Case reportChiropractic Treatment of Lateral Epicondylitis: A Case Report Utilizing Active Release Techniques
Introduction
Lateral epicondylitis, commonly known as tennis elbow, is described as a painful condition affecting the lateral aspect of the elbow that is aggravated by active and resisted wrist extension and direct palpation of the lateral epicondyle of the humerus, the radiohumeral joint space, or the proximal forearm extensor muscles.1, 2, 3, 4 This condition is most notably reported in athletes participating in racquet sports such as tennis. However it has been reported to affect other athletes as well such as golfers.5, 6, 7 Despite its well known relationship with athletes, lateral epicondylitis is primarily seen in workers engaging in repetitive rotation, extension and/or flexion of the forearm. It has been reported that lateral epicondylitis affects 1% to 3% of the general population and affects women more so than men.5, 8, 9, 10, 11, 12, 13
Generally, lateral epicondylitis is considered a self-limiting condition and recovery is seen with 1-2 years of conservative management. In some instances the condition may continue longer, with approximately 10% of cases requiring surgical treatment.14, 15, 16, 17 The choices of conservative treatment options are diverse and best management strategies remain controversial.9 This may be due to a current absence of universally accepted pathophysiological understanding, poor or biased methods of current studies, the existence of multiple variables which may influence outcomes, and the mere self-limiting character of the condition.18, 19
This study describes the chiropractic management of a patient with chronic lateral epicondylitis using the application of active release techniques (ART).
Section snippets
Case Report
A 48-year-old white man presented to a chiropractic clinic with left lateral elbow pain. The complaint originated 2 years previously with an insidious onset. Self-management strategies including over-the-counter non-steroidal anti-inflammatory medication, ice, and stretching were unsuccessful. The patient reported a slow progression of symptoms culminating in intense pain following playing 18 holes of golf 3 days prior to initial consultation. At the time of presentation, the patient described
Discussion
Chronic tendon injuries are a common reason for presentation to health care providers and may significantly impact one’s ability to work, exercise, and perform routine activities of daily living.21, 22, 23 Lateral epicondylitis is typically attributed to activities that require the repetitive use of the soft tissues. Although chronic tendon injuries, such as lateral epicondylitis, are traditionally described as a “tendonitis”, this term may not be appropriate. The term “epicondylitis” implies a
Limitations
A weakness of this study is a lack of objective outcome measurements utilized throughout the case. As with any single intervention, there is no way to determine the extent to which any individual treatment may or may not have contributed to the perceived beneficial outcome and to what extent the condition self-resolved. The findings from this case may not necessarily be applicable to other similar cases.
Conclusion
In this case, the administration of ART appeared to reduce symptomatology and allow functional restoration for a patient with chronic lateral epicondylitis.
Funding Sources and Conflicts of Interest
No funding sources or conflicts of interest were reported for this study.
References (50)
Combination of manipulation, exercise, and physical therapy for the treatment of a 57-year-old woman with lateral epicondylitis
J Manip Physiol Ther
(2009)- et al.
Treatment of lateral epicondylitis: where is the evidence?
Joint Bone Spine
(2004) - et al.
Understanding prognosis to improve rehabilitation: the example of lateral elbow pain
Arch Phys Med Rehabil
(1996) - et al.
Types and epidemiology of tendinopathy
Clin Sports Med
(2003) - et al.
Lateral tennis elbow: “Is there any science out there?”
J Shoulder Elbow Surg
(1999) Elbow tendonosis/tennis elbow
Clin Sports Med
(1992)- et al.
Golf for the mature athlete
Clin Sports Med
(1991) - et al.
Immediate effect on pain thresholds using active release technique on adductor strains: pilot study
J Bodyw Mov Ther
(2011) - et al.
A manual therapy and exercise approach to meralgia paresthetica in pregnancy: a case report
J Chiropr Med
(2006) - et al.
Conservative management of groin pain during pregnancy: a descriptive case study
J Chriopr Med
(2005)
Conservative management of a type III acromioclavicular separation: a case report and 10-year follow-up
J Chiropr Med
The effects of active release technique on carpal tunnel patients: a pilot study
J Chiropr Med
Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies
J Bone Joint Surg Am
Tennis elbow
BMJ
Diagnosing and treating lateral epicondylitis
Can Fam Physician
A critical review of the current conservative therapies for tennis elbow (lateral epicondylitis)
Australas Chiropr Osteopat
Tennis elbow: a review
J Orthop Sports Phys Ther
The biomechanics of tennis elbow. An integrated approach
Clin Sports Med
The prevalence and causation of tennis elbow (lateral humeral epicondylitis) in a population of workers in an engineering industry
Ergonomics
Prevalence and impact of musculoskeletal disorders of the upper limb in the general population
Arthritis Rheum
Prevalence, incidence and remission rates of some common rheumatic diseases and syndromes
Scand J Rheumatol
Why are manual workers at high risk of upper limb disorders? The role of physical work factors in a random sample of workers in France (the Pays de la Loire study)
Occup Environ Med
Gender differences in prevalence of upper extremity musculoskeletal disorders
Ergonomics
Management of tennis elbow by Agnikarma
J Ayurveda Integr Med
Tennis elbow: Its course, natural history, conservative and surgical management
J Bone Joint Surg Am
Cited by (4)
The impact of a hand therapy workplace-based educational approach on the management of lateral elbow tendinopathy: A randomized controlled study
2023, Journal of Hand TherapyCitation Excerpt :Previously thought to be an inflammatory condition, histological studies confirm that this condition progresses into a degenerative state characterized by an absence of inflammatory cells.2 LET is usually managed conservatively by health professionals from different backgrounds including physical therapists, chiropractors, occupational therapists and medical practitioners.3-6 The diversity of disciplines may explain the different methods and dosages of treatment approaches used for LET.7,8
Management of Chronic Lateral Epicondylitis With Manual Therapy and Local Cryostimulation: A Pilot Study
2017, Journal of Chiropractic MedicineCitation Excerpt :Positive outcomes were significant in both the short (4 weeks) and long (12 weeks) term.28 Manual mobilization of the elbow and wrist joints has also been studied.21 Many types of mobilization exist, and an extensive literature review by Herd and Meserve revealed a significant effect in favor of manipulative therapy on a short-term basis even though many studies reviewed were of low quality.22
Nonpharmacologic Options for Treating Acute and Chronic Pain
2015, PM and RCitation Excerpt :Active release techniques apply deep tissue tension in conjunction with specific patient active movements to mobilize soft tissues to reduce stiffness, fibrosis, and adhesions. Quality trials are lacking to conclude the effectiveness of active release techniques; however, case reports suggest its efficacy to improve Achilles tendinopathy, lateral epicondylitis, snapping hip, and acetabular labral tears [84-87]. Acupressure applies direct pressure over trigger points to decrease myofascial pain, which has been effective to treat acute LBP [88].
Autologous platelet lysate local injections for the treatment of refractory lateral epicondylitis
2016, Journal of Orthopaedic Surgery and Research