Exercises for Epicondylalgia

[sdkashif]

This topic has already been discussed in the forum and you may have a look over the related tags for detail in this forum.

[bmc]

Hi R.E.I.K.I,

Thanks for your interest.

about the mobs you did for your pt. was it painful at the beginning when you start using it with him?

No actually the mobilisations were very pain relieving. I started with him in a slightly provoking position (gripping a bottle in slight wrist extension/ulnar deviation) which he reported was about a 5/10 on both arms. Application of the lateral glide using a treatment belt reduced the pain to 0/10 on one arm and 2/10 on the other. This pain reduction was initially only during the mobilisations, and pain returned after the end of the first treatment. The self-gliding technique however also reduced his symptoms and he did that on his own a number of times a day at home.

when did you get the result that the pain is decreasing, immediately in the same session or after X sessions?

There was a significant improvement in pain from the first to the second treatment. The gripping task that was a 5/10 on initial examination was down to 3/10 and he reported less pain during his daily activities.

As I mentioned, I did a few Mulligan technique courses a number of years ago and one of the important principles we were taught was that the techniques (in this case a MWM or mobilisation with movement) should be pain relieving. If you do not get a significant improvement in symptoms during the application of the MWM you will probably not have a great result with this technique. We were also told that if you are going to get a good result using these techniques it will be reasonably fast and obvious.

That is to say, they certainly are not something that works on everyone, but when thay do, they work really well.

Further details on this technique are available in the mulligan textbook (The Mulligan Concept: NAGs, SNAGs, MWMs, etc.) and there are a number of randomised controlled trials listed below that have investigated the use of MWMs for lateral epicondylalgia.


1. Kochar, M. (2002). Effectiveness of a specific physiotherapy regimen on patients with tennis elbow. Physiotherapy, 88(6), 333-341.

2. Vicenzino, B. (2001). Specific manipulative therapy treatment for chronic lateral epicondylalgia produces uniquely characteristic hypoalgesia. Manual Therapy, 6(4), 205-212.

3. Paungmali, A. (2003). Hypoalgesic and Sympathoexcitatory effects of Mobilization with Movement for lateral epicondylalgia. Physical Therapy, 83(4), 374-383

Cheers,
bmc