Comparison of Joint Mobilization with and without Repeated Active Motion on the Restricted Range of Motion in the Elbow Joint after Immobilization: A Randomized Clinical Trial

Mahsa Ahmadi; Cyrus Taghizadeh Delkhoush

doi:10.5812/koomesh-149349

Koomesh

Journal of Semnan University of Medical Sciences

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https://doi.org/10.69107/koomesh-149349

Comparison of Joint Mobilization with and without Repeated Active Motion on the Restricted Range of Motion in the Elbow Joint after Immobilization: A Randomized Clinical Trial

Author(s):

Mahsa Ahmadi¹,

Cyrus Taghizadeh Delkhoush^2,*

1Department of Physiotherapy, School of Rehabilitation Sciences, Semnan University of Medical Sciences, Semnan, Iran

2Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran

Koomesh:Vol. 26, issue 4; e149349

Published online:Jan 20, 2025

Article type:Research Article

How to Cite:Ahmadi M, Delkhoush C T. Comparison of Joint Mobilization with and without Repeated Active Motion on the Restricted Range of Motion in the Elbow Joint after Immobilization: A Randomized Clinical Trial.koomesh.2025;26(4):e149349.https://doi.org/10.69107/koomesh-149349.

Abstract

Background: The stress exerted on periarticular tissues through repeated active motion may contribute to preserving the acquired range of motion in the elbow joint after joint mobilization.
Objectives: The purpose of the present study was to compare the effects of joint mobilization with and without repeated active motion on the restricted range of motion in the elbow joint after prescribed immobilization for treating an elbow fracture.
Methods: Twenty-eight participants with a restricted range of motion in the elbow joint after prescribed immobilization for their elbow fracture were randomly assigned to either the intervention or control group. The intervention group received Maitland’s mobilization techniques every other day. It repeated active motion exercises daily for four weeks, in addition to routine physical therapy, while the control group received only Maitland’s mobilization techniques. The active ranges of elbow flexion/extension and forearm supination/pronation were measured using smartphone protractor software before, weekly during, and after the intervention. Additionally, the disability of the arm, shoulder, and hand questionnaire was scored before and after the four-week intervention.
Results: The range of all cardinal motions in the elbow joint significantly (P < 0.001) increased during and after the intervention compared to before the intervention in both groups. Additionally, the intervention group exhibited a significant difference in the range of elbow flexion (P < 0.001) and forearm pronation (P = 0.036) compared to the control group. The disability of the arm, shoulder, and hand questionnaire scores significantly improved in both groups (P < 0.001).
Conclusions: The present study revealed, for the first time, that daily repeated active motion within a restricted range of motion in the elbow joint after prescribed immobilization for treating an elbow fracture significantly maintains the acquired range of elbow flexion and forearm pronation through joint mobilization.

Keywords

References

1.
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2.
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Chinchalkar SJ, Szekeres M. Rehabilitation of elbow trauma. Hand Clin. 2004;20(4):363-74. [PubMed ID:15539093]. https://doi.org/10.1016/j.hcl.2004.06.004.
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Pathan P, Samal S. To study effect of Maitland mobilization and conventional treatment on management of tennis elbow. Int J Adv Res, Ideas Innovations Technol. 2018;4(3):1303-7.
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Pustovoit B, Pashkevych S, Beziazychna О, Parfaniuk T. Physical Therapy For Patients With Posttraumatic Elbow Contractures. Slobozhanskyi herald of science and sport. 2021;9(1):50-64.
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Belomazheva-Dimitrova S. Study of the effect of mobilization and muscleinhibitory techniques on an elbow arthrokinematics after conservative treatment of intra-articular fractures of the elbow joint. Sci Rep Physical Educ Sport. 2013;19:98-103.
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Cohen MS, Hastings H. Acute elbow dislocation: evaluation and management. J Am Acad Orthop Surg. 1998;6(1):15-23. [PubMed ID:9692937]. https://doi.org/10.5435/00124635-199801000-00002.
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Enneking WF, Horowitz M. The Intra-Articular Effects of Immobilization on the Human Knee. J Bone Joint Surg. 1972;54(5):973-85. https://doi.org/10.2106/00004623-197254050-00003.
13.
de Haan J, Schep NW, Tuinebreijer WE, Patka P, den Hartog D. Simple elbow dislocations: a systematic review of the literature. Arch Orthop Trauma Surg. 2010;130(2):241-9. [PubMed ID:19340433]. [PubMed Central ID:PMC2797437]. https://doi.org/10.1007/s00402-009-0866-0.
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Catapano M, Pupic N, Multani I, Wasserstein D, Henry P. Early functional mobilization for non-operative treatment of simple elbow dislocations: a systematic review. Shoulder Elbow. 2022;14(2):211-21. [PubMed ID:35265188]. [PubMed Central ID:PMC8899322]. https://doi.org/10.1177/1758573220957631.
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Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001;14(2):128-46. [PubMed ID:11382253].
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Mousavi SJ, Parnianpour M, Abedi M, Askary-Ashtiani A, Karimi A, Khorsandi A, et al. Cultural adaptation and validation of the Persian version of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Clin Rehabil. 2008;22(8):749-57. [PubMed ID:18678575]. https://doi.org/10.1177/0269215508085821.
21.
Behnoush B, Tavakoli N, Bazmi E, Nateghi Fard F, Pourgharib Shahi MH, Okazi A, et al. Smartphone and Universal Goniometer for Measurement of Elbow Joint Motions: A Comparative Study. Asian J Sports Med. 2016;7(2):e30668. [PubMed ID:27625754]. [PubMed Central ID:PMC5003314]. https://doi.org/10.5812/asjsm.30668.
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Motaharinezhad F, lajevardi L, Hassani Mehraban A, Ghahari S. Occupational Challenges in the Caregivers of People with Multiple Sclerosis: A Qualitative Study. Middle East J Rehabil Health Stud. 2020;7(4):e105815. https://doi.org/10.5812/mejrh.105815.
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Akeson WH, Woo SL, Amiel D, Coutts RD, Daniel D. The connective tissue response to immobility: biochemical changes in periarticular connective tissue of the immobilized rabbit knee. Clin Orthop Relat Res. 1973(93):356-62. [PubMed ID:4269190]. https://doi.org/10.1097/00003086-197306000-00039.
24.
Akeson WH, Amiel D, Mechanic GL, Woo SL, Harwood FL, Hamer ML. Collagen cross-linking alterations in joint contractures: changes in the reducible cross-links in periarticular connective tissue collagen after nine weeks of immobilization. Connect Tissue Res. 1977;5(1):15-9. [PubMed ID:141358]. https://doi.org/10.3109/03008207709152607.
25.
Akeson WH, Amiel D, Abel MF, Garfin SR, Woo SLY. Effects of Immobilization on Joints. Clin Orthopaedics Related Res. 1987;219(&NA;). https://doi.org/10.1097/00003086-198706000-00006.
26.
Morrey BF, Sotelo JS, Morrey ME. Morrey's The Elbow and Its Disorders E-Book. Amsterdam, Netherlands: Elsevier; 2017.
27.
Page C, Backus SI, Lenhoff MW. Electromyographic activity in stiff and normal elbows during elbow flexion and extension. J Hand Ther. 2003;16(1):5-11. [PubMed ID:12611440]. https://doi.org/10.1016/s0894-1130(03)80018-2.
28.
Evans RB, Thompson DE. The application of force to the healing tendon. J Hand Ther. 1993;6(4):266-84. [PubMed ID:8124441]. https://doi.org/10.1016/s0894-1130(12)80328-0.
29.
Brand PW. Mechanical factors in joint stiffness and tissue growth. J Hand Ther. 1995;8(2):91-6. [PubMed ID:7550634]. https://doi.org/10.1016/s0894-1130(12)80305-x.
30.
Flowers KR, LaStayo P. Effect of total end range time on improving passive range of motion. J Hand Ther. 1994;7(3):150-7. [PubMed ID:7951706]. https://doi.org/10.1016/s0894-1130(12)80056-1.
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Maitland GD. Vertebral manipulation. Amsterdam, Netherlands: Elsevier Health Sciences; 1986.
32.
Maitland GD. Peripheral manipulation. Amsterdam, Netherlands: Elsevier; 1991.
33.
Evans EB, Eggers GWN, Butler JK, Blumel J. Experimental Immobilization and Remobilization of Rat Knee Joints. J Bone Joint Surg. 1960;42(5):737-58. https://doi.org/10.2106/00004623-196042050-00001.
34.
Valone LC, Waites C, Tartarilla AB, Whited A, Sugimoto D, Bae DS, et al. Functional Elbow Range of Motion in Children and Adolescents. J Pediatr Orthop. 2020;40(6):304-9. [PubMed ID:32501919]. https://doi.org/10.1097/BPO.0000000000001467.
35.
Myers JB, Lephart SM. Sensorimotor deficits contributing to glenohumeral instability. Clin Orthop Relat Res. 2002(400):98-104. [PubMed ID:12072751]. https://doi.org/10.1097/00003086-200207000-00013.
36.
On AY, Uludag B, Taskiran E, Ertekin C. Differential corticomotor control of a muscle adjacent to a painful joint. Neurorehabil Neural Repair. 2004;18(3):127-33. [PubMed ID:15375272]. https://doi.org/10.1177/0888439004269030.
37.
Klum M, Wolf MB, Hahn P, Leclere FM, Bruckner T, Unglaub F. Predicting grip strength and key pinch using anthropometric data, DASH questionnaire and wrist range of motion. Arch Orthop Trauma Surg. 2012;132(12):1807-11. [PubMed ID:22983146]. https://doi.org/10.1007/s00402-012-1602-8.
38.
Bot AG, Souer JS, van Dijk CN, Ring D. Association between individual DASH tasks and restricted wrist flexion and extension after volar plate fixation of a fracture of the distal radius. Hand (N Y). 2012;7(4):407-12. [PubMed ID:24294161]. [PubMed Central ID:PMC3508012]. https://doi.org/10.1007/s11552-012-9447-8.
39.
Dlkhoush CT, Bakhshi S, Safavi Farokhi Z, Mirmohammadkhani M. [Comparison of dry needling and inhibitory kinesio taping on the pain and functional disability in females with myofascial pain syndrome in upper trapezius muscle]. Koomesh J. 2019;21(4):610-8. Persian.
40.
1. Wyrick JD, Dailey SK, Gunzenhaeuser JM, Casstevens EC. Management of complex elbow dislocations: a mechanistic approach. J Am Acad Orthop Surg. 2015;23(5):297-306. [PubMed ID:25911662]. https://doi.org/10.5435/JAAOS-D-14-00023. 2. Sojbjerg JO. The stiff elbow. Acta Orthop Scand. 1996;67(6):626-31. [PubMed ID:9065082]. https://doi.org/10.3109/17453679608997771. 3. Chinchalkar SJ, Szekeres M. Rehabilitation of elbow trauma. Hand Clin. 2004;20(4):363-74. [PubMed ID:15539093]. https://doi.org/10.1016/j.hcl.2004.06.004. 4. Hengeveld E. The Maitland Concept: Evidence-based practice and the movement sciences. In: Hengeveld E, Banks K, editors. Maitland's Peripheral Manipulation: Management of Neuromusculoskeletal Disorders-Volume 2. Amsterdam, Netherlands: Elsevier Health Sciences; 2013. p. 66. 5. Davila SA, Johnston-Jones K. Managing the stiff elbow: operative, nonoperative, and postoperative techniques. J Hand Ther. 2006;19(2):268-81. [PubMed ID:16713873]. https://doi.org/10.1197/j.jht.2006.02.017. 6. Pathan P, Samal S. To study effect of Maitland mobilization and conventional treatment on management of tennis elbow. Int J Adv Res, Ideas Innovations Technol. 2018;4(3):1303-7. 7. Pustovoit B, Pashkevych S, Beziazychna О, Parfaniuk T. Physical Therapy For Patients With Posttraumatic Elbow Contractures. Slobozhanskyi herald of science and sport. 2021;9(1):50-64. 8. Belomazheva-Dimitrova S. Recovery of the muscle function after stable elbow fractures. J Physical Educ Sport. 2019;Vol 19:2070-4. https://doi.org/10.7752/jpes.2019.s6308. 9. Belomazheva-Dimitrova S. Study of the effect of mobilization and muscleinhibitory techniques on an elbow arthrokinematics after conservative treatment of intra-articular fractures of the elbow joint. Sci Rep Physical Educ Sport. 2013;19:98-103. 10. Cohen MS, Hastings H. Acute elbow dislocation: evaluation and management. J Am Acad Orthop Surg. 1998;6(1):15-23. [PubMed ID:9692937]. https://doi.org/10.5435/00124635-199801000-00002. 11. Harris P, Nagy S, Vardaxis N. Mosby's Dictionary of Medicine, Nursing and Health Professions - Australian & New Zealand Edition - eBook. Amsterdam, Netherlands: Elsevier Health Sciences; 2014. 12. Enneking WF, Horowitz M. The Intra-Articular Effects of Immobilization on the Human Knee. J Bone Joint Surg. 1972;54(5):973-85. https://doi.org/10.2106/00004623-197254050-00003. 13. de Haan J, Schep NW, Tuinebreijer WE, Patka P, den Hartog D. Simple elbow dislocations: a systematic review of the literature. Arch Orthop Trauma Surg. 2010;130(2):241-9. [PubMed ID:19340433]. [PubMed Central ID:PMC2797437]. https://doi.org/10.1007/s00402-009-0866-0. 14. Catapano M, Pupic N, Multani I, Wasserstein D, Henry P. Early functional mobilization for non-operative treatment of simple elbow dislocations: a systematic review. Shoulder Elbow. 2022;14(2):211-21. [PubMed ID:35265188]. [PubMed Central ID:PMC8899322]. https://doi.org/10.1177/1758573220957631. 15. Viveen J, Doornberg JN, Kodde IF, Goossens P, Koenraadt KLM, The B, et al. Continuous passive motion and physical therapy (CPM) versus physical therapy (PT) versus delayed physical therapy (DPT) after surgical release for elbow contractures; a study protocol for a prospective randomized controlled trial. BMC Musculoskelet Disord. 2017;18(1):484. [PubMed ID:29166890]. [PubMed Central ID:PMC5700741]. https://doi.org/10.1186/s12891-017-1854-0. 16. Kisner C, Colby LA, Borstad J. Therapeutic Exercise: Foundations and Techniques. Philadelphia, Pennsylvania: F.A. Davis Company; 2017. 17. Mareeswari M. Effect of Gong’s Mobilization Versus Maitland Mobilization on Pain, Shoulder Abduction and External Rotation Mobility and Functional Ability in Subjects with Adhesive Capsulitis of Shoulder Joint-A Quasi-Experimental Study. Indian J Natural Sci. 2022;13(72). 18. Colby LA. Therapeutic exercise: foundations and techniques. Philadelphia, Pennsylvania: FA Davis Company; 2007. 19. Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001;14(2):128-46. [PubMed ID:11382253]. 20. Mousavi SJ, Parnianpour M, Abedi M, Askary-Ashtiani A, Karimi A, Khorsandi A, et al. Cultural adaptation and validation of the Persian version of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Clin Rehabil. 2008;22(8):749-57. [PubMed ID:18678575]. https://doi.org/10.1177/0269215508085821. 21. Behnoush B, Tavakoli N, Bazmi E, Nateghi Fard F, Pourgharib Shahi MH, Okazi A, et al. Smartphone and Universal Goniometer for Measurement of Elbow Joint Motions: A Comparative Study. Asian J Sports Med. 2016;7(2):e30668. [PubMed ID:27625754]. [PubMed Central ID:PMC5003314]. https://doi.org/10.5812/asjsm.30668. 22. Motaharinezhad F, lajevardi L, Hassani Mehraban A, Ghahari S. Occupational Challenges in the Caregivers of People with Multiple Sclerosis: A Qualitative Study. Middle East J Rehabil Health Stud. 2020;7(4):e105815. https://doi.org/10.5812/mejrh.105815. 23. Akeson WH, Woo SL, Amiel D, Coutts RD, Daniel D. The connective tissue response to immobility: biochemical changes in periarticular connective tissue of the immobilized rabbit knee. Clin Orthop Relat Res. 1973(93):356-62. [PubMed ID:4269190]. https://doi.org/10.1097/00003086-197306000-00039. 24. Akeson WH, Amiel D, Mechanic GL, Woo SL, Harwood FL, Hamer ML. Collagen cross-linking alterations in joint contractures: changes in the reducible cross-links in periarticular connective tissue collagen after nine weeks of immobilization. Connect Tissue Res. 1977;5(1):15-9. [PubMed ID:141358]. https://doi.org/10.3109/03008207709152607. 25. Akeson WH, Amiel D, Abel MF, Garfin SR, Woo SLY. Effects of Immobilization on Joints. Clin Orthopaedics Related Res. 1987;219(&NA;). https://doi.org/10.1097/00003086-198706000-00006. 26. Morrey BF, Sotelo JS, Morrey ME. Morrey's The Elbow and Its Disorders E-Book. Amsterdam, Netherlands: Elsevier; 2017. 27. Page C, Backus SI, Lenhoff MW. Electromyographic activity in stiff and normal elbows during elbow flexion and extension. J Hand Ther. 2003;16(1):5-11. [PubMed ID:12611440]. https://doi.org/10.1016/s0894-1130(03)80018-2. 28. Evans RB, Thompson DE. The application of force to the healing tendon. J Hand Ther. 1993;6(4):266-84. [PubMed ID:8124441]. https://doi.org/10.1016/s0894-1130(12)80328-0. 29. Brand PW. Mechanical factors in joint stiffness and tissue growth. J Hand Ther. 1995;8(2):91-6. [PubMed ID:7550634]. https://doi.org/10.1016/s0894-1130(12)80305-x. 30. Flowers KR, LaStayo P. Effect of total end range time on improving passive range of motion. J Hand Ther. 1994;7(3):150-7. [PubMed ID:7951706]. https://doi.org/10.1016/s0894-1130(12)80056-1. 31. Maitland GD. Vertebral manipulation. Amsterdam, Netherlands: Elsevier Health Sciences; 1986. 32. Maitland GD. Peripheral manipulation. Amsterdam, Netherlands: Elsevier; 1991. 33. Evans EB, Eggers GWN, Butler JK, Blumel J. Experimental Immobilization and Remobilization of Rat Knee Joints. J Bone Joint Surg. 1960;42(5):737-58. https://doi.org/10.2106/00004623-196042050-00001. 34. Valone LC, Waites C, Tartarilla AB, Whited A, Sugimoto D, Bae DS, et al. Functional Elbow Range of Motion in Children and Adolescents. J Pediatr Orthop. 2020;40(6):304-9. [PubMed ID:32501919]. https://doi.org/10.1097/BPO.0000000000001467. 35. Myers JB, Lephart SM. Sensorimotor deficits contributing to glenohumeral instability. Clin Orthop Relat Res. 2002(400):98-104. [PubMed ID:12072751]. https://doi.org/10.1097/00003086-200207000-00013. 36. On AY, Uludag B, Taskiran E, Ertekin C. Differential corticomotor control of a muscle adjacent to a painful joint. Neurorehabil Neural Repair. 2004;18(3):127-33. [PubMed ID:15375272]. https://doi.org/10.1177/0888439004269030. 37. Klum M, Wolf MB, Hahn P, Leclere FM, Bruckner T, Unglaub F. Predicting grip strength and key pinch using anthropometric data, DASH questionnaire and wrist range of motion. Arch Orthop Trauma Surg. 2012;132(12):1807-11. [PubMed ID:22983146]. https://doi.org/10.1007/s00402-012-1602-8. 38. Bot AG, Souer JS, van Dijk CN, Ring D. Association between individual DASH tasks and restricted wrist flexion and extension after volar plate fixation of a fracture of the distal radius. Hand (N Y). 2012;7(4):407-12. [PubMed ID:24294161]. [PubMed Central ID:PMC3508012]. https://doi.org/10.1007/s11552-012-9447-8. 39. Dlkhoush CT, Bakhshi S, Safavi Farokhi Z, Mirmohammadkhani M. [Comparison of dry needling and inhibitory kinesio taping on the pain and functional disability in females with myofascial pain syndrome in upper trapezius muscle]. Koomesh J. 2019;21(4):610-8. Persian. 40. Jajarmi R, Safavi-Farokhi Z, Paknazar F. [The comparison between dry needling and electro-acupuncture of the upper trapezius on pain, ultrasonography changes, and functional disability of the upper limb in the subjects with myofascial pain syndrome]. Koomesh J. 2023;25(6):e154166. Persian.

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Author(s):

Mahsa Ahmadi:[PubMed][Scholar]
Cyrus Taghizadeh Delkhoush:[PubMed][Scholar]