip proprioception training. Outcomes were assessed using the numeric pain rating scale (NPRS), Jamar hand dynamometer grip strength, and the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire. These measures were administered at baseline and discharge. Each patient demonstrated improvements in all outcome measures and required ten visits or less to reach a satisfactory outcome. The NPRS improved by a mean of 7.1 points on a 0-10 scale, Quick DASH improved by an average of 37.1%, and grip strength improved by a mean of 27.6 pounds. Each patient was able to return to daily tasks without pain and all improvements were maintained at six month follow-up. An impairment based OMPT management approach was effective in managing three patients with DQT. The inclusion of first CMC manipulation within this multi-modal approach may enhance conservative management of patients with DQT. Because a cause and effect relationship cannot be inferred from a case series, further research is recommended to investigate the efficacy of this management approach.
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Affiliation(s)
- Scott W Young
- Rueckert-Hartman College for Health Professions, School of Physical Therapy, Regis University, Denver, Colorada, USA
| | - Thomas W Young
- Rueckert-Hartman College for Health Professions, School of Physical Therapy, Regis University, Denver, Colorada, USA
| | - Cameron W MacDonald
- Rueckert-Hartman College for Health Professions, School of Physical Therapy, Regis University, Denver, Colorada, USA
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The effects of kinesiotaping on wrist extensor strength using an isokinetic device in patients with chronic lateral epicondylitis: A randomized-controlled trial. Turk J Phys Med Rehabil 2020; 66:60-66. [PMID: 32318676 DOI: 10.5606/tftrd.2020.3298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/28/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to evaluate short-term effects of kinesiotaping (KT) on pain, arm function, grip strength, and wrist extensor strength in patients with chronic lateral epicondylitis (LE). Patients and methods A total of 48 patients (32 females, 16 males years; mean age 47.6 years; range 27 to 67 years) with chronic LE were randomly assigned to either KT group (n=27) or sham group (n=21). Pain intensity with visual analog sclae (VAS), arm pain and function with Patient-Rated Tennis Elbow Evaluation Questionnaire (PRTEE), grip strength with hand dynamometer, and wrist extensor strength by an isokinetic device were evaluated before and at the end of the treatment. The KT stayed on for five days and the procedure was repeated for three times. Results Although pain and functional levels of patients with chronic LE were significantly improved both with KT (pain, p=0.001; function, p=0.001) and sham groups (pain, p=0.001; function, p=0.001), no significant difference was observed between the groups. Conclusion Both KT and sham taping provided similar improvement in pain relief through arm functions in patients with chronic LE.
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Bostrøm K, Mæhlum S, Cvancarova Småstuen M, Storheim K. Clinical comparative effectiveness of acupuncture versus manual therapy treatment of lateral epicondylitis: feasibility randomized clinical trial. Pilot Feasibility Stud 2019; 5:110. [PMID: 31516727 PMCID: PMC6731611 DOI: 10.1186/s40814-019-0490-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 08/14/2019] [Indexed: 02/02/2023] Open
Abstract
Background Lateral epicondylitis (LE) is a challenging condition for clinicians, and research has yet not proven the superiority of one specific treatment approach. However, manual therapy (elbow mobilization) in addition to eccentric exercise has been found to be superior to exercise alone. As well, acupuncture is effective in short-term pain relief when compared with sham treatment, but there is little knowledge on the comparative effectiveness of manual therapy and acupuncture treatment of LE in terms of pain relief. The primary objective of this pilot trial was to assess the feasibility (retention and adherence rates) of performing a randomized controlled trial (RCT) to explore the clinical effectiveness of acupuncture and manual therapy treatment of LE. Methods This pilot trial took place in an outpatient interdisciplinary institute of sports medicine and rehabilitation in Oslo, Norway. Thirty-six adults with clinically diagnosed LE were randomly allocated into one of three groups: eccentric exercise alone, eccentric exercise plus acupuncture, or eccentric exercise plus manual therapy for a 12-week treatment period. Primary outcomes were patient retention and adherence rates. Secondary outcomes included patient-reported pain (NRS), level of disability (Quick-DASH), and participant’s satisfaction with treatment and global perceived effect. Results Nine (69%) patients in the acupuncture group completed the 1-year follow-up, compared to eight (67%) in the manual therapy group and five (45%) in exercise alone. Our goal was to demonstrate a retention rate above 80% to avoid serious threats to validity, but the result was lower than expected. The majority of participants (64%) in both treatment groups received only three-treatment sessions; the reasons included non-attendance or recovery from pain. Secondary outcomes support the rationale for conduction of an RCT. There were no adverse advents related to study participation. Conclusions Based on differences in pain relief between groups, patient retention, and adherence rates, an RCT seems to be feasible to assess treatment effectiveness more precisely. In a future definitive trial, greater dropout may be reduced by maintaining contact with the participants in the exercise alone group throughout the intervention, and objective assessments might be considered. Trial registration ClinicalTrials.gov, NCT02321696
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Affiliation(s)
- Katrine Bostrøm
- Norwegian Institute of Sports Medicine (NIMI), Sognsveien 75D, O805 Oslo, Norway.,2Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sverre Mæhlum
- Norwegian Institute of Sports Medicine (NIMI), Sognsveien 75D, O805 Oslo, Norway
| | - Milada Cvancarova Småstuen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,4Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Kjersti Storheim
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,4Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
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Pourahmadi MR, Mohsenifar H, Dariush M, Aftabi A, Amiri A. Effectiveness of mobilization with movement (Mulligan concept techniques) on low back pain: a systematic review. Clin Rehabil 2018; 32:1289-1298. [DOI: 10.1177/0269215518778321] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective: To evaluate evidence on the effectiveness of Mulligan techniques on low back pain. Data sources: PubMed/Medline, Scopus, Ovid, CINAHL, Embase, PEDro, Google Scholar, and Cochrane Library were searched from inception to 31 March 2018 for randomized clinical trials reporting outcomes of pain or disability in adult patients (⩾18 years) with low back pain. Review methods: Two authors screened the results and extracted data for use in this review. The risk of bias was evaluated using the Cochrane criteria. Basic information and treatment protocols were also extracted. In addition, the level of evidence of each study and strength of conclusion for pain and disability were determined. Results: A total of 20 studies with 693 patients were included. Nine trials focused on sustained natural apophyseal glide, three on spinal mobilization with limb movement and seven on bent leg raise. The results showed that Mulligan techniques can decrease pain and disability and increase range of motion in patients with low back pain; however, the strength of conclusion for pain and disability was moderate. Furthermore, inconclusive results were observed for the effectiveness of Mulligan techniques on movement speed. In this review, eight studies were categorized as low risk of bias, while 12 studies had high risk of bias. Level of evidence analysis revealed that 17 studies were classified as level of evidence B, while three studies were classified as level of evidence A2. Conclusion: Current evidence is insufficient in supporting the benefits of Mulligan techniques on pain, disability, and range of motion in low back pain patients.
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Affiliation(s)
- Mohammad Reza Pourahmadi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Holakoo Mohsenifar
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mozhdeh Dariush
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Amirreza Aftabi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Amiri
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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11
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Chronic Lateral Epicondylalgia Does Not Exhibit Mechanical Pain Modulation in Response to Noxious Conditioning Heat Stimulus. Clin J Pain 2017; 33:932-938. [DOI: 10.1097/ajp.0000000000000475] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marcolino AM, das Neves LMS, Oliveira BG, Alexandre AA, Corsatto G, Barbosa RI, de Cássia Registro Fonseca M. Multimodal approach to rehabilitation of the patients with lateral epicondylosis: a case series. SPRINGERPLUS 2016; 5:1718. [PMID: 27777854 PMCID: PMC5052242 DOI: 10.1186/s40064-016-3375-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 09/23/2016] [Indexed: 12/01/2022]
Abstract
Purpose The objective of this study was to evaluate the effectiveness of mobilization with movement and kinesiotherapy in the treatment of patients with lateral epicondylosis. Methods This cases series included eight volunteers who had chronic lateral epicondylosis. The patients were treated with stretching, massage deep transverse at the lateral epicondyle and mobilization with movement associated with eccentric exercise. The mobilization with movement that consisted of a force of lateral glide of the proximal forearm. We performed twelve sessions, twice a week for 45 min/session. All patients underwent an evaluation with a visual analog scale and functional assessment through questionnaires patient-rated tennis elbow evaluation (PRTEE) and disabilities of the arm, shoulder and hand (DASH), before and after the treatment. Data were analyzed by student’s t test (p < 0.05). Results The results showed statistical differences in pain symptoms before and after treatment, in the analysis and functional assessment through both questionnaires comparing the pre and post treatment. Conclusion The data obtained in this study demonstrates improvement of the function and pain status of the sample investigated.
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Affiliation(s)
- Alexandre Marcio Marcolino
- Laboratory of Assesment and Rehabilitation of the Locomotor Apparatus (LARAL), Federal University of Santa Catarina, Campus Araranguá, Rua Pedro João Pereira, 150, Florianópolis, SC CEP 88905-120 Brazil
| | | | | | | | | | - Rafael Inacio Barbosa
- Laboratory of Assesment and Rehabilitation of the Locomotor Apparatus (LARAL), Federal University of Santa Catarina, Campus Araranguá, Rua Pedro João Pereira, 150, Florianópolis, SC CEP 88905-120 Brazil
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Jordon MK, Beattie PF, D'Urso S, Scriven S. Spinal manipulation does not affect pressure pain thresholds in the absence of neuromodulators: a randomized controlled trial. J Man Manip Ther 2016; 25:172-181. [PMID: 28912629 DOI: 10.1080/10669817.2016.1230352] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Measurement of pressure pain threshold (PPT) is a way to determine one of the many potential treatment effects of spinal manipulative therapy. OBJECTIVE To determine how multiple spinal manipulations administered in a single-session affected PPTs at local and distal sites in asymptomatic individuals. METHODS Participants were randomly assigned into one of three groups: Group one (n = 18) received a lumbar manipulation followed by a cervical manipulation. Group two (n = 17) received a cervical manipulation followed by a lumbar manipulation. The control group (n = 19) received two bouts of five minutes of rest. At baseline and after each intervention or rest period, each participant's PPTs were obtained using a handheld algometer. The PPTs were tested bilaterally over the lateral epicondyles of the humerus and over the mid-bellies of the upper trapezius, lumbar paraspinal, and the tibialis anterior muscles. This study was registered with ClinicalTrials.gov, and its Identifier is NCT02828501. RESULTS Repeated-measures ANOVAs and Kruskal-Wallis tests showed no significant within- or between-group differences in PPT. Within-group effect sizes in the changes of PPT ranged from -.48 at the left paraspinal muscles to .24 at the left lateral humeral epicondyle. Statistical power to detect significant differences at α of 0.05 was calculated to be 0.94. CONCLUSIONS This study suggests that in young adults who do not have current or recent symptoms of spinal pain, multiple within-session treatments of cervical and lumbar spinal manipulation fail to influence PPTs. Changes in PPT that are observed in symptomatic individuals are likely to be primarily influenced by pain-related neuromodulators rather than by an isolated, mechanical effect of spinal manipulation.
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Affiliation(s)
- Max K Jordon
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Paul F Beattie
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sarah D'Urso
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sarah Scriven
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Jayaseelan DJ, Kecman M, Alcorn D, Sault JD. Manual therapy and eccentric exercise in the management of Achilles tendinopathy. J Man Manip Ther 2016; 25:106-114. [PMID: 28559670 DOI: 10.1080/10669817.2016.1183289] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Chronic Achilles tendinopathy (AT) is an overuse condition seen among runners. Eccentric exercise can decrease pain and improve function for those with chronic degenerative tendon changes; however, some individuals have continued pain requiring additional intervention. While joint mobilization and manipulation has not been studied in the management in Achilles tendinopathy, other chronic tendon dysfunction, such as lateral epicondylalgia, has responded well to manual therapy (MT). Three runners were seen in physical therapy (PT) for chronic AT. They were prescribed eccentric loading exercises and calf stretching. Joint mobilization and manipulation was implemented to improve foot and ankle mobility, decrease pain, and improve function. Immediate within-session changes in pain, heel raise repetitions, and pressure pain thresholds (PPT) were noted following joint-directed MT in each patient. Each patient improved in self-reported function on the Achilles tendon specific Victorian Institute for Sport Assessment questionnaire (VISA-A), pain levels, PPT, joint mobility, ankle motion, and single-leg heel raises at discharge and 9-month follow-up. The addition of MT directed at local and remote sites may enhance the rehabilitation of patients with AT. Further research is necessary to determine the efficacy of adding joint mobilization to standard care for AT. LEVEL OF EVIDENCE Case series. Therapy, Level 4.
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Affiliation(s)
- Dhinu J Jayaseelan
- Department of Physical Therapy and Health Care Sciences, The George Washington University, Washington, DC, USA
| | | | | | - Josiah D Sault
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
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15
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Manipulation Therapy Relieved Pain More Rapidly Than Acupuncture among Lateral Epicondylalgia (Tennis Elbow) Patients: A Randomized Controlled Trial with 8-Week Follow-Up. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:3079247. [PMID: 27143983 PMCID: PMC4837265 DOI: 10.1155/2016/3079247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/16/2016] [Accepted: 03/20/2016] [Indexed: 12/16/2022]
Abstract
Radial bone adjustment manipulation treatment may be effective to reduce pain rapidly in lateral epicondylalgia patients and the pathological tension in the biceps brachii muscle is highly concerned. To prove this hypothesis, we conducted a randomized controlled trial and included 35 patients with lateral epicondylalgia for more than 2 months. Either manipulation treatment (n = 16) or acupuncture (n = 19) was given to these patients for 2 weeks and all patients' symptoms were followed up for 8 weeks after treatment. Both groups demonstrated changes in pain VAS score, grip strength, and DASH questionnaire. Lateral epicondylalgia patients who received manipulation treatment felt pain relief sooner than those who had acupuncture treatments during the first few treatments. However, both acupuncture and manipulation are effective, while the difference has no significance at the 8-week follow-up. The trial was registered with Current Controlled Trials ISRCTN81308551 on 5 February 2016.
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16
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Mulligan Mobilization With Movement: Can It Be Used for the Management of Any Tendinopathy? Trauma Mon 2016. [DOI: 10.5812/traumamon.27312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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17
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Abstract
Elbow stiffness is a common consequence following trauma with the management of this condition posing a challenge to therapists and surgeons alike. This paper discusses the role of conservative treatment, such as exercise and splinting, in the prevention and management of the stiff elbow, along with a review of available evidence, to justify their usage.
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Affiliation(s)
- Val Jones
- Val Jones, Sheffield Shoulder & Elbow Unit, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK. Tel: +44 01142 714857.
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18
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Elbow Manual Therapy for Aging and Older Adults. TOPICS IN GERIATRIC REHABILITATION 2015. [DOI: 10.1097/tgr.0000000000000066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Sueki DG, Cleland JA, Wainner RS. A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications. J Man Manip Ther 2014; 21:90-102. [PMID: 24421619 DOI: 10.1179/2042618612y.0000000027] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The term 'regional interdependence' or RI has recently been introduced into the vernacular of physical therapy and rehabilitation literature as a clinical model of musculoskeletal assessment and intervention. The underlying premise of this model is that seemingly unrelated impairments in remote anatomical regions of the body may contribute to and be associated with a patient's primary report of symptoms. The clinical implication of this premise is that interventions directed at one region of the body will often have effects at remote and seeming unrelated areas. The formalized concept of RI is relatively new and was originally derived in an inductive manner from a variety of earlier publications and clinical observations. However, recent literature has provided additional support to the concept. The primary purpose of this article will be to further refine the operational definition for the concept of RI, examine supporting literature, discuss possible clinically relevant mechanisms, and conclude with a discussion of the implications of these findings on clinical practice and research.
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Affiliation(s)
- Derrick G Sueki
- Department of Physical Therapy, Mount St Mary's College, Los Angeles, CA, USA
| | - Joshua A Cleland
- Department of Physical Therapy, Franklin Pierce University, Concord, NH, USA
| | - Robert S Wainner
- Department of Physical Therapy, Texas State University, San Marcos, TX, USA
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20
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Fitzsimmons J. Improving Field Observation of Spinal Posture in Sitting. ERGONOMICS IN DESIGN 2014. [DOI: 10.1177/1064804614521998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Observing seated posture is important for ergonomic assessment; proper chair fit and chair adjustment should be considered for the entire context of work demands. Recommending only one seated posture presumes that all seated work has a similar location of visual targets, shoulder reach distances, and support surfaces. The nature of work tasks may influence posture more than does chair adjustment, and field observation of sitting should focus specifically on lumbar spine posture when work may cause forward movement of the torso. I suggest that the position and movement of the pelvis in relation to the torso is a reasonable and important indicator of spinal posture.
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Sueki DG, Chaconas EJ. The effect of thoracic manipulation on shoulder pain: a regional interdependence model. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x11y.0000000045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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22
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Middle and lower trapezius strengthening for the management of lateral epicondylalgia: a case report. J Orthop Sports Phys Ther 2013; 43:841-7. [PMID: 24175610 DOI: 10.2519/jospt.2013.4659] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case report. BACKGROUND Addressing weakness of the shoulder region, especially the rotator cuff and scapular musculature, is often suggested clinically for the treatment of individuals with lateral epicondylalgia. However, to our knowledge, the clinical effectiveness of this approach has not been established. CASE DESCRIPTION The patient was a 54-year-old woman with a 5-month history of right lateral elbow pain, whose symptoms were reproduced with clinical tests typically used to diagnose lateral elbow tendinopathy. The patient also demonstrated weakness in her middle and lower trapezius muscles, and the medial border of her scapula, measured with a tape measure, was 11 cm lateral from the spinous processes of the thoracic spine with the patient standing in relaxed stance. Based on improved grip strength and reduced associated elbow pain when tested with the scapula manually corrected in a more adducted position, treatment focused solely on strengthening of the middle and lower trapezius muscles over a 10-week period. OUTCOMES Following the intervention, the patient presented with improved scapular position, with the medial border of the scapula being 9 cm lateral to the midthoracic spine. The patient's middle and lower trapezius strength improved from 3+/5 and 4-/5, respectively, to 5/5, and her grip strength from 26.1 to 42.2 kg. The patient's scores on the Disabilities of the Arm, Shoulder and Hand questionnaire also improved from 44.2 at the initial evaluation to 0 at the completion of therapy, with the patient being able to perform all of her daily activities in a pain-free manner. DISCUSSION The results of this case report suggest that assessment and treatment of scapular musculature warrant consideration in the management of individuals with lateral epicondylalgia. LEVEL OF EVIDENCE Therapy, level 4.
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Papa JA. Two cases of work-related lateral epicondylopathy treated with Graston Technique® and conservative rehabilitation. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2012; 56:192-200. [PMID: 22997469 PMCID: PMC3430452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To chronicle the conservative treatment and management of two work-related cases of lateral elbow pain diagnosed as lateral epicondylopathy. CLINICAL FEATURES PATIENT 1: A 48-year old female presented with gradual onset of right lateral elbow pain over the course of six weeks related to work activities of repetitive flexion/extension movements of the wrist and finger keying. PATIENT 2: A 47-year old female presented with gradual onset of left lateral elbow pain over the course of four weeks related to work activities of repetitive squeezing and gripping. INTERVENTION AND OUTCOME The conservative treatment approach consisted of activity modification, bracing, medical acupuncture with electrical stimulation, Graston Technique®, and rehabilitative exercise prescription. Outcome measures included verbal pain rating scale (VPRS), QuickDASH Work Module Score (QDWMS), and a return to regular work activities. Both patients attained resolution of their complaints, and at eight month follow-up reported no recurrence of symptoms. CONCLUSION A combination of conservative rehabilitation strategies may be used by chiropractors to treat work-related lateral epicondylopathy and allow for individuals to minimize lost time related to this condition.
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Affiliation(s)
- John A Papa
- Private Practice, 338 Waterloo Street Unit 9, New Hamburg, Ontario, N3A 0C5. E-mail:
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Minaya Muñoz F, Valera Garrido F, Sánchez Ibáñez J, Medina i Mirapeix F. Estudio de coste-efectividad de la electrólisis percutánea intratisular (EPI®) en las epicondilalgias. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.ft.2012.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Herd CR, Meserve BB. A systematic review of the effectiveness of manipulative therapy in treating lateral epicondylalgia. J Man Manip Ther 2011; 16:225-37. [PMID: 19771195 DOI: 10.1179/106698108790818288] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Lateral epicondylalgia is a commonly encountered musculoskeletal complaint. Currently, there is no agreement regarding the exact underlying pathoanatomical cause or the most effective management strategy. Various forms of joint manipulation have been recommended as treatment. The purpose of this study was to systematically review available literature regarding the effectiveness of manipulation in treating lateral epicondylalgia. A comprehensive search of Medline, CINAHL, Health Source, SPORTDiscus, and the Physiotherapy Evidence Database ending in November 2007 was conducted. Thirteen studies, both randomized and non-randomized clinical trials, met inclusion criteria. Articles were assessed for quality by one reviewer using the 10-point PEDro scale. Quality scores ranged from 1-8 with a mean score of 5.15 +/- 1.85. This score represented fair quality overall; however, trends indicated the presence of consistent methodological flaws. Specifically, no study achieved successful blinding of the patient or treating therapist, and less than 50% used a blinded outcome assessor. Additionally, studies varied significantly in terms of outcome measures, follow-up, and comparison treatments, thus making comparing results across studies difficult. Results of this review support the use of Mulligan's mobilization with movement in providing immediate, short-, and long-term benefits. In addition, positive results were demonstrated with manipulative therapy directed at the cervical spine, although data regarding long-term effects were limited. Currently, limited evidence exists to support a synthesis of any particular technique whether directed at the elbow or cervical spine. Overall, this review identified the need for further high-quality studies using larger sample sizes, valid functional outcome measures, and longer follow-up periods.
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Fernández-Carnero J, Fernández-de-las-Peñas C, Cleland JA. Immediate Hypoalgesic and Motor Effects After a Single Cervical Spine Manipulation in Subjects With Lateral Epicondylalgia. J Manipulative Physiol Ther 2008; 31:675-81. [DOI: 10.1016/j.jmpt.2008.10.005] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 09/04/2008] [Accepted: 09/08/2008] [Indexed: 12/19/2022]
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