Elbow Evidence

Summary:

Manual therapy interventions for the elbow have been associated with improvements in pain and function in individuals with lateral epicondylalgia (LE).

Lateral Epicondylalgia (le):

One high quality randomized trial investigated the effectiveness of manual therapy interventions for the elbow on patients with LE. Bisset and colleagues compared three distinct conservative treatment approaches in individuals with LE. One group received a program of manual therapy (MT) interventions for the elbow combined with therapeutic exercises, another group received corticosteroid injections (CSI) and the third group was managed with a ‘wait and see’ approach. At 6 weeks the MT + exercise group rated their global improvement higher than the other 2 groups, but other outcomes such as pain-free grip strength and pain rating favored the CSI group. However, at long term follow up (1 year), all outcomes favored the MT and exercise group and the ‘wait and see’ group over the CSI group. Patients receiving CSI had a higher recurrence rate than the other two groups. Additionally, the MT + exercise group had the lowest medication usage among all three groups.

Vicenzino and colleagues conducted a post-hoc analyses (of the aforementioned study) to identify factors that could help predict individuals likely to respond favorably to a program of mobilization with movement (MWM) and exercise at 3-week follow up.  3 factors were identified and together formed the clinical prediction rule (CPR).  The factors identified were:

1) Age < 49 yea

rs

2) Pain-free grip strength

> 112N on the affected side

3) Pain free grip strength < 336N on the unaffected side 

Without attempt at prediction, the chance of patients achieving a successful outcome

was 79% and rose to 100% if patients had all 3 of these variables. This CPR has not been validated (Level IV Evidence).

• Bissett, 2006, BMJ
• Vicenzino, 2009, Man Ther
• Herd, 2008, J Man Manip Ther

Other Clinical Evidence:

• Slater, 2006, Man Ther
• Abbott, 2001, Man Ther
• Vicenzino, 2001, Man Ther

Other Relevant Evidence:

• Vicenzino, 2003, Man Ther
• Vicenzino, 2007, J Man Manip Ther