Kelsie Shaw, Bethany Ralph, Alex

Grodzicki, Seth Bruce

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• Topic of Interest: Effects of myofascial release
(MFR) on pain, range of motion (ROM) and muscle
force contractility among tennis players with
lateral epicondylitis
• Lateral Epicondylitis: Tendinopathy of the
common extensor–supinator tendon
• Myofascial Release: Hands- on soft tissue
technique, stretching restricted fascia
• Research Problem: Lateral epicondylitis among
tennis players
 Effectiveness of Myofascial Release in the Management of Lateral Epicondylitis
in Computer Professionals
• Conclusion: Evidence provided MFR was more effective than a control intervention for
lateral epicondylitis in computer professionals

Comparison between Myofascial Release Technique and Cryiax Manual Therapy

Prior on Pain and Disability in Subjects with Lateral Epicondylitis
Literature
• Conclusion: After 12 treatments, both groups showed statistically significant
improvement (p<0.05); non-statistically significant differences between groups (p>0.05)
in VAS and PRTEE

A Study to Compare the effectiveness of different Dosage of Therapeutic

Ultrasound on Pain and Grip Strength in Patients with Lateral Epicondylitis

• Conclusion: All three dosages were effective to reduce pain and improve grip strength in
patients with LE, however, continuous mode showed a better effect compared to other
dosages
Research Rationale
• Based on literature reviewed, myofascial
release alone, therapeutic ultrasound
alone, and a combination of myofascial
release and ultrasound have all proven
effective in treating LE among tennis players
• A gap in literature existed, proving evidence
of which of these treatments was most
effective
• Limited research focusing on:
• Tennis players with Lateral Epicondylitis
• Quantitative Sign-Based Measurements
 • Question: Is myofascial release combined with
therapeutic ultrasound more effective than
either therapeutic ultrasound alone or
Research myofascial release alone on function and pain
among tennis players with lateral
Question & epicondylitis?
• Hypothesis: The combined treatment of
Hypothesis ultrasound and myofascial release will be more
effective in treating lateral epicondylitis among
tennis players than myofascial release or
ultrasound alone.
 • 2 Independent:
• Treatment Group: Myofascial Release,
Therapeutic Ultrasound, Therapeutic
Ultrasound and Myofascial Release
• Measurement/ Observation Time: Baseline
Variables Measurement, Week 12, Week 24
• 3 Dependent
• Pain Sensitivity (Dolorimetry)
• Active Range of Motion (Goniometry)
• Maximal Muscle Force Production
(Handheld Dynamometry)
 • Sample Size: 90 subjects
• Sample Design: Convenience sampling for participant selection, random
assignment to groups
• Randomized, Controlled, Single Blinded Study
• Inclusion Criteria
• Amateur/ recreational tennis player
• Between ages 18 and 50 years
Participants • Patient diagnosed with lateral epicondylitis clinically
• Exclusion Criteria
• History of fracture, subluxation, dislocation, or elbow surgery
• Local arthritis or poly arthritis
• Corticosteroid injection within previous 6 months
• Any other form of previous or current therapy for lateral epicondylitis
 • Group 1- Myofascial Release
• 3 techniques performed 2 repetitions of 5 minutes each
• Technique 1: treating from common extensor tendon to
extensor retinaculum
• Technique 2: treating through periosteum of the ulna
• Technique 3: spreading the radius from the ulna
• 2 interventions provided 3 times per week for 4 weeks, with a

Treatment minimum of a 1-day gap between sessions

• Group 2- Therapeutic Ultrasound

Methods • Frequency- 1 MHz; Mode- Continuous; Intensity- 1.5 W/Cm2

• 7 treatments given 7 minutes for 7 days consecutively
• Group 3- Myofascial Release and Therapeutic Ultrasound
• 5 minutes ultrasound treatment at 1 W/ Cm2
• Pulsed mode 1:4 ratio with frequency of Cm2
• Myofascial release for 10 minutes
• 12 sessions over 3 weeks
 • Pain Sensitivity
• Dolorimetry
• Point Tested: Over lateral epicondyle of the
humerus
Testing • Active Range of Motion
• Goniometry
Methods • Motion Tested: Wrist Flexion
• Maximal Force Production
• Handheld Dynamometry
• Action Tested: Grip Strength
Statistical Analysis
Mixed Repeated Measures ANOVA
 • Wrist range of motion significantly improved with:
• Myofascial Release
• Ultrasound
• Myofascial Release & Ultrasound
Conclusion • Pain significantly decreased with:
• Myofascial Release
• Myofascial Release & Ultrasound
• None of the treatments showed significant improvement in grip strength
Questions?
 References
• Ajimsha M, Chithra S, Thulasyammal R. Effectiveness of Myofascial Release in the
Management of Lateral Epicondylitis in Computer Professionals. Arch Phys Med Rehabil.
2012;93(4):604-609. doi:10.1016/j.apmr.2011.10.012
• Alizadehkhaiyat O, Fisher AC, Kemp GJ, Vishwanathan K, Frostick SP. Upper limb muscle
imbalance in tennis elbow: A functional and electromyographic assessment. Wiley
Online Library. https://onlinelibrary.wiley.com/doi/pdf/10.1002/jor.20458. Published
June 28, 2007. Accessed October 13, 2019.
• Barnes M. The Basic Science of Myofascial Release: Morphologic Change in Connective
Tissue . Journal of Bodywork and Movement Therapies. 1997;4:231-238.
• Kumar R, Jetly S. Comparison between Myofascial Release Technique and Cyriax
Manual Therapy on Pain and Disability in Subjects with Lateral Epicondylitis. Indian
Journal of Physiotherapy and Occupational Therapy - An International Journal.
2016;10(3):12. doi:10.5958/0973-5674.2016.00075.7
• Lenoir H, Mares O, Carlier Y. Management of lateral epicondylitis. Orthopaedics &
Traumatology: Surgery & Research. September 2019.
• Shanishwara MH, Kakkad A. A Study to Compare the effectiveness of different Dosage
of Therapeutic Ultrasound on Pain and Grip Strength in Patients with Lateral
Epicondylitis. Indian Journal of Physiotherapy and Occupational Therapy - An
International Journal. 2014;8(4):168. doi:10.5958/0973-5674.2014.00032.x.