The aim of our study was to verify the efficiency of the multimodal treatment with mobilization with movement associated with eccentric strengthening, transverse massage and stretching in the treatment of eight volunteers with symptoms of lateral epicondylosis.
According to Abbott and collaborators (2001), the mobilization with movement is a manual therapy strategy that uses forces that influence in the biomechanical joint alignment which can facilitate the desired movement.
In our study, the data obtained at the end of treatment using the visual analogue scale (VAS), disabilities of the arm, shoulder, and hand (DASH) and patient-rated tennis elbow evaluation (PRTEE) were effective and embodying the idea that mobilization with movement is an effective technique when used in the treatment of lateral epicondylosis.
In this study, pain was assessed using VAS, an improve was noted in pain status of the volunteers comparing before and after 12 sessions of treatment (p < 0.01). Only the fifth volunteer did not observe difference in pain relief, since the seventh volunteer complained little pain at the beginning of treatment and after the treatment, the pain was cured, and when the other volunteers observed, there was overall improvement in pain symptoms.
Regarding PRTEE and DASH questionnaires obtained, both had a decrease in post-treatment period with a statistical difference when comparing the pre and post treatment with p value <0.01.
We must consider that we did not get an even better result, because the majority of patients during the treatment period did not stop their occupational activities that may be the offending agent of this injury. For this study, volunteers underwent a multimodal approach corroborating the study of Gonzalez-Iglesias and collaborators (2011) that rehabilitated patients with lateral epicondylalgia with association techniques.
Herd and Meserve (2008), conducted a systematic review to assess the effectiveness of manipulative therapy in lateral epicondylitis, according to the authors the mobilization with movement provides short and long term benefits in treated individuals.
Paungmali and collaborators (2003), conducted a study to evaluate the effect Sympathoexcitatory and hypoalgesic the mobilization with movement on the side of epicondylalgia, according to the authors, MWM has a physiological effect similar to that seen in the manipulation of the spine. Abbott (2001), states that the MWM improves shoulder range of movement (ROM) in patients with lateral epicondylitis, in the affected side and the unaffected side, according to this author, the MWM can lead to decreased muscle tone mediated neurophysiologically. Paungmali et al. (2006) reported that the technique of mobilization with movement has rapid effect in reducing immediate pain, followed by the progression of improved function. Corroborating with these authors was observed improved function and pain of the volunteers treated this search.
Agreement with our study Pagorek (Miller 2000) reports that the benefit of this intervention in clinical practice is that it is faster compared to other methods of treatment, requiring no additional equipment and results in sudden attenuation of pain and improved function. In this study, it was observed attenuation of pain and it made possible the development of eccentric exercise associated with MWM. In the present study, we used the standardized weight 1 kgf, this load was chosen because it is a low load and all the volunteers were able to perform the task without that promotes pain after the session, in the course of weeks there was an increase in the number of repetitions of the exercise.
However, Slater and collaborators (2006) in their study showed there was no significant analgesic effects in the short term in response to mobilization with movement, the present study the improvement in pain was observed and hence improved function, since the volunteers were able to perform exercise proposed when we conduct mobilization.
The eight volunteers reported improvement in pain during the performance of mobilization with movement of the elbow. Since according to Vicenzino and collaborators (2001), the MWM provides improved pain symptoms of patients, and infers that the improvement in pain at the start of a rehabilitation program may accelerate the recovery or better motivate the patient to persist in the proposed treatment program (Vicenzino 2003).
Cullnane et al. (2014) and Peterson et al. (2014), report that eccentric exercise of extensor muscles of wrist and fingers, reduce pain and improve grip strength in chronic individuals and suggest that these exercises can be included as part of multimodal treatment of lateral epicondylitis, being that, in present study was performed at multimodal methodology with eccentric exercise associated with mobilization with movement. By contrast, Heijnders and Lin (2015) reported the need for further studies to confirm the effectiveness established by this technique and the size of the effect of eccentric exercise in lateral epicondylitis.
Fernández-Carnero and collaborators (2007, 2008), They conducted a controlled clinical study and blind, to assess the presence of active and latent trigger point in patients with lateral epicondylalgia, according to these authors triggers points are present in the forearm muscles of the patients and contribute in pain on the affected side. The current study corroborates the studies cited above it was observed presence of point triggers on volunteers, so was held inhibition of point triggers the extensor muscles of the wrist and fingers.
Our study had some limitations for the benefit of the results as absence of surface electromyography, the dynamometer device as an aid to assess the pre and post treatment and the number of volunteers. We suggest that there is a need conduct a randomized clinical study using the techniques used in this study in different groups to observe the effect of the interaction of these techniques in the rehabilitation in a greater number of the patients with lateral epicondylosis.