What Is The Evidence For Effects Of Cervical And Elbow Mobilisations On Neurophysiology Of Pain In Patients With Lateral Epicondylalgia?

Background Lateral epicondylalgia is a challenging condition to treat and in its chronic form is characterised by pain system changes. Cervical and Elbow mobilisations have been employed as interventions in the treatment of lateral epicondylalgia. Despite theories regarding the effects of mobilisations on the neurophysiology of pain, there is a lack of synthesised evidence and the hypotheses underlying mechanisms of action still need to be substantiated. Objectives The purpose of this systematic review was to evaluate the effects of cervical and elbow mobilisations on neurophysiology of pain in patients with lateral epicondylalgia and determine the level of evidence which exists. Methods Literature searching was conducted utilising electronic databases and entering defined keywords. Studies selected were required to fulfil pre-determined and specific inclusion and exclusion criteria. This process generated studies which were concerned with assessing the effects of either cervical or elbow joint mobilisations on neurophysiological outcome measures in patients with chronic lateral epicondylalgia. The reference lists of the selected studies were then checked to find other suitable papers. Data Extraction of relevant information from the studies was carried out. The selected studies underwent methodological quality assessment via the Physiotherapy Evidence Database scale and the Effective Public Health Practice Project assessment tool. Results Six studies were included within this review. The total number of participants included across all studies was 129. Five of the studies were randomised, repeated-measures crossover trials and one study was a repeated-measures, before-and-after design. The resuts from all studies showed statistically significant sympathoexcitation occurred concurrent with analgesia and improvements in pressure pain threshold. Conclusions The results from all studies provide evidence to support the theory that joint mobilisations evoke analgesia via activation of descending pathways of nociceptive control. There is a need for additional high-quality research to further explore the neurophysiological effects, including further research into other theories of action.msc_physpreunpub1654_ethesesunpu