Exercises for Epicondylalgia

[bmc]

Hi all,

I have a question regarding rehabilitation exercises for a patient with bilateral lateral epicondylalgia who is responding very well to Mulligan lateral glide technique (lateral glides of the proximal Ulna on a stabilised humerus).

This patient works as a carpenter and has had severe (8-10/10) bilateral pain for six months- so much so that he couldn't even hold a hammer let alone hit anything with it...

Before he came to see me he had tried soft tisse release, accupuncture, shock wave therapy, strengthening exercises and stretching, all of which failed to relieve his symptoms or aggrivated them.

During my examination I found that a lateral glide of his ulna on the humerus almost completely took the pain away from specific gripping tests so I proceeded with a Mulligan lateral glide treatment and gave him a self glide as a home exercise.

I also treated his cervical spine with lateral gliges of C6.

On his second appointment he said that one elbow was much much better (1-2/10 and the other about 5/10). I am planning on continuing along this line of treatment whilst we are still getting good improvements and then moving to a specific rehabilitation execise program.

When I learned these treatment techniques (quite a few years now...) I remember there was an exercise that worked well in lateral epicondylalgia patients who responded to this treatment regime. I think it involved eccentric control of pronation but I can't remember exactly - can anyone out there give me a refresher

Thanks.

[R.E.I.K.I]

hi bmc,

I have question to you if I may, about the mobs you did for your pt. was it painful at the beginning when you start using it with him? 'coz I have pt. similar to yours but not as severe as your case, when did you get the result that the pain is decreasing, immediately in the same session or after X sessions?

I would like from any one to replay to your "eccentric control of the pronation" It seems useful

Thank you, bmc

[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