Hypoalgesic and Sympathoexcitatory Effects of Mobilization With Movement for Lateral Epicondylalgia

Abstract

Background and Purpose. Mulligan has proposed the use of mobilization with movement for lateral epicondylalgia. In this study, mobilization with movement for the elbow was examined to determine whether this intervention was capable of inducing physiological effects similar to those reported for some forms of spinal manipulation. Participants. Seven women and 17 men (mean ageϭ48.5 years, SDϭ7.2) with chronic lateral epicondylalgia participated in the study. Methods. A placebo, control, repeated-measures study was conducted to evaluate whether mobilization with movement at the elbow produced concurrent hypoalgesia and sympathoexcitation. Results. The treatment demonstrated an initial hypoalgesic effect and concurrent sympathoexcitation. Improvements in pain resulted in increased pain-free grip force and pressure pain thresholds. Sympathoexcitation was indicated by changes in heart rate, blood pressure, and cutaneous sudomotor and vasomotor function. Discussion and Conclusion. This study showed that a mobilization with movement treatment technique exerted a physiological effect similar to that reported for some spinal manipulations. M ulligan 1 has recently described an intervention in which a therapist applies a passive glide mobilization to a joint (usually an accessory motion) and sustains it while the client performs a physical task involving the limbs. The techniques, called "mobilization with movements" (MWM), are claimed to bring about improvements in pain and function immediately following their application in the clinic, 1 but there is a lack of experimental data reported in peer-reviewed publications. The MWM group of techniques are claimed to achieve this rapid improvement in persistent musculoskeletal pain states that have been recalcitrant to other forms of therapy. 2,3 To date, the postulated mechanism(s) of action of this treatment approach has focused on mechanical effects such as the restoration of bony positional faults. 4,5 The physiological effects have largely been ignored.Much of the research about manipulation over the past decade has not focused on evaluating the subluxation theory of spinal manipulation, but rather such research has concentrated on elucidating the physiological effects of spinal manipulations. 6 -13 Most of this research, however, has not dealt with the effects of the MWM technique. Several authors 6 -13 have reported data that have been interpreted as reflecting possible neurophysiologic mechanism(s) for hypothesized actions. Some studies 6,7 have shown that passive mobilization treatments of the cervical spine, techniques frequently used by physical therapists, may produce an initial hypoalgesia and concurrent excitation in the motor system and the sympathetic nervous system (SNS). 6,7 Any concurrent initial hypoalgesic and physiological effects have not been studied in manipulation of peripheral joints. Our study represents an initial investigation of the effect of a MWM treatment technique at the elbow A Paungmali, PT, MPT, is a doctoral student, Department of Physiot...

Effectiveness of Mulligan Mobilisation With Movement Compared to Supervised Exercise Program in Subjects With Lateral Epicondylitis

“…A Paungmali (2004) showed that MWM produces sensory input sufficient to recruit and activate descending pain inhibitory systems that result in some or all of the pain relieving effects. It produces hypoalgesic effects during and following its application, as well as sympathoexcitatory effect [8].…”

Chronic Lateral Epicondylalgia Does Not Exhibit Mechanical Pain Modulation in Response to Noxious Conditioning Heat Stimulus

“…Notwithstanding that it is not a candidate as an experimental test stimulus in assessing CPM, it is interesting to note that like PPT it did not change with the painful thermal conditioning stimulus. Both PFG and PPT have been shown to improve with some treatments (e.g., manual therapy 4,39 ). It is tempting to speculate that treatments that reduce deficits in PPT and PFG in LE might be doing so through stimulating an endogenous inhibitory mechanism, as suggested previously.…”

“…22,23 PFG strength was measured using a digital grip dynamometer (MIE, Medical Research, Leeds, UK) in a supine position with the tested elbow in relaxed extension and forearm pronated. 4,24 The PRTEE questionnaire was used as a standardized quantitative assessment of pain and disability. It has been shown to have excellent test-retest reliability (r=.93) and good correlation with other functional scales including the Disability of Arm and Shoulder (DASH) questionnaire (r=.87) in LE.…”

“…Lateral epicondylalgia (LE) is a painful and disabling musculoskeletal condition with significant individual and societal impact. [1][2][3][4] Though unilateral LE is described clinically as a localized peripheral musculoskeletal condition it exhibits characteristics of central sensitization. For example, there is evidence of lower pressure pain thresholds at remote sites, 3,5 and spinal cord hyperexcitability (reduced nociceptive flexion reflex threshold) 6 when compared to healthy controls that do not have pain.…”

Cyriax Physiotherapy Versus Phonophoresis with Supervised Exercise in Subjects with Lateral Epicondylalgia: A Randomized Clinical Trial

“…This technique was shown to result in increased pain-free grip, pressure pain threshold, as well as a sympathetic nervous system response as indicated with measures of skin conductance and blood flux. More recently, Paungmali et al 33 found similar results with improved pain-free grip, pressure pain threshold, and sympatho-excitation following mobilization with movement directed at the elbow. It should be noted that the above studies captured outcomes only immediately following treatment; therefore, no generalization can be made regarding long-term effects.…”