Neurodynamic treatment in combination with manual therapy in patients with persistent lateral elbow pain : A Single Subject Experimental Design study

Abstract: Introduction Lateral elbow pain is a common disorder and affects 1-3 % of the population each year. Beside the typical characterization with pain in restricted dorsal and radial deviation of the wrist and local tenderness of the lateral epicondyle, a neurodynamic dysfunction of the radial nerve can co-exist with the tendon dysfunction.  Purpose The aim of the study was to evaluate the effects of individualized neurodynamic treatment in combination with neurodynamic self-treatment in patient with persistent lateral elbow pain with a neurodynamic dysfunction of the radial nerve on grip strength, pain, disability, and function.  Method A single subject experimental design with A-B-A design was conducted. Seven participants with lateral elbow pain and a neurodynamic dysfunction of the radial nerve were recruited for the study. Five participants completed the study which consisted of individualized neurodynamic treatment directed to the neurodynamic dysfunction in combination with home exercises which included self-mobilization with sliders and/or tensioners in combination of the strengthening- and stretching exercises. The treatment was evaluated by pain-free and maximal grip strength, the Disabilities of the Arm, Shoulder and Hand (DASH) and Patient-rated Tennis Elbow Evaluation (PRTEE) questionnaires and range of motion of the upper limb neurodynamic test (ULNT) biased n. radialis.   Results The result of this SSED shows that neurodynamic treatment with manual mobilization and self-mobilization improves the ROM of the ULNT n. radialis in all five participants. Neurodynamic treatment also improved outcomes of DASH and PRTEE in 3 of the 5 participants.  Conclusion Neurodynamic treatment including manual mobilization and self-mobilization in combination with individual strength exercises tends to improve self-rated pain and disability, function and mechanosenstivity of the radial nerve in patients with persistent lateral elbow pain.