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26-09-2011 | Orthopaedics | Article

Cervical spine thrust manipulation ‘best’ for treating tennis elbow


Free abstract

MedWire News: Cervical spine thrust manipulation (CSM) should be considered as an effective treatment technique for patients with tennis elbow, say researchers.

The investigators compared the motor and hypoalgesic effects of a cervical versus thoracic spine thrust manipulation (TSM) technique on pressure pain threshold (PPT) and pain-free grip strength (PFGS) in patients with lateral epicondylalgia (LE).

They found that CSM produced greater changes in PPT than TSM, but no between-group differences were observed for PFGS.

"LE represents one of the most frequent musculoskeletal disorders of the upper extremity in the working population… with a prevalence of 1.3% with women, and individuals between the age of 45 and 54 years most likely to be afflicted," explain Josue Fernández-Carnero (Rey Juan Carlos University, Madrid, Spain) and colleagues.

"Studies have consistently demonstrated that manual therapy techniques may exert their effects through neurophysiologic mechanisms," they say. But no studies have compared the effects of CSM with TSM.

A total of 18 LE patients (aged 30-60 years) were randomly assigned to receive one treatment session of either CSM or TSM. LE was identified by the presence of two or more of the following: pain on palpation over the lateral epicondyle and the associated common extensor unit; pain on gripping a hand dynamometer; and pain with stretching or contraction of the wrist extensor muscles.

CSM was directed at the C5-C6 vertebral level; the patient was supine with the cervical spine in a neutral position. The patients in the TSM group received a thrust manipulation targeting the middle thoracic spine (T5-T6). The patient was supine with their arms crossed over their chest, and was instructed to clasp his/her hands to the opposite shoulder.

PPT over the lateral epicondyle of both elbows, PFGS on the affected arm, and maximum grip force (MGF) on the unaffected side were assessed preintervention and 5 minutes postintervention.

As reported in the Journal of Manipulative and Physiological Therapeutics, hypoalgesic but not motor effects occurred in favor of the CSM technique. Specifically, PPT scores increased by 35.1% for the affected side and 25.4% for the unaffected side in the CSM group, whereas the corresponding changes in the TSM group were 0.8% and -0.9%.

No significant differences for changes in PFGS and MGF were found between the CSM and TSM groups. However, both techniques did increase PFGS on the affected side, by 24.7% and 19.8% for the CSM and TSM techniques, respectively.

"Elbow pain and mechanical hyperalgesia are one of the principal clinical findings in patients with tennis elbow," say the authors. "Overall, the cervical treatment effect was superior to the thoracic treatment."

Fernández-Carnero et al conclude: "Future studies should continue to investigate if spinal manipulation results in a delta or C-fiber-mediated hypoalgesia."

By Nikki Withers

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