Ultra-sonographic study of the effect of dry needling of extensor muscles combined with Mulligan mobilization technique on extensor muscle tendon thickness, pain and upper limb function in patients with lateral epicondylitis: A double-blinded randomized clinical trial

authors:

avatar samiei samiei , avatar Atefeh Aminianfar ORCID , * , avatar Fatemeh Paknazar ORCID

Koomesh: Vol.23, issue 6; 730-740
published online: December 01, 2021
article type: Research Article
received: October 06, 2020
accepted: June 01, 2021

how to cite: samiei S, Aminianfar A, Paknazar F. Ultra-sonographic study of the effect of dry needling of extensor muscles combined with Mulligan mobilization technique on extensor muscle tendon thickness, pain and upper limb function in patients with lateral epicondylitis: A double-blinded randomized clinical trial. koomesh. 2021;23(6):e153306. 

Abstract

Introduction: Lateral epicondylitis (LE) is one of the most common causes of pain in the elbow. The aim of this study was to evaluate the effect of dry needling (DN) of wrist extensor muscles along with Mulligan mobilization (MM) technique on extensor muscle tendon thickness, pain and upper limb function in patients with LE. Materials and Methods: 39 patients with LE participated in this double-blinded clinical trial study and were randomly divided into one of three groups: first intervention (DN), second intervention (DN with MM) and control. In first intervention group, DN was inserted in the trigger point(s) of the target muscles during 3 sessions of treatment, every other day. In second intervention group, in addition to DN, MM technique was performed. Control group didn’t receive any intervention. Pain intensity, function level, grip strength, and tendon thickness of extensor muscles were assessed in three stages before treatment, 24 hours after last session, and ten days after the end of sessions. Results: The results showed that all variables in the DN group and DN with MM had a significant improvement compared to the control group. Function and VAS scores in the DN with MM group showed a more significant difference than in the DN alone, but the differences in tendon thickness between the two groups were not significant. Conclusion: Dry needling with Mulligan mobilization can produce further improvement in grip strength, function and pain level in patients with LE. DN is sufficient to improve the thickness of the extensor muscle tendon

References

  • 1.

    Lipman K, Wang C, Ting K, Soo C, Zheng Z. Tendinopathy: injury, repair, and current exploration. Drug Des Devel Ther 2018; 12: 591. https://doi.org/10.2147/DDDT.S154660 PMid:29593382 PMCid:PMC5865563.

  • 2.

    Kaux JF, Forthomme B, Le Goff C, Crielaard JM, Croisier JL. Current opinions on tendinopathy. J Sports Sci Med 2011; 10: 238.

  • 3.

    Bhabra G, Wang A, Ebert JR, Edwards P, Zheng M, Zheng MH. Lateral elbow tendinopathy: development of a pathophysiology-based treatment algorithm. Orthop J Sports Med 2016; 4: 2325967116670635. https://doi.org/10.1177/2325967116670635 PMid:27833925 PMCid:PMC5094303.

  • 4.

    Maffulli N. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy 1998; 14: 840-843. https://doi.org/10.1016/S0749-8063(98)70021-0.

  • 5.

    Radpasand M. Combination of manipulation, exercise, and physical therapy for the treatment of a 57-year-old woman with lateral epicondylitis. J Manipulative Physiol Ther 2009; 32: 166-172. https://doi.org/10.1016/j.jmpt.2008.12.007 PMid:19243730.

  • 6.

    Ziaeifar M, Arab AM, Karimi N, Nourbakhsh MR. The effect of dry needling on pain, pressure pain threshold and disability in patients with a myofascial trigger point in the upper trapezius muscle. J Bodyw Mov Ther 2014; 18: 298-305. https://doi.org/10.1016/j.jbmt.2013.11.004 PMid:24725800.

  • 7.

    Amro A, Diener I, Bdair WO, Isra'M H, Shalabi AI, Dua'I I. The effects of Mulligan mobilisation with movement and taping techniques on pain, grip strength, and function in patients with lateral epicondylitis. Hong Kong Physiother J 2010; 28: 19-23. https://doi.org/10.1016/j.hkpj.2010.11.004.

  • 8.

    Nirschl RP, Pettrone F. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am 1979; 61: 832-839. https://doi.org/10.2106/00004623-197961060-00005.

  • 9.

    Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow): clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg 1999; 81: 259. https://doi.org/10.2106/00004623-199902000-00014.

  • 10.

    Hariharasudhan R, Balamurugan J. Effectiveness of muscle energy technique and Mulligan's movement with mobilization in the management of lateral epicondylalgia. Arch Med Health Sci 2015; 3: 198. https://doi.org/10.4103/2321-4848.171904.

  • 11.

    Ahmad Z, Siddiqui N, Malik S, Abdus-Samee M, Tytherleigh-Strong G, Rushton N. Lateral epicondylitis: a review of pathology and management. Bone Joint J 2013; 95: 1158-1164. https://doi.org/10.1302/0301-620X.95B9.29285 PMid:23997125.

  • 12.

    Kotnis NA, Chiavaras MM, Harish S. Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation. Skeletal Radiol 2012; 41: 369-386. https://doi.org/10.1007/s00256-011-1343-8 PMid:22205505.

  • 13.

    Coombes BK, Bisset L, Vicenzino B. A new integrative model of lateral epicondylalgia. Br J Sports Med 2009; 43: 252-258. https://doi.org/10.1136/bjsm.2008.052738 PMid:19050004.

  • 14.

    Ozkut AT, Kilincoglu V, Ozkan NK, Eren A, Ertas M. [Extracorporeal shock wave therapy in patients with lateral epicondylitis]. Acta Orthop Traumatol Turc 2007; 41: 207-210.

  • 15.

    Tsikopoulos K, Tsikopoulos I, Simeonidis E, Papathanasiou E, Haidich AB, Anastasopoulos N, et al. The clinical impact of platelet-rich plasma on tendinopathy compared to placebo or dry needling injections: A meta-analysis. Phys Ther Sport 2016; 17: 87-94. https://doi.org/10.1016/j.ptsp.2015.06.003 PMid:26621224.

  • 16.

    Cagnie B, Dewitte V, Barbe T, Timmermans F, Delrue N, Meeus M. Physiologic effects of dry needling. Curr Pain Headache Rep 2013; 17: 348. https://doi.org/10.1007/s11916-013-0348-5 PMid:23801002.

  • 17.

    Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. Phys Ther Rev 2014; 19: 252-265. https://doi.org/10.1179/108331913X13844245102034 PMid:25143704 PMCid:PMC4117383.

  • 18.

    Ozden AV, Alptekin HK, Esmaeilzadeh S, Cihan C, Aki S, Aksoy C, et al. Evaluation of the sympathetic skin response to the dry needling treatment in female myofascial pain syndrome patients. J Clin Med Res 2016; 8: 513. https://doi.org/10.14740/jocmr2589w PMid:27298659 PMCid:PMC4894020.

  • 19.

    Kalichman L, Vulfsons S. Dry needling in the management of musculoskeletal pain. J Am Board Fam Med 2010; 23: 640-646. https://doi.org/10.3122/jabfm.2010.05.090296 PMid:20823359.

  • 20.

    Saylor-Pavkovich E. Strength exercises combined with dry needling with electrical stimulation improve pain and function in patients with chronic rotator cuff tendinopathy: a retrospective case series. Int J Sports Phys Ther 2016; 11: 409.

  • 21.

    Uygur E, Aktas B, Ozkut A, Erinc S, Yilmazoglu EG. Dry needling in lateral epicondylitis: a prospective controlled study. Int Orthop 2017; 41: 2321-2325. https://doi.org/10.1007/s00264-017-3604-1 PMid:28828509.

  • 22.

    Hing W, Bigelow R, Bremner T. Mulligan's mobilization with movement: a systematic review. J Manual Manipul Ther 2009; 17: 39E-66E. https://doi.org/10.1179/jmt.2009.17.2.39E.

  • 23.

    Baker RT, Nasypany A, Seegmiller JG, Baker JG. The mulligan concept: mobilizations with movement. Int J Athletic Ther Train 2013; 18: 30-34. https://doi.org/10.1123/ijatt.18.1.30.

  • 24.

    Arora L, Arora R. A randomized controlled trial to study the efficacy of mobilization with movement combined with low level laser therapy in lateral Epicondylitis. Adv Appl Sci Res 2013; 4: 381-386.

  • 25.

    Aydin CG, Aykut S, ztrk K, Arslanoglu F, Kilin CY, Kocaer N. Long-term efficiency of extracorporeal shockwave therapy on lateral epicondylitis. Acta Orthop Belgica 2017; 83: 438-444.

  • 26.

    Saroja G, Aseer P, Venkata Sai P. Diagnostic accuracy of provocative tests in lateral epicondylitis. Int J Physiother Res 2014; 2: 815-823. https://doi.org/10.16965/ijpr.2014.699.

  • 27.

    Kalaria P, Kapuriya D. Effective of mulligan mobilization and taping in lateral epicondylitis. [dissertation]. RK Univ.

  • 28.

    Kheradmandi A, Ebrahimian M, Ghafarinejad F, Ehyaii V, Farazdaghi M. The effect of dry needling of the trigger points of shoulder muscles on pain and grip strength in patients with lateral epicondylitis: a pilot study. J Rehab Sci Res 2015; 2: 58-62.

  • 29.

    Mohan PC, editor Lateral elbow tendinopathy: correlation between ultrasound findings and clinical outcomes after percutaneous ultrasonic tenotomy2015: European Congress of Radiology 2015.

  • 30.

    Jester A, Harth A, Germann G. Measuring levels of upper-extremity disability in employed adults using the DASH Questionnaire. J Hand Surg 2005; 30: 1074. e1-.e10. https://doi.org/10.1016/j.jhsa.2005.04.009 PMid:16182070.

  • 31.

    Myles PS, Troedel S, Boquest M, Reeves M. The pain visual analog scale: is it linear or nonlinear? Anesthesiology 1999; 87: 1517. https://doi.org/10.1213/00000539-199912000-00038.

  • 32.

    Kuzala EA, Vargo MC. The relationship between elbow position and grip strength. Am J Occup Ther 1992; 46: 509-512. https://doi.org/10.5014/ajot.46.6.509 PMid:1605295.

  • 33.

    Miller J. Mulligan concept management of tennis elbow. Orthop Divis Rev 2000; 45-46.##[34 Mulligan BR. Manual Therapy, Nags, Snags, MWMs, etc. 6th Edition. Orthopedic Physical Therapy Products. 2010.

  • 34.

    Cyriax JH. The pathology and treatment of tennis elbow. J Bone Joint Surg Br 1936; 18: 921-940.

  • 35.

    Navarro-Santana MJ, Sanchez-Infante J, Gmez-Chiguano GF, Cleland JA, Lpez-de-Uralde-Villanueva I, Fernndez-de-Las-Peas C, et al. Effects of trigger point dry needling on lateral epicondylalgia of musculoskeletal origin: a systematic review and meta-analysis. Clin Rehab 2020; 269215520937468. https://doi.org/10.1093/ptj/pzaa216 PMid:33340405.

  • 36.

    Reyhan AC, Sindel D, Dereli EE. The effects of Mulligan's mobilization with movement technique in patients with lateral epicondylitis. J Back Musculoskelet Rehabil 2020; 33: 99-107. https://doi.org/10.3233/BMR-181135 PMid:31104005.

  • 37.

    Langevin HM, Bouffard NA, Churchill DL, Badger GJ. Connective tissue fibroblast response to acupuncture: dose-dependent effect of bidirectional needle rotation. J Altern Complement Med 2007; 13: 355-360. https://doi.org/10.1089/acm.2007.6351 PMid:17480137 PMCid:PMC3065718.

  • 38.

    Dommerholt J. Dry needling-peripheral and central considerations. J Man Manip Ther 2011; 19: 223-227. https://doi.org/10.1179/106698111X13129729552065 PMid:23115475 PMCid:PMC3201653.

  • 39.

    Ceballos-Laita L, Jimnez-del-Barrio S, Marn-Zurdo J, Moreno-Calvo A, Marn-Bon J, Albarova-Corral MI, et al. Effects of dry needling on pain, pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis: Secondary analysis of a randomized controlled trial. Complement Ther Med 2020; 102443. https://doi.org/10.1016/j.ctim.2020.102443 PMid:32507443.

  • 40.

    Cagnie B, Dewitte V, Barbe T, Timmermans F, Delrue N, Meeus M. Physiologic effects of dry needling. Curr Pain Headache Rep 2013; 17: 348. https://doi.org/10.1007/s11916-013-0348-5 PMid:23801002.

  • 41.

    Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. Phys Ther Rev 2014; 19: 252-265. https://doi.org/10.1179/108331913X13844245102034 PMid:25143704 PMCid:PMC4117383.

  • 42.

    Miller J. Mulligan concept management of tennis elbow. Orthop Div Rev 2000; 45-46.

  • 43.

    Kishner C, Colby L. Therapeutic exercise foundations and technique. Margaret Biblis. 2007.

  • 44.

    Vicenzino B, Brooksbank J, Minto J, Offord S, Paungmali A. Initial effects of elbow taping on pain-free grip strength and pressure pain threshold. J Orthop Sports Phys Ther 2003; 33: 400-407. https://doi.org/10.2519/jospt.2003.33.7.400 PMid:12918865.

  • 45.

    Jacobs MA, Austin N, Austin NM. Splinting the hand and upper extremity: principles and process: Lippincott Williams & Wilkins; 2003.

  • 46.

    Ring D, Kadzielski J, Fabian L, Zurakowski D, Malhotra LR, Jupiter JB. Self-reported upper extremity health status correlates with depression. J Bone Joint Surg Am 2006; 88: 1983-1988. https://doi.org/10.2106/00004623-200609000-00012 https://doi.org/10.2106/JBJS.E.00932 PMid:16951115.

  • 47.

    Manchanda G, Grover D. Effectiveness of movement with mobilization compared with manipulation of wrist in case of lateral epicondylitis. Indian J Physiother Occup Ther 2008; 2: 16-25.

  • 48.

    Herd CR, Meserve BB. A systematic review of the effectiveness of manipulative therapy in treating lateral epicondylalgia. J Man Manip Ther 2008; 16: 225-237. https://doi.org/10.1179/106698108790818288 PMid:19771195 PMCid:PMC2716156.

  • 49.

    Reyhan AC, Sindel D, Dereli EE. The effects of Mulligan's mobilization with movement technique in patients with lateral epicondylitis. J Back Musculoskelet Rehabil 2020; 1-9. https://doi.org/10.3233/BMR-181135 PMid:31104005.

  • 50.

    Tsikopoulos K, Tsikopoulos I, Simeonidis E, Papathanasiou E, Haidich AB, Anastasopoulos N, et al. The clinical impact of platelet-rich plasma on tendinopathy compared to placebo or dry needling injections: A meta-analysis. Phys Ther Sport 2016; 17: 87-94. https://doi.org/10.1016/j.ptsp.2015.06.003 PMid:26621224.