Author Names
Savva, C, Karagiannis, C, Korakakis, V, and Efstathiou, M
Reviewer Name
Annemarie Jacob
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Objective: To summarize the available literature with regards to the potential analgesic effect and mechanism of joint mobilization and manipulation in tendinopathy. Results: The effect of these techniques in rotator cuff tendinopathy and lateral elbow tendinopathy, applied alone, compared to a placebo intervention or along with other interventions has been reported in some randomized controlled trials which have been scrutinized in systematic reviews. Due to the small randomized controlled trials and other methodological limitations of the evidence base, including short-term follow-ups, small sample size and lack of homogenous samples further studies are needed. Literature in other tendinopathies such as medial elbow tendinopathy, de Quervain’s disease and Achilles tendinopathy is limited since the analgesic effect of these techniques has been identified in few case series and reports. Therefore, the low methodological quality renders caution in the generalization of findings in clinical practice. Studies on the analgesic mechanism of these techniques highlight the activation of the descending inhibitory pain mechanism and sympathoexcitation although this area needs further investigation. Conclusion: Study suggests that joint mobilization and manipulation may be a potential contributor in the management of tendinopathy as a pre-conditioning process prior to formal exercise loading rehabilitation or other proven effective treatment approaches.
NIH Risk of Bias Tool
Quality Assessment of Systematic Reviews and Meta-Analyses
- Is the review based on a focused question that is adequately formulated and described?
- Cannot Determine, Not Reported, Not Applicable
- Were eligibility criteria for included and excluded studies predefined and specified?
- Yes
- Did the literature search strategy use a comprehensive, systematic approach?
- Yes
- Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
- Cannot Determine, Not Reported, Not Applicable
- Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
- Were the included studies listed along with important characteristics and results of each study?
- Yes
- Was publication bias assessed?
- No
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- Cannot Determine, Not Reported, Not Applicable
Key Finding #1
Manual therapy in combination with exercise is suggested to reduce rotator cuff tendon pain and improve short term function moreso than just exercise therapy on it’s own.
Key Finding #2
Joint mobilizations and manipulations that are directed at the cervical and thoracic spine (or the elbow and the wrist) have been shown to be effective on both pain and function in patients with lateral elbow tendinopathy.
Please provide your summary of the paper
There is still, overall, limited research out there that can firmly support the effectiveness of manual therapy in numerous tendinopathies. However, in rotator cuff tendinopathies and lateral elbow tendinopathies, there is more evidence. These techniques when used with both of these conditions could be utilized as a pre-conditioning treatment in order to prepare the individual for formal exercise that can further help their condition.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
The findings of this review support the idea that joint mobilizations and manipulations, whether applied alone or in combination with other interventions, could be effective in reducting tendon pain both in the rotator cuff and the lateral elbow. Moreover, these techniques can be used as an analgesic modality in many sessions that can provide an outlet to manage the patient’s pain so that they can work through other, more intensive interventions as well.
