Elsevier

Journal of Hand Therapy

Volume 21, Issue 1, January–March 2008, Pages 4-14
Journal of Hand Therapy

Scientific/Clinical Article
The Effect of Oscillating-energy Manual Therapy on Lateral Epicondylitis: A Randomized, Placebo-control, Double-blinded Study

https://doi.org/10.1197/j.jht.2007.09.005Get rights and content

Abstract

Symptoms of lateral epicondylitis (LE) are attributed to degenerative changes and inflammatory reactions in the common extensor tendon induced by microscopic tears in the tissue after repetitive or overload functions of the wrist and hand extensor muscles. Conventional treatments, provided on the premise of inflammatory basis of LE, have shown 39–80% failure rate. An alternative approach suggests that symptoms of LE could be due to active tender points developed in the origin of hand and wrist extensor muscles after overuse or repetitive movements. Oscillating-energy Manual Therapy (OEMT), also known as V-spread, is a craniosacral manual technique that has been clinically used for treating tender points over the suture lines in the skull. Considering symptoms of LE may result from active tender points, the purpose of this study was to investigate the effect of OEMT on pain, grip strength, and functional abilities of subjects with chronic LE. Twenty-three subjects with chronic LE (>3 mo) between ages of 24 and 72 years participated in this study. Before their participation, all subjects were screened to rule out cervical and other pathologies that could possibly contribute to their lateral elbow pain. Subjects who met the inclusion criteria were randomized into treatment and placebo treatment groups by a second (treating) therapist. Subjects were blinded to their group assignment. Subjects in the treatment group received OEMT for six sessions. During each treatment session, first a tender point was located through palpation. After proper hand placement, the therapist focused the direction of the oscillating energy on the localized tender point. Subjects in the placebo group underwent the same procedure, but the direction of the oscillating energy was directed to an area above or below the tender points, not covering the affected area. Jamar Dynamometer, Patient Specific Functional Scale (PSFS), and Numeric Rating Scale (NRS) were used to measure grip strength, functional status, and pain intensity and limited activity due to pain, respectively. The screening therapist who was blinded to the subjects' group assignment performed pretest, posttest, and six-month follow-up measurements. Subjects in the treatment group showed both clinically and statistically significant improvement in grip strength (p = 0.03), pain intensity (p = 0.006), function (p = 0.003), and limited activity due to pain (p = 0.025) compared with those in the placebo group. Follow-up data, collected after six months, showed no significant difference between posttest and follow-up measurements in functional activity (p = 0.35), pain intensity (p = 0.72), and activity limitation due to pain (p = 0.34). Of all the subjects contacted for follow-up assessment, 91% maintained improved function and 73% remained pain free for at least six months. OEMT seems to be a viable, effective, and efficient alternative treatment for LE.

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

  • #2.

    The subjects

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    • Management of Chronic Lateral Epicondylitis With Manual Therapy and Local Cryostimulation: A Pilot Study

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      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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