Indian Journal of Physiotherapy & Occupational Therapy-An International Journal

Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

Neural Tissue Mobilisation Using ULTT2b and Radial Head Mobilisation v/s Exercise Programme in Lateral Epicondylitis


Affiliations
1 Department of Physiotherapy, Pad. Dr.D.Y.Patil University, Nerul, Navi Mumbai, India
     

   Subscribe/Renew Journal


Background & Purpose: Lateral epicondylitis has been associated with adverse neural tension in radial nerve. Research also implicates the affection of radial head in this condition. Exercise program advocates claim that it is the most effective treatment for lateral epicondylitis. Thus comparison between Exercises alone and Neural tissue mobilisation along with Radial head mobilisation seems to give an insight into its different treatment strategy.

Methodology: Total 40 subject with lateral epicondylitis were recruited. They were divided in 2 groups. 20 in Experimental Group and 20 in Control Group. In Experimental group, NDS + Radial Head Mobilisation + Exercise programme was given and in Control group only Exercise programme was given to the patient. The outcome measures were Visual Analogue Scale (VAS), Pain Free Grip Strength (GS), Pain Pressure Threshold (PPT) and Patient Rated Tennis Elbow Evaluation Questionnaire (PRTEE) were assessed Pre and Post treatment. Duration of treatment was 4 days/ week for 4 weeks.

Results: Experimental group, have shown that Mulligan's MWM to Radial head and Neural tissue mobilisation have found to achieve favourable outcome as compared to exercise group and even Exercise group, have been shown to have significant effects.

Conclusion: Neural tissue mobilization along with radial head mobilization was found to have a favourable outcome as compared to exercise programme.


Keywords

Tennis Elbow, NDS, Mulligan Mobilisation, Exercises
Subscription Login to verify subscription
User
Notifications
Font Size


  • Abbott JH, Patla CE, Jensen RH. The initial effects of an elbow mobilisation with movement technique on grip strength in subjects with lateral epicondylalgia. Man Ther 2001; 6:163–9.

  • Allander E. Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes. Scand J Rheumatol 1974; 3:145–53.

  • B Vicenzino and A. Wright. Effects of novel manipulative physiotherapy technique on tennis elbow: a single case study. Manual therapy (1995) 1, 30-35.

  • B Vicenzino. Lateral epicondylalgia: a musculoskeletal physiotherapy perspective. Manual therapy (2003) 8(2), 66-79.

  • Bisset, L., et al., A systematic review and metaanalysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005; 39(7):411-422.

  • Butler DS, Gifford L. The concept of adverse mechanical tension in the nervous system, part 1: testing for dural tension. Australian Journal of Physiotherapy.1989 ; 75: 623–636.

  • Butler DS. Mobilisation of the Nervous System. New York, NY: Churchill Livingstone Inc; 1991.

  • Butler DS. The Sensitive Nervous System. Adelaide, Australia: Noigroup Publications, 2000.

  • Butler DS, Shacklock MO, Slater H. Treatment of altered nervous system mechanics. In: Boyling J, Palastanga N, eds. Grieve’s Modern Manual Therapy: The Vertebral Column. 2nd ed. Edinburgh, UK: Livingston Churchill, 1994: 693–703.

  • Calvin WH, Devor M, Howe JF. Can neuralgias arise from minor demyelination? Spontaneous firing, mechanosensitivity, and after discharge from conducting axons. Exp Neurol. 1982; 75: 755–763.

  • Chard MD, Cawston TE, Riley GP, et al. Rotator cuff degeneration and lateral epicondylitis: a comparative histological study. Ann Rheum Dis. 1994 ; 53:30–34.

  • Coonrad R, Hooper W. Tennis elbow: its course, natural history, conservative and surgical management. J Bone Joint Surg (Am) 1973; 55: 1177–82.

  • Coonrad RW, Hooper WR. Tennis elbow: its course, natural history, conservative and surgical management. J Bone Joint Surg Am. 1973; 55:1177–1182.

  • David S.Butler. Adverse Mechanical Tension in the Nervous System: A Model for Assessment and Treatment. The Australian Journal of Physiotherapy. Vol.35, No.4, 1989.

  • Devereaux MD, Hazleman BL, Page Thomas P. Chronic lateral humeral epicondylitis – a doubleblind controlled assessment of pulsed electromagnetic field therapy. Clin Exp Rheumatol 1985; 3:333–6.

  • Ebbets J. Autonomic pain in the upper limb. Physiotherapy. 1971; 57:270–275.

  • Elvey RL. Treatment of arm pain associated with abnormal brachial plexus tension. Australian Journal of Physiotherapy. 1986; 32:225–230.

  • Gabel GT. (1999) Acute and chronic tendinopathies at the elbow. Curr Opinion Rheumatol. 11:138–143.

  • Gifford L. Neurodynamics. In: Pitt-Brooke J, Reid H, Lockwood J, Kerr K, eds. Rehabilitation of Movement. London, UK: WB Saunders Company Ltd, 1998:159–195.

  • Gruchow HH, Pelletier BS. An epidemiologic study of tennis elbow: incidence, recurrence and effectiveness of prevention strategies. Am J Sports Med 1979; 7: 2348.

  • Gunn CC, Milbrandt WE. Tennis elbow and the cervical spine. Can Med Assoc J.1976; 114:803– 809.

  • Hamilton PG. The prevalence of humeral epicondylitis: a survey in general practice. J R Coll Gen Pract 1986; 36:464–5.

  • Hutchinson MR, Laprade RF, Burnett QM, Moss R, Terpstra J. Injury surveillance at the USTA Boys’ Tennis Championships: a 6-year study. Med Sci Sports Exerc 1995; 27:826–30.

  • Johnston J, Plancher KD, Hawkins RJ. Elbow injuries to the throwing athlete. Clin Sports Med.1996; 15:307–329.

  • Khan K, Cook J, Taunton J, et al. Overuse tendonosis, not tendonitis: a new paradigm for a difficult clinical problem. Physician Sportsmed 2000; 28:38-48.

  • Khan KM, Cook JL, Kannus P, et al. Time to abandon the word tendonitis myth. Br Med J 2002; 324:626-7.

  • Kitteringham C. The effect of straight leg raise exercises after lumbar decompression surgery: A pilot study. Physiotherapy 1996; 82:115–123.

  • Kivi P. The etiology and conservative treatment of humeral epicondylitis. Scand J Rehabil Med 1982; 15:37–41.

  • Kuslich SD, Ulstrom CL, Michael CJ. The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am.1991; 22: 181–187.

  • Lee D. Tennis elbow: a manual therapist’s perspective. J Orthop Sports Phys Ther 1986; 8:134–42.

  • Maigne R. Orthopedic Medicine: A New Approach to Vertebral Manipulations. Liberson WT, trans-ed. Springfield, Ill: Charles C Thomas Publishers; 1972.

  • McLellan DL, Swash M. Longitudinal sliding of the median nerve during movements of the upper limb. J Neurol Neurosurg Psychiatry.1976; 39:566–570.

  • Nirschl R. Elbow tendinosis/tennis elbow. Clin J Sports Med (Am) 1992; 11:851–70.

  • Nirschl R, Pettrone F. Tennis elbow: the surgical treatment of lateral epicondylitis. J Bone Joint Surg (Am) 1979; 61:832.

  • Ohberg L, Lorentzen R, Alfredsons H. Eccentric training in patients with Achilies tendinosis: normalised tendon structure and decreased thickness at follow-up. Br J Sports Med 2004; 38: 8-11.

  • Paungmali A, O’Leary S, Souvlis T, Vicenzino B. Hypoalgesic and sympathoexcitatory effects of mobilisation with movement for lateral epicondylalgia. Phys Ther 2003; 83:374–83.

  • Peanchai Khamwong, Kazunori Nosaka. Reliability of muscle function and sensory perception measurements of the wrist extensors. Physiotherapy Theory and Practice, 26(6), 408-415.

  • Potter HG, Hannafin JA, Morwessel RM, et al. Lateral epicondylitis: correlation of MR imaging, surgical, and histopathologic findings. Radiology.1995; 196:43–46.

  • Rehab for Tennis Elbow: The Super 7. Tim L. Uhl, P.T., A.T.C.

  • Robert A.Donatelli. Orthopaedic Physical Therapy. Third Edition.

  • Robert J. Nee a, David Butler b. Management of peripheral neuropathic pain: Integrating neurobiology, neurodynamics, and clinical evidence. Physical Therapy in Sport 7 (2006) 36– 50.Robert A.Donatelli. Orthopaedic Physical Therapy. Third Edition.

  • Roles NC, Maudsley KH. Radial tunnel syndrome: resistant tennis elbow as nerve entrapment. J Bone Joint Surg Br.1972; 54:499– 508. (24)

  • Rompe JD, Hopf C, Kullmer K, Heine J, Burger R. (1996) Analgesic effect of extracorporeal shockwave therapy on chronic tennis elbow. J Bone Joint Surg. 78B:233-237.

  • Shacklock M 2005a. Clinical Neurodynamics: a new system of musculoskeletal treatment. Elsevier, Oxford.

  • Shacklock MO. Neurodynamics. Physiotherapy 1995; 81:9–16.

  • Shacklock MO. Clinical Neurodynamics: A New System of Neuromusculoskeletal Treatment. Oxford, UK: Butterworth Heinemann, 2005.

  • Smidt N, van der Windt D, Assendelft W, Deville W, Korthalsde Bos I, Bouter L. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomized controlled trial. Lancet 2002; 359:657–62.

  • Verhaar J. Tennis elbow. Anatomical, epidemiological and therapeutic aspects. Int Orthop 1994; 18:263–7.

  • Wilgis EF, Murphy R. The significance of longitudinal excursion in peripheral nerves. Hand Clin. 1986; 2:761–766.

  • Vicenzino B, Wright A. Lateral epicondylalgia. 1: Epidemiology, pathophysiology, aetiology and natural history. Phys Ther Rev 1996; 1:23–34.

  • Wall and Melzack’s. Textbook of Pain. 5th Edition.

  • Yaxley GA, Jull GA. Adverse tension in neural system: a preliminary study of tennis elbow. Australian Journal of Physiotherapy. 1993; 39: 15-22.

  • Zuluaga, Sports physiotherapy.


Abstract Views: 1190

PDF Views: 0




  • Neural Tissue Mobilisation Using ULTT2b and Radial Head Mobilisation v/s Exercise Programme in Lateral Epicondylitis

Abstract Views: 1190  |  PDF Views: 0

Authors

Ajit S. Dabholkar
Department of Physiotherapy, Pad. Dr.D.Y.Patil University, Nerul, Navi Mumbai, India
Vanita M. Kalbande
Department of Physiotherapy, Pad. Dr.D.Y.Patil University, Nerul, Navi Mumbai, India
Sujata Yardi
Department of Physiotherapy, Pad. Dr.D.Y.Patil University, Nerul, Navi Mumbai, India

Abstract


Background & Purpose: Lateral epicondylitis has been associated with adverse neural tension in radial nerve. Research also implicates the affection of radial head in this condition. Exercise program advocates claim that it is the most effective treatment for lateral epicondylitis. Thus comparison between Exercises alone and Neural tissue mobilisation along with Radial head mobilisation seems to give an insight into its different treatment strategy.

Methodology: Total 40 subject with lateral epicondylitis were recruited. They were divided in 2 groups. 20 in Experimental Group and 20 in Control Group. In Experimental group, NDS + Radial Head Mobilisation + Exercise programme was given and in Control group only Exercise programme was given to the patient. The outcome measures were Visual Analogue Scale (VAS), Pain Free Grip Strength (GS), Pain Pressure Threshold (PPT) and Patient Rated Tennis Elbow Evaluation Questionnaire (PRTEE) were assessed Pre and Post treatment. Duration of treatment was 4 days/ week for 4 weeks.

Results: Experimental group, have shown that Mulligan's MWM to Radial head and Neural tissue mobilisation have found to achieve favourable outcome as compared to exercise group and even Exercise group, have been shown to have significant effects.

Conclusion: Neural tissue mobilization along with radial head mobilization was found to have a favourable outcome as compared to exercise programme.


Keywords


Tennis Elbow, NDS, Mulligan Mobilisation, Exercises

References