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

      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.
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      References

        • Ernst E.
        Conservative therapy for tennis elbow.
        Br J Clin Physiol. 1992; 46
        • Chop W.M.
        Tennis elbow.
        Postgrad Med. 1989; 86: 301-308
        • Levangie P.K.
        • Norkin C.C.
        Joint Structure and Function: A Comprehensive Analysis.
        F.A. Davis Company, Philadelphia, PA2001
        • Gabel G.
        Acute and chronic tendinopathies at the elbow.
        Curr Opin Rheumatol. 1999; 11: 138
        • Muirhead W.R.
        • Allen S.D.
        • DaSilva M.F.
        • Akelman E.
        Operative treatment of lateral epicondylitis.
        Curr Opin Orthop. 2001; 12: 348-352
        • Cyrix J.H.
        6th ed. Textbook of Orthopaedic Medicine: Treatment by Manipulation and Massage. Vol. 2. Harper & Row, New York1959
        • Greenbaum B.
        The pathoanatomy and histopathy of tennis elbow.
        Curr Opin Orthop. 2001; 12: 353-355
        • Nirschl R.P.
        Elbow tendinosis/tennis elbow.
        Clin Sports Med. 1992; 11: 851-870
        • Coonrad R.W.
        • Hooper W.R.
        Tennis elbow: its course, natural history, conservative and surgical measurements.
        J Bone Joint Surg. 1973; 53A: 1177-1182
        • Kivi P.
        The etiology and conservative treatment of humeral epicondylitis.
        Scand J Rehabil Med. 1982; 15: 37-41
        • Wadsworth T.G.
        Tennis elbow: conservative surgical and manipulative treatment.
        Br Med J. 1987; 294: 621-624
        • Solveborn S.A.
        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. 1997; 7: 229-237
        • Gordon R.
        • Chambers R.
        Surgical and nonsurgical treatment for athletic tendinopathy.
        Curr Opin Orthop. 2001; 12: 174-180
        • Cameron M.H.
        Physical Agents in Physical Rehabilitation: From Research to Practice.
        2nd ed. Saunders, St. Louis, MO2003
        • Stratford P.W.
        • Levy D.R.
        • Gauldie S.
        • Miseferi D.
        • Levy K.
        The evaluation of phonophoresis and friction massage as treatments for extensor carpi radialis tendinitis: a randomized controlled trial.
        Physiother Can. 1989; 41: 93-99
        • Binder A.
        • Hodge G.
        • Greenwood A.M.
        • Hazleman B.L.
        • Page Thomas D.P.
        Is therapeutic ultrasound effective in treating soft tissue lesions?.
        Br Med J. 1985; 290: 512-514
        • Struijs P.A.
        • Damen P.
        • Bakker E.W.
        • Blanevoort L.
        • Assendelft W.J.
        • van Kijjk C.N.
        Manipulation of the wrist for management of lateral epicondylitis: a randomized pilot study.
        Phys Ther. 2003; 83: 608-616
        • Drechsler W.I.
        • Knarr J.F.
        • Snyder-Mackler L.
        A comparison of two treatment regimens for lateral epicondylitis: a randomized trial of clinical interventions.
        J Sport Rehabil. 1997; 6: 226-234
        • Pienimaki T.T.
        • Pienimaki T.K.
        • Siira P.T.
        • Vanharanta H.
        Progressive strengthening and stretching exercises and ultrasound for chronic lateral epicondylitis.
        Physiotherapy. 1996; 82: 522-530
        • Hacker E.
        • Lundberg T.
        Is low energy laser treatment effective in lateral epicondylalgia.
        J Pain Symptom Manage. 1991; 6: 241-246
        • Lundberg T.
        • Abrahamsson P.
        • Haker E.
        A comparative study of continuous ultrasound, placebo ultrasound and rest in epicondylalgia.
        Scand J Rehabil Med. 1988; 20: 99-101
        • Struijs P.A.
        • Smidt N.
        • Arola H.
        • van Dijk C.N.
        • Buchbinder R.
        • Assendelft W.J.
        Orthotic devices for tennis elbow: a systematic review.
        Br J Gen Pract. 2001; 51: 924-929
        • Wadsworth C.T.
        • Neilsen D.H.
        • Burns L.T.
        • Krull J.D.
        • Thompson C.G.
        Effect of the counterforce armband and grip strength and pain in subjects with tennis elbow.
        J Orthop Sport Phys Ther. 1989; 11: 192-197
        • Wuori J.L.
        • Overend T.J.
        • Kramer J.F.
        • MacDermid J.
        Strength and pain measures associated with lateral epicondylitis bracing.
        Arch Phys Med Rehabil. 1998; 79: 832-836
        • Labelle H.
        • Guibert R.
        • Joncas J.
        • Newman N.
        • Fallaha M.
        • Rivard C.H.
        Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow.
        J Bone Joint Surg. 1992; 74-B: 646-651
        • Altay T.
        • Gunal I.
        • Ozturk H.
        Local injection treatment for lateral epicondylitis.
        Clin Orthop Relat Res. 2002; 1: 127-130
        • Verhaar J.A.
        • Walenkamp G.H.
        • van Mameren H.
        • Kester A.D.
        • van der Linden A.J.
        Local corticosteroid injection versus cyriax-type physiotherapy for tennis elbow.
        J Bone Joint Surg. 1995; 78-B: 128-132
        • Nirschl R.P.
        • Pettrone F.A.
        Tennis elbow. The surgical treatment of lateral epicondylitis.
        J Bone Joint Surg. 1979; 61: 832-839
        • Baker C.L.
        • Jones L.J.
        Arthroscopy of the elbow.
        Am J Sports Med. 1999; 27: 251-264
        • Grundberg A.B.
        • Dobson J.F.
        Percutaneous release of the common extensor origin for tennis elbow.
        Clin Orthop Relat Res. 2000; 376: 137-140
        • Cummings G.S.
        • Crutchfield C.A.
        • Barnes M.R.
        Orthopedic Physical Therapy Series: Soft Tissue Changes in Contractures.
        Stokesville Publishing Company, Atlanta1983
        • Chaitow L.
        Positional Release Techniques.
        Churchill Livingstone, Edinburgh, Scotland2002
        • Simons D.G.
        • Travell J.G.
        • Simons L.S.
        2nd ed. Travell & Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol. 1. Williams & Wilkins, Baltimore, MD1999
      1. Nourbakhsh MR, Fearon FJ. An alternative approach to treating lateral epicondylitis. A randomized, placebo-controlled, double blinded study. [under review]. Journal of Hand Therapy.

        • American Association of Colleges of Osteopathic Medicine
        (Available at:) (accessed Oct 27, 2007)
        • Chaitow L.
        Cranial Manipulation Theory and Practice, Osseous and Soft Tissue Approaches.
        Churchill Livingstone, London1999 (pp. 144–146)
        • Upledger J.E.
        Craniosacral Therapy.
        (18th printing) Eastland press, Seattle, WA1997 (pp. 74)
        • Hruby R.J.
        Craniosacral Osteopathic Technique: A Manual.
        2nd ed. The Institute for Osteopathic Studies, Okemos, MI1996 (pp. 43)
        • Oschman J.L.
        Polarity, therapeutic touch, magnet therapy and related methods.
        J Body Work Mov Ther. 1997; : 123-128
        • Hamilton G.F.
        • McDonald C.
        • Chenier T.C.
        Measurement of grip strength: validity and reliability of the sphygmomanometer and Jamar grip dynamometer.
        J Orthop Sports Phys Ther. 1992; 16: 215-218
        • Peolsson A.
        • Hedlund R.
        • Oberg B.
        Intra- and inter-tester reliability and reference values for hand strength.
        J Rehabil Med. 2001; 33: 36-41
        • Westaway M.D.
        • Stratford P.W.
        • Binkley J.M.
        The patient-specific functional scale: validation of its use in persons with neck dysfunction.
        J Orthop Sports Phys Ther. 1998; 27: 331-338
        • Chatman A.B.
        • Hyams S.P.
        • Neel J.M.
        • Binkley J.M.
        • Stratford P.W.
        • Shomberg A.
        • Stabler M.
        The patient-specific functional scale: measurement properties in patients with knee dysfunction.
        Phys Ther. 1997; 77: 820-829
        • Stratford P.
        • Gill C.
        • Westaway M.
        • Binkley J.
        Assessing disability and change on individual patients: a report of a patient specific measure.
        Physiother Can. 1995; 47: 258-263
        • Price D.D.
        • Bush F.M.
        • Long S.
        • Harkins S.W.
        A comparison of pain measurement characteristics of mechanical visual analog and simple numerical rating scales.
        Pain. 1994; 56: 217-226
        • Caraceni A.
        Evaluation and assessment of cancer pain and cancer pain treatment.
        Acta Anaesthesiol Scand. 2001; 45: 1067-1075
        • Spadoni G.F.
        • Stratford P.W.
        • Solomon P.E.
        • Wishart L.R.
        The evaluation of change in pain intensity: a comparison of the P4 and single-item numeric pain rating scales.
        J Orthop Sports Phys Ther. 2004; 34: 187-193
        • Magee D.J.
        Orthopedic Physical Assessment.
        4th ed. Saunders, Philadelphia, PA2002
        • Agur A.M.
        • Dalley A.F.
        Grant's Atlas of Anatomy.
        11th ed. Lippincott Williams and Wilkins, Philadelphia, PA2005
        • Pienimaki T.
        • Tarvainen T.
        • Siira P.
        • Malmivaara A.
        • Vanharanta H.
        Associations between pain, grip strengths, and manual tests in the treatment evaluation of chronic tennis elbow.
        Clin J Pain. 2002; 18: 164-170
        • Vicenzino B.
        Lateral epicondylalgia: a musculoskeletal physiotherapy perspective.
        Man Ther. 2003; 8: 66-79
        • Baskurt F.
        • Ozcan A.
        • Algun C.
        Comparison of the effects of phonophoresis and iontophoresis of naproxen in the treatment of lateral epicondylitis.
        Clin Rehabil. 2003; 17: 96-100
        • Vicenzino B.
        • Paungmali A.
        • Buratowski S.
        • Wright A.
        Specific manipulative therapy treatments for chronic lateral epicondylalgia produces uniquely characteristic hypoalgesia.
        Man Ther. 2001; 6: 205-212
        • Vicenzino B.
        • Brooksbank J.
        • Minto J.
        • Offord S.
        • Paungmali A.
        Initial effects of elbow taping on pain-free grip strength and pressure pain threshold.
        J Orthop Sports Phys Ther. 2003; 33: 400-407
        • Svernlov B.
        • Adolfsson L.
        Non-operative treatment regime including eccentric training for lateral humeral epicondylalgia.
        Scand J Med Sci Sports. 2001; 11: 328-334
        • Abbott J.H.
        • Patla C.E.
        • Jensen R.H.
        The initial effects of an elbow mobilization with movement technique on grip strength in subjects with lateral epicondylalgia.
        Man Ther. 2001; 6: 163-169
        • Green S.
        • Buckbinder R.
        • Barnsley L.
        • Hall S.
        • White M.
        • Smidt N.
        • Assendelft W.
        Non-steroidal anti-inflammatory drugs (NSAID) for treating lateral elbow pain in adults.
        Cochrane Database Syst Rev. 2002; (CD003686)
        • Smidt N.
        • Assendelft W.J.
        • van der Windt D.A.
        • Hay E.M.
        • Buchbinder R.
        • Bouter L.M.
        Corticosteroid injections for lateral epicondylitis: a systematic review.
        Pain. 2002; 96: 23-40
        • Tsui P.
        • Leung M.C.
        Comparison of the effectiveness between manual acupuncture and elector-acupuncture on patients with tennis elbow.
        Acupunct Electrother Res. 2002; 27: 107-117
        • Newcomer K.L.
        • Laskowski E.R.
        • Idank D.M.
        • Mclean T.J.
        • Egan K.S.
        Corticosteroid injection in early treatment of lateral epicondylitis.
        Clin J Sports Med. 2001; 11: 214-222
        • Van De Streek M.D.
        • Van Der Schans C.P.
        • De Greef M.H.
        • Postema K.
        The effect of a forearm/hand splint compared with an elbow band as a treatment for lateral epicondylitis.
        Prosthet Orthot Int. 2004; 28: 183-189
        • Chung B.
        • Wiley J.P.
        Effectiveness of extracorporeal shock wave therapy in the treatment of previously untreated lateral epicondylitis: a randomized controlled trial.
        Am J Sports Med. 2004; 32: 1660-1667
        • Melikyan E.Y.
        • Shahin E.
        • Miles J.
        • Bainbridge L.C.
        Extracorporeal shock-wave treatment for tennis elbow. A randomize double blind study.
        J Bone Joint Surg Br. 2003; 85: 852-855
        • Brosseau L.
        • Casimiro L.
        • Milne S.
        • Robinson V.
        • Shea B.
        • Tugwell P.
        • Wells G.
        Deep traverse friction message for treating tendinitis.
        Update Cochrane Database Syst Rev. 2002; 1 (CD003528; PMID:11869672)
        • Jansen C.W.
        • Olson S.L.
        • Hasson S.M.
        The effect of use of wrist orthosis during functional activities on surface electromyography of the wrist extensors in normal subjects.
        J Hand Ther. 1997; 10: 238-289
        • Dowling D.J.
        Progressive inhibition of neuromuscular structures (PINS) technique.
        J Am Osteopath Assoc (JAOA). 2000; 100: 285-298
        • Michlovitz S.L.
        Thermal Agents in Rehabilitation.
        3rd ed. F.A. Davis Company, Philadelphia, PA1996 (pp. 222–227)
        • Aaron R.K.
        • Boyan B.D.
        • Ciombor D.M.
        • Schwartz Z.
        • Simon B.J.
        Stimulation of growth factor synthesis by electric and electromagnetic fields.
        Clin Orthop Relat Res. 2004; 419: 30-37
        • Darendeliler M.A.
        • Darendeliler A.
        • Sinclair P.M.
        Effects of static magnetic and pulsed electromagnetic fields on bone healing.
        Int J Adult Orthod Orthognath Surg. 1997; 12: 43-53
        • Aaron R.K.
        • Ciombor D.M.
        Therapeutic effects of electromagnetic fields in the stimulation of connective tissue repair.
        J Cell Biochem. 1993; 52: 42-46
        • Oschman J.L.
        Clinical aspects of biologic fields: an introduction for health care professionals.
        J Body Works Mov Ther. 2002; : 117-125
      2. Sickens BF, Walker J., Therapeutic aspects of electromagnetic fields for soft tissue healing. In Blank M (ed). Electromagnetic Fields: Biological Interactions and Mechanisms. Advances in Chemistry Series Vol. 250. American Chemical Society. Washington, DC. pp 277–285.

      JHT Read for Credit

      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 were evaluated with the following instruments
        • a.
          Jamar Dynamometer, MMT, and EMG
        • b.
          NRS, PSFS, and MMT
        • c.
          MMT, EMG, and PSFS
        • d.
          NRS, PSFS, and the Jamar Dynamometer
      • #3.
        At 6 months posttesting the subjects demonstrated ___vs scores at the end of treatment
        • a.
          a significant increase in function
        • b.
          a significant decrease in function
        • c.
          no significant change in function
        • d.
          significant anesthesia over the lateral elbow area
      • #4.
        At 6 months posttesting the subjects demonstrated ___vs scores at the end of treatment
        • a.
          an increase in pain
        • b.
          no significant change in pain
        • c.
          a decrease in pain
        • d.
          an increase in ROM
      • #5.
        The authors present conclusive evidence as to the pathological process responsible for the pain of lateral epicondylitis
        • a.
          true
        • b.
          false
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