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Examination of motor and hypoalgesic effects of cervical vs thoracic spine manipulation in patients with lateral epicondylalgia: a clinical trial
Authors:Fernández-Carnero Josue  Cleland Joshua A  Arbizu Roy La Touche
Institution:aPhysical Therapist and Professor, Deparment of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Rey Juan Carlos University, Alcorcón, Madrid, Spain;bPhysical Therapist, Department of Physical Therapy, Franklin Pierce College, Concord, NH;cPhysical Therapist, Rehabilitation Services, Concord Hospital, Concord, NH;dManual Therapy Fellowship Program, Regis University, Denver, CO;ePhysical Therapist, Research Group in Musculoskeletal Pain and Motor Control, Department of Physical Therapy, Universidad Europea de Madrid, Villaviciosa de Odon, Madrid, Spain
Abstract:

Objectives

The purpose of this study was to compare the effects of a cervical vs thoracic spine manipulation on pressure pain threshold (PPT) and pain-free grip strength in patients with lateral epicondylalgia (LE).

Methods

A single-blind randomized clinical trial was completed with 18 participants with LE. Each subject attended 1 experimental session. Participants were randomized to receive either a cervical or thoracic spine manipulation. Pressure pain threshold over the lateral epicondyle of both elbows pain-free grip strength on the affected arm and maximum grip force on the unaffected side were assessed preintervention and 5 minutes postintervention by an examiner blind to group assignment. A 3-way analysis of variance with time and side as within-subject variable and intervention as between-subject variable was used to evaluate changes in PPT and pain-free grip.

Results

The analysis of variance detected a significant interaction between group and time (F = 31.7, P < .000) for PPT levels. Post hoc testing revealed that the cervical spine manipulation produced a greater increase of PPT in both sides compared with thoracic spine manipulation (P < .001). For pain-free grip strength, no interaction between group and time (F = .66, P = .42) existed.

Conclusions

Cervical spine manipulation produced greater changes in PPT than thoracic spine manipulation in patients with LE. No differences between groups were identified for pain-free grip. Future studies with larger sample sizes are required to further examine the effects of manipulation on mechanisms of pain and motor control in upper extremity conditions.
Keywords:Key Indexing Terms: Lateral Humeral Epicondylitis  Tennis Elbow  Manual Therapy  Spinal Manipulation
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