Multimodal approach to rehabilitation of the patients with lateral epicondylosis: a case series
The aim of our study was to verify the efficiency of the multimodal treatment with
mobilization with movement associated with eccentric strengthening, transverse massage
and stretching in the treatment of eight volunteers with symptoms of lateral epicondylosis.
According to Abbott and collaborators (2001]), the mobilization with movement is a manual therapy strategy that uses forces that
influence in the biomechanical joint alignment which can facilitate the desired movement.
In our study, the data obtained at the end of treatment using the visual analogue
scale (VAS), disabilities of the arm, shoulder, and hand (DASH) and patient-rated
tennis elbow evaluation (PRTEE) were effective and embodying the idea that mobilization
with movement is an effective technique when used in the treatment of lateral epicondylosis.
In this study, pain was assessed using VAS, an improve was noted in pain status of
the volunteers comparing before and after 12 sessions of treatment (p 0.01). Only
the fifth volunteer did not observe difference in pain relief, since the seventh volunteer
complained little pain at the beginning of treatment and after the treatment, the
pain was cured, and when the other volunteers observed, there was overall improvement
in pain symptoms.
Regarding PRTEE and DASH questionnaires obtained, both had a decrease in post-treatment
period with a statistical difference when comparing the pre and post treatment with
p value 0.01.
We must consider that we did not get an even better result, because the majority of
patients during the treatment period did not stop their occupational activities that
may be the offending agent of this injury. For this study, volunteers underwent a
multimodal approach corroborating the study of Gonzalez-Iglesias and collaborators
(2011]) that rehabilitated patients with lateral epicondylalgia with association techniques.
Herd and Meserve (2008]), conducted a systematic review to assess the effectiveness of manipulative therapy
in lateral epicondylitis, according to the authors the mobilization with movement
provides short and long term benefits in treated individuals.
Paungmali and collaborators (2003]), conducted a study to evaluate the effect Sympathoexcitatory and hypoalgesic the
mobilization with movement on the side of epicondylalgia, according to the authors,
MWM has a physiological effect similar to that seen in the manipulation of the spine.
Abbott (2001]), states that the MWM improves shoulder range of movement (ROM) in patients with
lateral epicondylitis, in the affected side and the unaffected side, according to
this author, the MWM can lead to decreased muscle tone mediated neurophysiologically.
Paungmali et al. (2006]) reported that the technique of mobilization with movement has rapid effect in reducing
immediate pain, followed by the progression of improved function. Corroborating with
these authors was observed improved function and pain of the volunteers treated this
search.
Agreement with our study Pagorek (Miller 2000]) reports that the benefit of this intervention in clinical practice is that it is
faster compared to other methods of treatment, requiring no additional equipment and
results in sudden attenuation of pain and improved function. In this study, it was
observed attenuation of pain and it made possible the development of eccentric exercise
associated with MWM. In the present study, we used the standardized weight 1 kgf,
this load was chosen because it is a low load and all the volunteers were able to
perform the task without that promotes pain after the session, in the course of weeks
there was an increase in the number of repetitions of the exercise.
However, Slater and collaborators (2006]) in their study showed there was no significant analgesic effects in the short term
in response to mobilization with movement, the present study the improvement in pain
was observed and hence improved function, since the volunteers were able to perform
exercise proposed when we conduct mobilization.
The eight volunteers reported improvement in pain during the performance of mobilization
with movement of the elbow. Since according to Vicenzino and collaborators (2001]), the MWM provides improved pain symptoms of patients, and infers that the improvement
in pain at the start of a rehabilitation program may accelerate the recovery or better
motivate the patient to persist in the proposed treatment program (Vicenzino 2003]).
Cullnane et al. (2014]) and Peterson et al. (2014]), report that eccentric exercise of extensor muscles of wrist and fingers, reduce
pain and improve grip strength in chronic individuals and suggest that these exercises
can be included as part of multimodal treatment of lateral epicondylitis, being that,
in present study was performed at multimodal methodology with eccentric exercise associated
with mobilization with movement. By contrast, Heijnders and Lin (2015]) reported the need for further studies to confirm the effectiveness established by
this technique and the size of the effect of eccentric exercise in lateral epicondylitis.
Fernández-Carnero and collaborators (2007], 2008]), They conducted a controlled clinical study and blind, to assess the presence of
active and latent trigger point in patients with lateral epicondylalgia, according
to these authors triggers points are present in the forearm muscles of the patients
and contribute in pain on the affected side. The current study corroborates the studies
cited above it was observed presence of point triggers on volunteers, so was held
inhibition of point triggers the extensor muscles of the wrist and fingers.
Our study had some limitations for the benefit of the results as absence of surface
electromyography, the dynamometer device as an aid to assess the pre and post treatment
and the number of volunteers. We suggest that there is a need conduct a randomized
clinical study using the techniques used in this study in different groups to observe
the effect of the interaction of these techniques in the rehabilitation in a greater
number of the patients with lateral epicondylosis.