Scientific/Clinical Article| Volume 21, ISSUE 1, P4-14, January 2008

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


      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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      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.
        • b.
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