Good Example Of Effectiveness Of Manual Therapy For Treatment Of Elbow Pain In Older Adult Literature Review

Nourbakksh, M. and F. Fearon. "The Effect of Oscillating Energy Manual Therapy on Lateral Epicondylitis: A randomized, placebo controlled, double blinded study." Journal of Hand Therapy (2008).
In this study, the authors did a research about the medical condition, lateral epicondylitis. Lateral epicondylitis is one of the many conditions in the elbow. It main involves the lateral epicondyle, which is the common origin of the extensor muscles of the wrist such as the extensor carpi radialis longus and brevis tendons, among others. The authors also investigated the effect of manual therapy on this medical condition. 23 subjects with chronic LE (greater than 3 months) were recruited between the ages of 24 and 72. The subjects were blinded. There are many types of manual therapy. In this case, the one that the authors used was the oscillation, a technique used in peripheral joint mobilization. The outcomes used in the study were the patient specific functional scale (PSFS), and the Numeric Rating Scale (NRS). Results showed that 91 percent of the subjects maintained an improved function with 73 percent had improved pain-free status post treatment. This can be interpreted as a highly positive result considering that the authors witness a 91 percent success rate in improving the outcomes of the respondents with elbow pain.
McClatchie, L., et al. "Mobilizations of the Asymptomatic Cervical Spine can Reduce Signs of Shoulder Dysfunction in Adults." Journal of Manual Therapy (2009): 369-374.
This study used a randomized controlled cross-over, blinded, and placebo-controlled trial to determine the effect of a manual therapy using lateral glide mobilization on the pain intensity upon shoulder abduction on patients who experience painful arc or particularly those with shoulder pain. There were a total of twenty one subjects recruited in the study. All of the subjects received both placebo and mobilization treatments. The outcome used was a pain using the visual analog scale (as the primary tool) to measure the intensity of the pain. Results of the study showed that joint mobilization indeed led to significant reductions on shoulder abduction painful arc and shoulder pain intensity suggesting that manual therapy may indeed expedite recovery of patients with joint muscular conditions.
Brooke, C., et al. "The Immediate Effects of Manual Massage on Power Grip Performance After Maximal Exercise in Health Adults." The Journal of Alternative and Complementary Medicine (2005).
In this study, the authors studied the effects of manual massage on the physical performance of patients with either a shoulder or elbow condition. Fifty two respondents were recruited for this study, with no mention of their age in the study using a suburban allied health school as their setting. The intervention used was a series of effleurage and friction massage on the prescribed area followed by at least five minutes of passive joint range of motion and then lastly followed by five minutes of non-intervention rest. The outcome measures used were power grip measurements using a dynamometer. Results showed that manual massage to the affected joints after maximal exercise can be associated with greater effects than non-massage treatments.
Bisset, L., et al. "A Systematic Review and Meta-Analysis of Clinical Trials on Physical Interventions for Lateral Epicondylalgia." British Journal of Sports Medicine (2005): 411-422.
This study was a systematic review of previously published studies starting from the year 2005 regarding the physical interventions used in patients diagnosed with tennis elbow. In the hierarchy of studies, systematic reviews and meta-analyses offer the highest level of evidence, closely followed next by randomized controlled trials. In this study, 76 studies were identified and 28 of which satisfied the minimum criteria for the analysis. The evidence suggested that the extracorporeal shock wave therapy (a non-manual therapy) is not an effective intervention in treating patients with tennis elbow suggesting that further research with long term follow up into manipulation (manual therapy) and exercise as treatments may be necessary.
Ulrich, S., et al. "Restoring Range of Motion via Stress Relaxation and Static Progressive Stretch in Posttraumatic Elbow Contractures." Journal of Shoulder and Elbow Surgery (2010): 196-201.
Slater, H., et al. "Effects of a Manual Therapy Technique in Experimental Lateral Epicondylalgia." Manual Therapy (2006): 107-117.
The intervention used in this study was mobilization with movement, which is essentially a type of manual therapy only that it incorporates movement while applying the manual forces. The objective was to determine its effectiveness in treating cases of lateral epicondylalgia. There were a total of twenty four subjects recruited as respondents in this study; 12 in the intervention group and 12 in the placebo group. Pain was the main outcome used. A visual analogue scale was used to measure the pain. Results showed that in both groups, DOMS (delayed onset muscle soreness) was recorded particularly on the lateral epicondyle (common origin of the extensor muscles of the wrist); both groups also reported a significant increase in the pain and soreness of their muscles as a response to the intervention, suggesting that mobilization with movement appeared to be ineffective in decreasing the pain of patients with lateral epicondylitis because it did not active mechanisms associated with force augmentation or analgesia in the subjects recruited in the study.
Vincenzino, B., J. Cleland and L. Bisset. "Joint Manipulation in the Management of Lateral Epicondylalgia: A Clinical Commentary." Journal of Manual and Manipulative Therapy (2007): 50-56.
Lateral epicondylitis has been characterized in the study as one of the most common elbow conditions that cause secondary complications such as limitation of joint range of motion in the elbow joint not only in the adolescent and adult populations who are sedentary but even for those who are continuously engaged in high impact activities. In the study, the author outlined the effects of joint manipulation in the clinical course of the disorder using a series of clinical commentaries. The author concluded that there exist evidences, both from previously published literatures and from the clinical commentaries that underlying physiological mechanisms coupled with joint manipulation could indeed lead to observed improvement son the clinical course of elbow conditions.
Higgs, Z. "Outcomes of Open Arthrolysis of the elbow without post-operative passive streatching." The Journal of Bone and Joint Surgery (2012): 348-352.
Passive joint stretching is one of the most common and most practical means of using manual therapy in rehabilitating an injured joint. Passive joint manipulation is often done so that currently available joint ROM can be maintained and so that contractures and other secondary complications of immobility can be prevented. In this study, the author investigated the effects of passive stretching of the elbow following an arthrolytic procedure. 81 adult patients were recruited as respondents, all of whom had sustained an intra-articular fracture involving the elbow under the same surgeon. The joint range of motion was the primary outcome that the author proposed to use. A senior physiotherapist was recruited to do the measuring procedures. In order to validate the research hypothesis, the author compared the changes in the respondents’ mean ROM measurement in all elbow motions starting from the time the passive stretching-based treatments started until the end of the study. Pain and functional outcome scores using the Disabilities of the Arm Shoulder and Hand questionnaire were also used as an accessory outcome. Results showed that passive stretching could indeed lead to great improvements on joint mobility especially on the stiffest of elbows. The mean range of movement improvement in the study improved from 69 to 109 degrees and the score in the assessment questionnaires used almost halved from 20 to 10 in majority of the patients. This study demonstrated that good results may be obtained by using passive stretching in the rehabilitation of patients with stiff elbows.
Guitton, T., A. Vranceanu and D. Ring. "Attitude Towards Stretch Pain of the Elbow after Radial Head Fracture." Shoulder and Elbow (2012): 127-130.
Liu, H., K. Wu and C. Chang. "Treatment of Complex Elbow Injuries with a Postoperative Custom Made Progressive Stretching Static Elbow Splint." The Journal of Trauma (2011): 1268-1272.
Trauma-related events are some of the most common causes of injuries to the elbow joint. In this study, the authors investigated the role of elbow splinting in conjunction with manual therapy in treating postoperative elbow injuries and complications. Over a period of five years, 14 adult patients with elbow fractures and or instability who also underwent surgery in the Far Easter Memorial hospital were studied, focusing on their response to a rehabilitation regiment featuring the use of a custom made static splint in conjunction with conventional manual therapy techniques. After reviewing the results retrospectively, the authors concluded that using elbow splints may prove to be more problematic than using plain manual therapies because they (splints) were associated with stiffness and in some cases, instability.
Loew, L., et al. "Deep Transverse Friction Massage for Treating Lateral Elbow or Lateral Knee Tendinitis." The Cochrange Database of Systematic Reviews (2014).
Deep transverse friction massage is one of the several PT interventions in muscular conditions. The objective of this study was to assess the harms and benefits of this particular treatment option in treating lateral elbow epicondylitis. Using a systematic review as the research design, the authors discussed numerous RCTs about the topic. In the first study, for example, the researchers focused on 40 adult subjects using deep transverse friction massage combined with phonophoresis versus the control group who received phonophoresis treatments only. Results of that study showed that the group that received the paired treatment got higher ratings on the outcome measures the researchers used. The authors of the larger systematic review concluded that deep transverse friction massage could indeed be a good alternative manual therapy choice in the rehabilitation of patients with lateral epicondylitis of the elbow.
Li, X., et al. "Therapeutic Effect of Electroacupuncture, massage, and blocking therapy on external humeral epicondylitis." Journal of Traditional Chinese Medicine (2014): 281-286.
The objective of this study was to compare two common therapeutic methods used in rehabilitating patients with lateral epicondylitis. A total of 86 adult patients were grouped into two, making a group comprised of 43 people each. The control group received manual massage with blocking therapy only while the other group received electroacupuncture with massage and blocking therapy. Over the span of 10 treatments, the outcomes of the two groups were compared, using the visual analogue scale and the Mayo elbow performance score before and at the 6th, 12th, and 24th months after the treatment in order to observe the total effective rate effectively. In the end, the authors found that both methods proved to be effective in the treatment of lateral epicondylitis although the combination in the intervention group’s effects lasted longer as proved by the patients’ responses after the 6th month, 12th, and 24th month post-treatment.

Works Cited

Bisset, L., et al. "A Systematic Review and Meta-Analysis of Clinical Trials on Physical Interventions for Lateral Epicondylalgia." British Journal of Sports Medicine (2005): 411-422.
Brooke, C., et al. "The Immediate Effects of Manual Massage on Power Grip Performance After Maximal Exercise in Health Adults." The Journal of Alternative and Complementary Medicine (2005).
Guitton, T., A. Vranceanu and D. Ring. "Attitude Towards Stretch Pain of the Elbow after Radial Head Fracture." Shoulder and Elbow (2012): 127-130.
Higgs, Z. "Outcomes of Open Arthrolysis of the elbow without post-operative passive streatching." The Journal of Bone and Joint Surgery (2012): 348-352.
Li, X., et al. "Therapeutic Effect of Electroacupuncture, massage, and blocking therapy on external humeral epicondylitis." Journal of Traditional Chinese Medicine (2014): 281-286.
Liu, H., K. Wu and C. Chang. "Treatment of Complex Elbow Injuries with a Postoperative Custom Made Progressive Stretching Static Elbow Splint." The Journal of Trauma (2011): 1268-1272.
Loew, L., et al. "Deep Transverse Friction Massage for Treating Lateral Elbow or Lateral Knee Tendinitis." The Cochrange Database of Systematic Reviews (2014).
McClatchie, L., et al. "Mobilizations of the Asymptomatic Cervical Spine can Reduce Signs of Shoulder Dysfunction in Adults." Journal of Manual Therapy (2009): 369-374.
Nourbakksh, M. and F. Fearon. "The Effect of Oscillating Energy Manual Therapy on Lateral Epicondylitis: A randomized, placebo controlled, double blinded study." Journal of Hand Therapy (2008).
Slater, H., et al. "Effects of a Manual Therapy Technique in Experimental Lateral Epicondylalgia." Manual Therapy (2006): 107-117.
Ulrich, S., et al. "Restoring Range of Motion via Stress Relaxation and Static Progressive Stretch in Posttraumatic Elbow Contractures." Journal of Shoulder and Elbow Surgery (2010): 196-201.
Vincenzino, B., J. Cleland and L. Bisset. "Joint Manipulation in the Management of Lateral Epicondylalgia: A Clinical Commentary." Journal of Manual and Manipulative Therapy (2007): 50-56.