Incorporation of Manual Therapy Directed at the Cervicothoracic Spine in Patients with Lateral Epicondylalgia: A Pilot Clinical Trial

Recent trends in the use of manual therapy directed at the cervicothoracic spine in patients with lateral epicondylalgia have been observed. However, only short-term preliminary evidence exists to support the use of these techniques. This pilot clinical trial describes the outcomes of patients with lateral epicondylalgia undergoing local treatment (LT) solely directed at the elbow and a program consisting of local treatment plus manual therapy aimed at the cervicothoracic spine (LT + MTCT). Ten consecutive patients referred to physical therapy by their primary care physician with a diagnosis of lateral epicondylalgia were randomly assigned to receive LT or LT + MTCT. Both groups received 10 treatments over a 6-week period. Outcome measures, including the Numeric Pain Rating Scale; pain-free grip strength; Disability of the Arm, Shoulder, and Hand questionnaire; and a global rating of change were completed at discharge and at 6-month follow-up. Patients in both groups exhibited clinically meaningful improvement at discharge and at the 6-month follow-up. The LT + MTCT group demonstrated greater improvement in all outcome measures as compared to the LT group. The results suggest that the incorporation of manual therapy directed at the cervicothoracic spine may be an effective adjunct to treatment directed solely at the elbow for patients with lateral epicondylalgia.