A STUDY TO ASSESS THE EFFECTIVENESS OF POSITIONAL RELEASE THERAPY IN MANAGING LATERAL EPICONDYLITIS

GUIDED BY -Mr.R.Manigandan M.P.T .,M.I.A.P PRESENTED BY - J.Joshua Chadwick & S.Valarmathy

INTRODUCTION
Tennis elbow affects between 1 to 3 percent of population and occurs most commonly between the ages of 35 and 50 years.  There are many treatments available for tennis elbow, out of which Positional release therapy is found to be more effective.


OPERATIONAL DEFINITIONS
LATERAL EPICONDYLITIS:
Lateral epicondylitis refers to the degeneration at the extensor muscle group origin principally in the extensor carpi radialis brevis.

-Miller2000

POSITIONAL RELEASE THERAPY:

Positional release therapy is an indirect technique which places the body into a position of greatest comfort and employs tender points to identify and monitor the lesion. -DAmbrogio

NEED OF THE STUDY

The need of the study is to find out the effectiveness of positional release therapy in lateral epicondylitis

AIM OF THE STUDY

The main aim of the study is to find out the effectiveness of Positional release therapy in reducing pain, functional disability and tenderness in patients with lateral epicondylitis.

HYPOTHESIS
NULL HYPOTHESIS: Positional release therapy is not effective in reducing pain, functional disability and tenderness for patients with lateral epicondylitis.

ALTERNATE HYPOTHESIS:
Positional release therapy is effective in reducing pain, functional disability and tenderness for patients with lateral epicondylitis.

METHODOLOGY
STUDY DESIGN:
An experimental design.

SETTING:
Outpatient department of Sree Balaji College of Physiotherapy, Chennai.

STUDY SAMPLE: 18 subjects with unilateral lateral epicondylitis (15 males and 3 females) aged 35 to 50 years, where chosen using random sampling method.

SAMPLE SELECTION CRITERIA

INCLUSION CRITERIA:  Patients with unilateral lateral epicondylitis.  Patients between the ages 35-50 years.  Both females and males.

EXCLUSION CRITERIA
       

Medial epicondylitis Radial tunnel syndrome. Referred pain from cervical radiculopathy. Synovitis of radiohumeral joint Radiohumeral bursitis Humeral radial head fracture Degenerative joint disease of elbow Cubital tunnel Syndrome

EXCLUSION CRITERIA
     

Myositis ossificans at elbow Open wounds at elbow Hypersensitivity of skin Healing fractures History of long term steroid usage Use of analgesics in previous 24 hours

MATERIALS USED
Chair  Table  Patient Rated Tennis Elbow Evaluation Questionnaire  Tenderness Grading


MEASUREMENT TOOLS
TENDERNESS GRADING SCALE: According to Maggie tenderness is graded as

0 No pain 1 Patient complains of pain 2 Patient complains of pain and

winces 3 Patient winces and withdraws joint 4 Patient will not allow palpation

THE PATIENT RATED TENNIS ELBOW EVALUATION

1.PAIN IN YOUR AFFECTED ARM
Rate the average amount of pain in your arm over the past week by circling the number that best describes your pain on a scale 0 to 10. A zero (0) means that you did not have any pain and a ten (10) means that you had the worst pain imaginable. RATE YOUR PAIN: No Pain Worst Imaginable When you are at rest 0 1 2 3 4 5 6 7 8 9 10 When doing a task with repeated arm movement 0 1 2 3 4 5 6 7 8 9 10 When carrying a plastic bag of groceries 0 1 2 3 4 5 6 7 8 9 10 When your pain was at its least 0 1 2 3 4 5 6 7 8 9 10 When your pain was at its worst 0 1 2 3 4 5 6 7 8 9 10

A. SPECIFIC ACTIVITIES
Rate the amount of difficulty you experience performing each of the task listed below, the past week, by circling the number that best describes your difficulty on a scale of 010.A zero (0) means you did not experience any difficulty and a ten (10) means it was so difficult you were unable to do it at all.
No difficulty Turn a doorknob or key Carry a grocery bag or briefcase by the handle Lift a full coffee cup or glass of milk to your mouth Open a jar Pull up pants Wring out a washcloth or wet towel Unable to do 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10

B. USUAL ACTIVITIES Rate the amount of difficulty you experienced performing your usual activities in each of the areas listed below, over the past week, by circling the number that best describes your difficulty on a scale of 0-10-. By usual activities," we mean the activities that performed before you started having a problem with your arm. A zero (0) means you did not experience any difficulty and a ten (10) means it was so difficult you were unable to do any of your usual activities.
1. 2. 3. 4.

Personal activities (dressing, washing) Household work (cleaning, maintenance) Work (your job or everyday work) Recreational or sporting activities

0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10

  

Pain score Function Score Total score

= = =

PROCEDURE


The patient was asked to sit in a resting position and positional release therapy was given. The technique of positional release therapy is as follows: STEP 1: Palpating the tender point.

PALPATING THE TENDER POINT

STEP 2: The affected arm is taken into comfort zone.



Comfort Zone: It is a position at which there is no tenderness and the tissues are completely relaxed

STEP 3:


The affected arm is maintained in comfort zone for 90 seconds.

APPLYING POSITIONAL RELEASE THERAPY

DATA ANALYSIS AND INTEREPTATION

RESULTS
Post test shows t value as 0.000 significant when compared to pretest on Patient Rated Tennis Elbow Evaluation Score.  Post test shows t value as 0.001 significant when compared to pretest on Tenderness Grading Scale.


DISCUSSION


The study results shows that positional release therapy is effective in reducing pain, functional disability and tenderness in lateral epicondylitis.So this study accepts the alternate hypothesis and the null hypothesis is rejected.

Positional release therapy reduces pain, functional disability and tenderness by the following mechanism: When the part is positioned in the comfort zone musculoskeletal structures are relaxed Pressure on the intervening structures such as lymph & blood vessels are reduced

Increased vascular & interstitial circulation

Increased vascular & interstitial circulation

Healing of damaged tissue Resolution of lateral epicondylitis Removal of chemical mediators of inflammation Resolution of guarding reflexes in the myofascial structures Reduction in the release of nociceptive substance Reduction of pain

Improved lymphatic drainage

Reabsorption of tissue fluids Reduction of swelling associated with inflammation

 By all these means Positional

release therapy effectively alleviates the symptoms of lateral epicondylitis & aids in healing of the damaged tissue.

CONCLUSION


Thus from the study we conclude that Positional release therapy is effective in reducing pain, functional disability and tenderness in patients with lateral epicondylitis.

THANK YOU