Test your knowledge: Lateral epicondylitis of the elbow
Lateral epicondylitis or tennis elbow is a musculoskeletal disorder, which is commonly seen in everyday practice. There are several treatment strategies: mobilization of the cervicothoracic spine, Mill’s manipulation, techniques for releasing the connective tissue, stretch techniques, carpal bone mobilizations/manipulations, isometric and eccentric exercise etc. Sometimes also Extracorporeal Shock Wave Therapy (ESWT) is used, when a calcification is the cause of lateral elbow pain.
One particular manual therapy technique that has been receiving considerable attention in the literature is Mulligan’s Mobilization with Movement (MWM). It is a non-thrust manipulative technique. The patient is instructed to clench the fist of the painful arm. The therapist then provides a laterally directed glide to the humero-ulnar joint. Directing the lateral glide force somewhat posterior or directly lateral is most effective. The effect is a reduction of pain when it is repeated 6-10 times with 6-10 seconds of lateral glide force.
- Are you familiar with this technique?
- Based on rationale, what could be the mechanism behind pain reduction? (Open discussion)
(Video taken from: youtube.com)
A possible explanation for lateral elbow pain is a positional fault* (see below for explanation) in the humero-ulnair joint, probably due to the overuse of the extensor muscles of the forearm (Mulligan’s statement). This produces a mechanical alteration, leading to joint dysfunction and pain, which can be corrected by the use of appropriately directed mobilization techniques. Sometimes, immediate pain relief and return to function is achieved.
It is thought that degenerative rather than inflammatory mechanisms play a major role in the pathogenesis of lateral elbow pain. Mobilization with movement produces a non-opioid form of analgesia that leads to an immediate reduction in pain and improvement in function which is characterized by significant increase in pain free grip strength.
*Positional fault theory Mulligan:
– Joint alignment alteration due to injury or chronic/poor arthokinematics
- a tracking problem in the joint
- a displacement of the instantaneous axis of rotation.
– Inconsistent bony congruencies that occur after strain or injury
– Minor / subtle: Neither palpable nor evident on imaging?
– Movement restrictions -- pain results
– Responsible for movement restricted and painful joints
Want more information on this subject? Read this free full text article: Vicenzino et al., J Man Manip Ther 15 (2007) 50-56.