Medial Epicondylitis and Whole Body Vibration
Medial Epicondylitis (ME) or golfer’s elbow causes pain and tenderness around the inside region of the elbow. Repetitive movements lead to micro tears of the tendons that attach to the medial aspect of the elbow (mainly the flexor-pronator muscles of the arm/hand including pronator teres, flexor carpi radialis and palmaris longus), causing non inflammatory degenerative changes. An individual may also experience ulnar neuropraxia due to the compression of the ulnar nerve in the medial epicondylar grove. ME is often caused by activities that require repetitive movements of the arm and hand (more specifically flexion and pronation movements). ME is often work related or due to an athletic injury (improper golf swing or pitching technique) but can also it can also be caused by an acute injury. Symptoms include pain and tenderness over the medial epicondyle of the elbow, pain with activities involving wrist flexion and forearm pronation and, if the ulnar nerve is involved, numbness and tingling which radiates into the fourth and fifth fingers. Treatments include: rest, ice/heat, non steroidal anti–inflammatory drugs, stretching, and ultrasound therapy. For prevention and return to activity, a progressive stretch and strengthening program is recommended. Sometimes strapping or bracing is also used to help realign the muscles.
Vibration has been used to treat pain in musculoskeletal conditions. Several studies have shown the short term benefits of using vibratory stimulation to help alleviate pain symptoms 1-4. The most effective relief of pain was found when the vibration was placed directly on or close to the area of pain; or on a trigger point close to the affected area at a moderate intensity for greater than 25 minutes. Individuals reported pain relief for several hours following the intervention. Research using WBV has shown improvements in low back pain and treating pain related syndromes like fibromyalgia 5, 6. However, there is no research available to determine if the use of Whole Body Vibration (WBV) would have the same impact on pain for specific conditions like ME.
It is important to check with a doctor or health care provider when beginning any new exercise program to ensure it will be beneficial and that there are no underlying medical issues that may be contraindicated to the use of WBV. Once a physician has cleared an individual to use WBV, they should begin at a lower intensity and duration to monitor whether pain in the medial aspect of the elbow or other symptoms of ME increase. If the pain does increase WBV should be discontinued until the ME has been resolved. To avoid aggravating ME symptoms WBV exercises, involving hands on the platform with the wrist in a more flexed or pronated position, should be avoided. Generally, if an exercise is causing any increase in pain or other symptoms it should be avoided. Exercises such as the pectoral stretch and upper arm massage may provide some temporary relief of pain, but there is no specific evidence or research involving WBV in this area. It is also important to follow the recommended time restriction of one ten minute session per day on the machine. In general, if an individual experiences any increase in pain, shortness of breath or dizziness they should discontinue the use of WBV immediately.
References
1. Lundeberg T, Nordemar R, Ottoson D. 1984. Pain alleviation by vibratory stimulation, Pain, 20(1), 25 – 44.
2. Lundeberg TC. 1983. Vibratory stimulation for the alleviation of chronic pain, Acta Physiologica Scandinavica Supplementum, 523, 1 – 51.
3. Lundeberg T. 1984. Vibratory stimulation for the alleviation of pain, American Journal of Chinese Medicine, 12(1 – 4), 60 – 70.
4. Kakigi R, Shibasaki H. 1992. Mechanisms of pain relief by vibration and movement, Journal of Neurology, Neurosurgery and Psychiatry, 55(4), 282 – 6.
5. Rittweger J. Vibration as an exercise modality: how it may work, and what its potential might be, European Journal of Applied Physiology
6. Alentorn-Geli E, Padilla J, Moras G, Lázaro Haro C, Fernández-Solà J. 2008. Six weeks of whole-body vibration exercise improves pain and fatigue in women with fibromyalgia, Journal of Alternative and Complementary Medicine, 14(8), 975 – 81.
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