Manipulation in the treatment of tennis elbow

With the increasing popularity of tennis there has been an increasing interest in the etiology and treatrnent of lateral epicondylitis. The current pathophysiology is assumed to be related to repeated wrist extension and rotation leading to microtrauma at the common wrist extensor origin with an ultimate change in the histology of the area. Treatment involves exercise, the use of many modalities to treat the area locally, and more specifically when tennis is the etiology a whole variety of functional adaptations as well as a modification of equipment. Specifically, manipulation of the elbow has played a large role in the treatment of resistant tennis elbow and the large number of different named maneuvers has led to a certain amount of confusion. The second half of the paper attempts to review these manipulations including that described by Mills, Cyriax, Kaltenborn, Mennell, and Stoddard. These manipulations seem to fall into two basic varieties: those that seek full extension and those that will produce a varus thrust. The manipulations done with the elbow in extension and the forearm in pronation have the greatest chance of affecting the contractile elements whereas those performed with a varus thrust at the elbow seem to act primarily on the capsular structures causing gapping and restoring joint play. While manipulation may be effective it always must be used in conjunction with a total treatment regime including exercise, modalities, and modification of the activities involved in the etiology. J Orthop Sports Phys Ther 1986;7(5):264-272.