Highlights
- •Novel approach, a regional interdependence model, to reduce symptoms of upper extremity musculoskeletal overuse in populations at risk by addressing a broader systematic approach versus a localized symptom driven approach for the assessment and treatment of lateral elbow pain.
- •“Think in nerve length and layers”- accounts for nerve tension and muscle balance in the entire extremity.
- •Application of the “Think in nerve length and layers” model for assessment and treatment of SRSN irritation in individuals with lateral elbow pain and proposal of a method for treatment and for further studies.
- •The proposed treatment approach combines mobilization with movement, elastic taping, and isometric exercises to address impairment at each level: joint alignment, neural tension, and the superficial sensory nervous system.
Abstract
Background
Lateral elbow pain is a prevalent musculoskeletal overuse disorder that has serious
consequences for musculoskeletal health, occupational performance, and overall healthcare
burden. Available treatment options (traditional therapy and steroid injections) have
been studied rigorously, yet supporting evidence is weak. The majority of treatment
options available are targeted at the local pathology of the common extensor tendon
as the apparent source of pain, and do not adequately address the cause, the source
of overuse, and mechanism of injury.
Purpose
The purpose of this paper is to describe a novel approach, a regional interdependence
model, to reduce symptoms of upper extremity musculoskeletal overuse in populations
at risk by addressing a broader systematic approach versus a localized symptom driven
approach for the assessment and treatment of lateral elbow pain.
Methods
The proposed framework - Think in nerve length and layers (TINLL)- accounts for nerve
tension and muscle balance in the entire extremity. In this paper we describe the
application of the TINLL model for assessment and treatment of SRSN irritation in
individuals with lateral elbow pain and propose a method for treatment and for further
studies. The proposed treatment approach combines mobilization with movement, elastic
taping, and isometric exercises to address impairment at each level: joint alignment,
neural tension, and the superficial sensory nervous system.
Results
Our findings of reduced pain with a relatively small number of therapy sessions in
a small retrospective cohort of patients using the TINLL framework for assessment
and treatment supports further formal study of this approach in a larger cohort with
longer follow-up to determine effectiveness compared to current treatments.
Conclusion
Future studies will test and compare the efficacy of the TINLL framework and model
of treatment on the short- and long-term outcomes in individuals with chronic lateral
elbow pain compared to traditional therapy.
Keywords
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References
- Epidemiology and disease burden of lateral epicondylitis in the USA: analysis of 85,318 patients.HSS J. 2018; 14: 9-14https://doi.org/10.1007/s11420-017-9559-3
- [Epidemiological profile of lateral epicondylitis in rehabilitation department].Pan Afr Med J. 2020; 36: 265https://doi.org/10.11604/pamj.2020.36.265.21403
- Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: a systematic review.Br J Sports Med. 2014; 48: 957-965https://doi.org/10.1136/bjsports-2012-091513
- Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review.Br J Sports Med. 2013; 47: 1112-1119https://doi.org/10.1136/bjsports-2012-091990
- Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials.Br J Sports Med. 2020; (Published online November 4)https://doi.org/10.1136/bjsports-2020-102525
- The initial effects of a Mulligan's mobilization with movement technique on range of movement and pressure pain threshold in pain-limited shoulders.Man Ther. 2008; 13: 37-42https://doi.org/10.1016/j.math.2006.07.011
- [Shoulder joint pain of rotator cuff injury treated with electroacupuncture and Mulligan's mobilization: a randomized controlled trial].Zhongguo Zhen Jiu. 2018; 38: 17-21https://doi.org/10.13703/j.0255-2930.2018.01.004
- Radial nerve excursion and strain at the elbow and wrist associated with upper-extremity motion.J Hand Surg Am. 2005; 30: 990-996https://doi.org/10.1016/j.jhsa.2005.06.008
- Dynamic glenohumeral joint stability.J Shoulder Elbow Surg. 1998; 7: 43-52https://doi.org/10.1016/s1058-2746(98)90182-3
- Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes.Int J Sports Phys Ther. 2011; 6: 51-58
- Surgical approach to the proximal end of the radius and its use in fractures of the head and neck of the radius.JBJS. 1941; 23: 86-92
- The dynamic anatomy and patterning of skin.Exp Dermatol. 2016; 25: 92-98https://doi.org/10.1111/exd.12832
- Investigating the effects of neuromobilization in lateral epicondylitis.J Hand Ther. 2020; 13 (Published online November)https://doi.org/10.1016/j.jht.2020.11.003
- Lateral epicondylitis in tennis: update on aetiology, biomechanics and treatment.Br J Sports Med. 2007; 41: 816-819https://doi.org/10.1136/bjsm.2007.036723
- Medial elbow joint laxity in professional baseball pitchers. A bilateral comparison using stress radiography.Am J Sports Med. 1998; 26: 420-424https://doi.org/10.1177/03635465980260031301
- Mulligan's mobilization-with-movement, positional faults and pain relief: current concepts from a critical review of literature.Man Ther. 2007; 12: 98-108https://doi.org/10.1016/j.math.2006.07.012
- The initial effects of an elbow mobilization with movement technique on grip strength in subjects with lateral epicondylalgia.Man Ther. 2001; 6: 163-169https://doi.org/10.1054/math.2001.0408
- The effects of Mulligan mobilisation with movement and taping techniques on pain, grip strength, and function in patients with lateral epicondylitis.Hong Kong Physiother J. 2010; 28: 19-23https://doi.org/10.1016/j.hkpj.2010.11.004
- The effects of new taping methods designed to increase muscle strength.J Phys Ther Sci. 2017; 29: 70-74https://doi.org/10.1589/jpts.29.70
- The effect of Kinesio Taping on handgrip strength.J Phys Ther Sci. 2015; 27: 567-570https://doi.org/10.1589/jpts.27.567
- Immediate effect of forearm Kinesio taping on maximal grip strength and force sense in healthy collegiate athletes.Phys Ther Sport. 2010; 11: 122-127https://doi.org/10.1016/j.ptsp.2010.06.007
- Comparing the effectiveness of Mulligan mobilization versus Cyriax approach in the management of patients with subacute lateral epicondylitis.J Pak Med Assoc. 2021; 71: 12-15https://doi.org/10.47391/JPMA.186
JHT Read for Credit
Quiz: # 759
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- # 1.The authors are justifiably
- a.advocating EMG NCV testing for most patients with lateral elbow pain
- b.promoting the Mayo Clinic System of addressing lateral elbow pain
- c.enthusiastic about the standard techniques of managing lateral elbow pain
- d.skeptical of the standard techniques of managing lateral elbow pain
- a.
- # 2.The SRSN is especially vulnerable because it
- a.courses through the cubital tunnel
- b.lies deep to the extensor wad
- c.sits in close proximity to the radial head
- d.has a low threshold for overload
- a.
- # 3.Their proposed intervention includes
- a.isometric exercise
- b.elastic taping
- c.mobilization with movement
- d.all of the above
- a.
- # 4.The proposed method was implemented
- a.in a case series
- b.on a limited cohort
- c.in RCTs
- d.for 3 years with 50 patient subjects
- a.
- # 5.The recommended program is based on thinking in layers and length
- a.not true
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: June 03, 2021
Accepted:
May 27,
2021
Received:
May 16,
2021
Footnotes
Conflict of interest: All named authors hereby declare that they have no conflicts of interest to disclose.
Research Institution: Hospital for Special Surgery.
Identification
Copyright
© 2021 Published by Elsevier Inc.
