Nourbakhsh Mohammad Reza, Fearon Frank J
Department of Physical Therapy, North Georgia College and State University, Dahlonega, Georgia 30597, USA.
J Hand Ther. 2008 Jan-Mar;21(1):4-13; quiz 14. doi: 10.1197/j.jht.2007.09.005.
Symptoms of lateral epicondylitis (LE) are attributed to degenerative changes and inflammatory reactions in the common extensor tendon induced by microscopic tears in the tissue after repetitive or overload functions of the wrist and hand extensor muscles. Conventional treatments, provided on the premise of inflammatory basis of LE, have shown 39-80% failure rate. An alternative approach suggests that symptoms of LE could be due to active tender points developed in the origin of hand and wrist extensor muscles after overuse or repetitive movements. Oscillating-energy Manual Therapy (OEMT), also known as V-spread, is a craniosacral manual technique that has been clinically used for treating tender points over the suture lines in the skull. Considering symptoms of LE may result from active tender points, the purpose of this study was to investigate the effect of OEMT on pain, grip strength, and functional abilities of subjects with chronic LE. Twenty-three subjects with chronic LE (>3mo) between ages of 24 and 72 years participated in this study. Before their participation, all subjects were screened to rule out cervical and other pathologies that could possibly contribute to their lateral elbow pain. Subjects who met the inclusion criteria were randomized into treatment and placebo treatment groups by a second (treating) therapist. Subjects were blinded to their group assignment. Subjects in the treatment group received OEMT for six sessions. During each treatment session, first a tender point was located through palpation. After proper hand placement, the therapist focused the direction of the oscillating energy on the localized tender point. Subjects in the placebo group underwent the same procedure, but the direction of the oscillating energy was directed to an area above or below the tender points, not covering the affected area. Jamar Dynamometer, Patient Specific Functional Scale (PSFS), and Numeric Rating Scale (NRS) were used to measure grip strength, functional status, and pain intensity and limited activity due to pain, respectively. The screening therapist who was blinded to the subjects' group assignment performed pretest, posttest, and six-month follow-up measurements. Subjects in the treatment group showed both clinically and statistically significant improvement in grip strength (p=0.03), pain intensity (p=0.006), function (p=0.003), and limited activity due to pain (p=0.025) compared with those in the placebo group. Follow-up data, collected after six months, showed no significant difference between posttest and follow-up measurements in functional activity (p=0.35), pain intensity (p=0.72), and activity limitation due to pain (p=0.34). Of all the subjects contacted for follow-up assessment, 91% maintained improved function and 73% remained pain free for at least six months. OEMT seems to be a viable, effective, and efficient alternative treatment for LE.
外侧上髁炎（LE）的症状归因于手腕和手部伸肌重复或过度使用后组织内微观撕裂所引发的常见伸肌肌腱的退行性改变和炎症反应。基于LE炎症基础进行的传统治疗显示失败率为39% - 80%。另一种方法认为，LE的症状可能是由于手部和手腕伸肌起点处因过度使用或重复运动而产生的活性压痛点所致。振荡能量手动疗法（OEMT），也称为V形扩散法，是一种颅骶部手动技术，已在临床上用于治疗颅骨缝线处的压痛点。鉴于LE的症状可能由活性压痛点引起，本研究的目的是调查OEMT对慢性LE患者的疼痛、握力和功能能力的影响。23名年龄在24至72岁之间的慢性LE（>3个月）患者参与了本研究。在他们参与之前，所有受试者都经过筛查以排除可能导致其外侧肘部疼痛的颈椎及其他病变。符合纳入标准的受试者由第二位（治疗）治疗师随机分为治疗组和安慰剂治疗组。受试者对其分组情况不知情。治疗组的受试者接受了六次OEMT治疗。在每次治疗过程中，首先通过触诊确定一个压痛点。在正确放置手部后，治疗师将振荡能量的方向集中在局部压痛点上。安慰剂组的受试者接受相同的程序，但振荡能量的方向指向压痛点上方或下方的区域，而不覆盖受影响区域。分别使用Jamar测力计、患者特定功能量表（PSFS）和数字评分量表（NRS）来测量握力、功能状态、疼痛强度以及因疼痛导致的活动受限情况。对受试者分组情况不知情的筛查治疗师进行了预测试、后测试以及六个月的随访测量。与安慰剂组相比，治疗组的受试者在握力（p = 0.03）、疼痛强度（p = 0.006）、功能（p = 0.003）以及因疼痛导致的活动受限（p = 0.025）方面均显示出临床和统计学上的显著改善。六个月后收集的随访数据显示，后测试和随访测量在功能活动（p = 0.35）、疼痛强度（p = 0.72）以及因疼痛导致的活动受限（p = 0.34）方面无显著差异。在所有被联系进行随访评估的受试者中，91%的人功能持续改善，73%的人至少六个月无疼痛。OEMT似乎是一种可行、有效且高效的LE替代治疗方法。
