Mobilisation-with-movement induces analgesia during exercise but exercise alone is not analgesic in people with lateral elbow tendinopathy: An assessor blinded, randomised crossover trial

Background

Isometric exercise has shown hypoalgesic effects in healthy individuals, while mobilisation-with-movement (MWM) has demonstrated hypoalgesia in people with lateral elbow tendinopathy (LET). This study aimed to explore the local and remote hypoalgesic effects of an isometric gripping exercise, with and without MWM, in individuals with LET.

Methods

A repeated-measures, crossover randomised study design was employed with 24 participants clinically diagnosed with LET. Each participant underwent three conditions: isometric gripping exercise (Exercise), MWM combined with isometric gripping exercise (MWM + EX), and a Control condition with a minimum 10-min wash-out period between each condition. Primary outcomes were pressure pain threshold (PPT) and temporal summation of pain (TS), assessed at local and remote sites. Secondary outcomes were pain at rest (Pain), assessed using a numerical rating scale (NRS 0–10), and grip force during the exercise task.

Results

Compared to control, pain increased immediately following Exercise, but not MWM + EX. Compared to Control, MWM + EX demonstrated higher PPT at both local and remote sites and lower first pinprick pain rating. No changes in TS were observed. Compared to Exercise, greater grip force and work was performed during contractions when MWM was applied.

Discussion

When combined with pain-provoking exercise, MWM produced hypoalgesic effects. Effects were largest when measured locally but also present at remote site, suggesting that both reduced stimulation of peripheral nociceptors and activation of descending pain inhibitory pathways may underpin its efficacy. By mitigating exercise-related pain and improving grip force, MWM may facilitate better adherence to exercise-based rehabilitation programs.