Scientific/Clinical ArticleThe Effect of Oscillating-energy Manual Therapy on Lateral Epicondylitis: A Randomized, Placebo-control, Double-blinded Study
Section snippets
Design of the Study
A randomized, placebo-controlled, double-blinded design was used in this study. Two separate physical therapists performed measurements and treatments. One (the examiner therapist) conducted all the examination and measurements and the other (treating therapist) performed the treatments. Subjects were first examined by the examiner therapist; then subjects were randomly assigned into treatment or placebo groups by the treating therapist. Randomization was performed by having subjects to draw a
Material
The following instruments were used in this study:
- 1.
A Calibrated Jamar Hand Dynamometer was used to measure grip strength in the affected arm in the standardized recommended position. The reliability and validity of this method have previously been established.40, 41 Grip strength was measured three times. The average value of the measurements was used for data analysis.
- 2.
An adopted PSFS was used to measure changes in subjects' functional abilities.42 The scale requires the subjects to list three
Reliability Assessment for PSFS
A test–retest reliability of the PSFS adapted for use with elbow injuries was conducted in ten subjects (seven males and three females). After the initial functional assessment, subjects were asked to complete a second PSFS survey at a different scheduled time before initiation of their treatment.
Screening Process and Group Assignment
Before their participation, all subjects were screened by an orthopedic clinical specialist for proper diagnosis of LE and for ruling out other pathologies that could possibly contribute to lateral
Subjects
Descriptive statistics related to the subjects in the treatment and placebo groups are presented in Table 1. Eleven subjects were randomly assigned to the treatment; and 12 subjects to the placebo group. It should be noted that, although not intentional, the sample recruited for this study represents a population of chronic LE subjects. The typical subject reported a mean duration of symptoms greater than 12 months. Therefore, the results may be limited to treatment of chronic LE. All subjects
Grip Strength
During grip, wrist extensor muscles originating from the lateral epicondyle work, as wrist fixators, in synergy with the finger flexor muscles.3, 49 The impairment of these muscles due to LE, therefore, could result in decreased grip strength.15, 16, 17, 19, 23, 50 In this study, subjects in the treatment group showed a significant improvement (p = 0.04) in grip strength (16% increase) after two weeks of treatment with OEMT. Other investigators, using conventional physical therapy treatments16, 23
Acknowledgment
The authors would like to thank the following graduate students at North Georgia College and State University for their assistance in this research: Alexis Gaines, Matthew R. Marchman, Leon Romero, and John Stuart.
Quiz: Article # 077
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue. There is only one best answer for each question.
- #1.
The subjects in this study were
- a.
consecutively assigned into 2 groups all of whom had lateral epicondylitis for less than 3 months
- b.
randomly placed into one of 2 groups all of whom had lateral epicondylitis for 3 months or longer
- c.
divided into 3 groups: a chronic, an acute, and a sub acute group
- d.
all treated with a steroid injection plus OEMT
- a.
- #2.
The subjects
References (72)
Elbow tendinosis/tennis elbow
Clin Sports Med
(1992)- et al.
Progressive strengthening and stretching exercises and ultrasound for chronic lateral epicondylitis
Physiotherapy
(1996) - et al.
A comparison of pain measurement characteristics of mechanical visual analog and simple numerical rating scales
Pain
(1994) Lateral epicondylalgia: a musculoskeletal physiotherapy perspective
Man Ther
(2003)- et al.
Specific manipulative therapy treatments for chronic lateral epicondylalgia produces uniquely characteristic hypoalgesia
Man Ther
(2001) - et al.
The initial effects of an elbow mobilization with movement technique on grip strength in subjects with lateral epicondylalgia
Man Ther
(2001) - et al.
Corticosteroid injections for lateral epicondylitis: a systematic review
Pain
(2002) Clinical aspects of biologic fields: an introduction for health care professionals
J Body Works Mov Ther
(2002)Conservative therapy for tennis elbow
Br J Clin Physiol
(1992)Tennis elbow
Postgrad Med
(1989)
Joint Structure and Function: A Comprehensive Analysis
Acute and chronic tendinopathies at the elbow
Curr Opin Rheumatol
Operative treatment of lateral epicondylitis
Curr Opin Orthop
The pathoanatomy and histopathy of tennis elbow
Curr Opin Orthop
Tennis elbow: its course, natural history, conservative and surgical measurements
J Bone Joint Surg
The etiology and conservative treatment of humeral epicondylitis
Scand J Rehabil Med
Tennis elbow: conservative surgical and manipulative treatment
Br Med J
Radial epicondylalgia (‘tennis elbow’): treatment with stretching or forearm band. A prospective study with long-term follow-up including range-of-motion measurements
Scand J Med Sci Sports
Surgical and nonsurgical treatment for athletic tendinopathy
Curr Opin Orthop
Physical Agents in Physical Rehabilitation: From Research to Practice
The evaluation of phonophoresis and friction massage as treatments for extensor carpi radialis tendinitis: a randomized controlled trial
Physiother Can
Is therapeutic ultrasound effective in treating soft tissue lesions?
Br Med J
Manipulation of the wrist for management of lateral epicondylitis: a randomized pilot study
Phys Ther
A comparison of two treatment regimens for lateral epicondylitis: a randomized trial of clinical interventions
J Sport Rehabil
Is low energy laser treatment effective in lateral epicondylalgia
J Pain Symptom Manage
A comparative study of continuous ultrasound, placebo ultrasound and rest in epicondylalgia
Scand J Rehabil Med
Orthotic devices for tennis elbow: a systematic review
Br J Gen Pract
Effect of the counterforce armband and grip strength and pain in subjects with tennis elbow
J Orthop Sport Phys Ther
Strength and pain measures associated with lateral epicondylitis bracing
Arch Phys Med Rehabil
Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow
J Bone Joint Surg
Local injection treatment for lateral epicondylitis
Clin Orthop Relat Res
Local corticosteroid injection versus cyriax-type physiotherapy for tennis elbow
J Bone Joint Surg
Tennis elbow. The surgical treatment of lateral epicondylitis
J Bone Joint Surg
Arthroscopy of the elbow
Am J Sports Med
Percutaneous release of the common extensor origin for tennis elbow
Clin Orthop Relat Res
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2017, Journal of Chiropractic MedicineCitation Excerpt :Pain-free grip measures did not improve in either group at any time point. The results obtained herein agree with those of other studies reporting a positive effect of soft-tissue therapy in the treatment of LE.1,20,28,47,48 The review conducted by Shmushkevich et al49 reported positive effects on pain perception and function (PRTEE scores) at the end of experiments and at long-term follow-ups while using either manual therapy or augmented soft-tissue mobilization.10,20,28
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