The analgesic effect of joint mobilization and manipulation in tendinopathy: a narrative review

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.

KEYWORDS:

• Manual therapy
• manipulation
• mobilization
• tendinopathy

Acknowledgments

Open Access funding provided by the Qatar National Library.

None declared

Sources of funding

None declared

Disclosure statement

All authors declare that there is not any interest or relationship, financial or otherwise that might be perceived as influencing an author’s objectivity is considered a potential source of conflict of interest.

Data availability statement:

None declared

Additional information

Notes on contributors

Christos Savva

Dr. Christos Savva is an Assistant Professor in Musculoskeletal Physiotherapy at the Department of Health Sciences of the European University Cyprus. He studied physiotherapy (2004–2008) at the Technological Educational Institute of Athens and continued with an MSc in Manipulative Physiotherapy (2009–2011) at the University of Birmingham. In 2014, he completed his PhD in the area of Neural Mobilization. Dr. Savva’ areas of interest include tendinopathies and neural mobilization

Christos Karagiannis

Dr. Christos Karagiannis is a Lecturer in Physiotherapy at the Department of Health Sciences of the European University Cyprus. He studied physiotherapy (2004–2008) at the Technological Educational Institute of Athens and continued with an MSc in Cardiopulmonary Resuscitation (2009–2011) at the Medical School of the National and Kapodistrian University of Athens. In 2020, he completed his PhD in the area of respiratory physiotherapy. Dr. Karagiannis’ areas of interest include cardiac rehabilitation, pulmonary rehabilitation, evaluation of musculoskeletal dysfunctions, and treatment of musculoskeletal dysfunctions.

Vasileios Korakakis

Vasileios Korakakis is a specialist spine and sports physiotherapist working as Clinical Leader at Aspetar Sports Medicine Hospital. He has worked as a physiotherapist in elite football teams and has several years of experience in spinal and orthopedic rehabilitation. He is a senior lecturer in Orthopaedic Manipulative Therapy in IFOMPT certified programmes, has a diploma in Mechanical Diagnosis and Therapy from the University of Otago (NZ). After gaining his MSc in Health and Exercise from the University of Thessaly in 2012, he continued to gain his PhD in biomechanics (2020). He has published more than 50 original publications and book chapters. His recent research interest is focused on blood flow restriction training, tendinopathies, spinal biomechanics, sports rehabilitation, systematic reviews, and clinimetrics.

Michalis Efstathiou

Michalis Efstathiou holds a bachelor degree in Physiotherapy form the Technological Educational Institute (TEI) of Athens where he graduated in 2008. Two years after he completed his Master’s Degree (MSc) in Advancing Practice – Specialist in Manual Therapy at the University of Birmingham in the UK. Currently he is a PhD candidate in Neuromusculoskeletal Physiotherapy at the University of Nicosia. He has published studies in per reviewed journals and has given oral presentations at scientific conferences concerning musculoskeletal physiotherapy disorders. Michalis has worked as a musculoskeletal physiotherapist at private physiotherapy clinics in Greece, UK and Cyprus. Since 2013 he holds the title ″Associate Lecturer″ of Physiotherapy and teaches musculoskeletal courses for the Physiotherapy programme of the University of Nicosia.