Manual Therapy Combined with Self-Stretching to Manage Heel Pain
PRP and lateral Epicondylitis – The (Re)search Continues
PRP Outperforms Corticosteroid Injections for Lateral Epicondylitis
Ajimsha MS, Chithra S, & Thulasyammal RP (2012). Effectiveness of Myofascial Release in the Management of Lateral Epicondylitis in Computer Professionals. Archives of Physical Medicine and Rehabilitation PMID: 22236639
Effectiveness of Myofascial Release in the Management of Lateral Epicondylitis in Computer Professionals
Ajimsha MS, Chithra S, Thulasyammal RP. Arch Phys Med Rehabil. 2012 Jan 9. [Epub ahead of print]
Myofascial release is the direct or indirect application of a long-duration (120 to 300 seconds), low-load stretch to restricted fascial layers and is intended to decrease pain and improve function. This technique is often used to treat patients with lateral epicondylitis but there is limited data to determine if it is an effective treatment for lateral epicondylitis symptoms. Therefore, Ajimsha et al conducted a randomized, controlled, single-blind trial (evaluators were blinded) among computer professionals with lateral epicondylitis to evaluate whether myofascial release reduces pain and functional limitations associated with lateral epicondylitis relative to a control group receiving sham ultrasound therapy. Participants had lateral elbow pain for more than 3 months, lasting greater than a day in the last 7 days, tenderness over the lateral elbow, and pain with active wrist extension. From the 78 computer professionals referred to the clinic, 68 patients were eligible and agreed to participate. Both groups were treated 3 times (30 minutes/session) per week for 4 weeks (at least 1 day between sessions). The myofascial release treatment consisted of 3 direct techniques that involved the application of pressure (directly on the fascia in the posterior (extensor aspect of the) on the forearm in accordance with previously described methods. For example, one technique involved the therapist using their knuckles “to work over the periosteum of the ulna. Patients were trained to do alternating ulnar and radial deviation of the wrist, while periosteum of ulna was engaged (5 min x 2 repetitions).” The techniques were performed by certified myofascial release practitioners. Pain severity and functional disability were based on the Patient-Rated Tennis Elbow Evaluation scale. Overall, the authors reported that the myofascial release group (n = 33) had less pain and functional disability than the control group (n = 32) at week 4 (immediately after the treatment course was over) and week 12 (3 participants did not complete the study; including 2 from the control group). The number of responders, defined as patients with at least a 50% reduction in their Patient-Rated Tennis Elbow Evaluation scale scores between baseline and week 4, was 100% among those receiving myofascial release treatments and 0% among the control group. Five participants in the myofascial release group reported an increase in symptoms after the first week of treatment but these complaints subsided in less than a week (neither group had any adverse outcomes).
This clinical trial is a nice first step demonstrating the benefits of myofascial release for lateral epicondylitis. It is not clear if these findings will apply to other patient populations (e.g., athletes) but the results are promising. While we wait for more data, it is comforting to note that there were no adverse outcomes with myofascial release. Myofascial release may be an interesting and safe treatment that we can integrate into our treatment plans for patients with lateral epicondylitis. It will be interesting to see how effective myofascial release is when compared between practitioners and to different treatment options (e.g., does myofascial release provide better treatment outcomes compared to our traditional intervention programs?). These future studies may allow us to determine if these techniques can be used by any clinician and if myofascial release is a better option than our current treatment approaches. I would also be curious to see more data assessing more outcome measures (e.g., grip strength). It is studies like this one that will help us determine the effectiveness of the treatments we are currently using. Hopefully, we will see more randomized clinical trials in sports medicine; especially, ones that compare treatments so we can determine how to optimize our treatment plans. Do you use myofascial release to treat lateral epicondylitis? If so, what are your experiences with this?
Written by: Jeffrey Driban
Reviewed by: Stephen Thomas