Physical Therapy - Science topic

Dear Amirul AB , this article may be of interest to you.

“I would fall five to six times per day,” says architect and former mayor Marc Gauthier, reflecting on his life before receiving a highly experimental implant that delivers electrical stimulation to his spinal cord. Gauthier has advanced Parkinson’s disease, and the technology enables him to walk fluidly — something no other therapy can do. Researchers say larger studies are needed to assess whether the device will work for others with the disease...

Have you seen the APTA Clinical Practice Guidelines? This is the 2020 CPG for Heart Failure:

Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure Michael J. Shoemaker, Konrad J. Dias, Kristin M. Lefebvre, John D. Heick, Sean M. Collins

There are a few others listed on the APTA CVP (Cardiovascular Pulmonary website).

Clinical Practice Guidelines (aptacvp.org)

Hi,

You can find it on the following link :)

Hope that helps!

Best of luck from India!

Thank you Thomas Gloor-Juzi !

Follows below the reference I found. However, I am not sure this is the oldest reference.

CHRYSTAL M, HOFFNUNG A, BARSKY M, ROY JB. Possibilities and limitations of rehabilitation procedures for paralysis agitans. Phys Ther Rev (1948). 1952 May;32(5):231-5. doi: 10.1093/ptj/32.5.231. PMID: 14920202.

answer submitted

Hi there, are you trying to establish the ''clinical utility'' of a given tool, in assessing baseline status or progress made in rehab?

What is the variable that most impacts according to patient reports or clinical tests

Patient reports are always of prime importance. In our facility we cannot have equipment all the tests / pts may not be able to afford comprehensive tests..so in that situation also patient reports gain importance.

no of episodes, duration of episode and accompanying symptoms are always helpful in making clinical decision. Then one can decide on whether to go with vestibular assessment or radiological.

issue with patient reports is, skill level of the clinician and time it takes to get all relevant information.

Regards

Also check the following very good link:

Dear Feras, the following papers may help you:

Boden I, Skinner EH, Browning L, et al. Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial. BMJ 2018;360:j5916. https://www.bmj.com/content/360/bmj.j5916.long

Bashir S, Siddiqi FA, Baig M, et al. Effect of chest physical therapy with early mobilization on post-operative pulmonary complications in upper abdominal surgeries. Rawal Medical Journal 2019;44(1):99-105. http://www.rmj.org.pk/fulltext/27-1536294286.pdf?1625217061

Wegner F, et al. Preoperative physical activity has a protective effect against postoperative pulmonary complications after abdominal surgery. Fisioterapia Brasil 2020;21(4):363-371. https://portalatlanticaeditora.com.br/index.php/fisioterapiabrasil/article/view/3971/pdf

Best wishes from Germany, Martin

Bulletin of physical therapy journal.

If you are master candidate, it will be a fit for you

Shweta Singh Fantastic. Thank you very much. We are asking (neuro)psychologists, neurosurgeons, speech-language therapists, occupational therapists, physiotherapists, and psychotherapists to participate. If you have a few contacts you would like to share, please message me privately. We will be happy to reach out to these people directly, if it helps save your time. I am also providing my email address: MPolczynska@mendet.ucla.edu just in case. Best wishes, Monika

Thank you, Aedrian Abrilla! I did some research beforehand, however, I was trying to look for RCT or systematic review studies but I can't ask for a full-text request of the article. Thank you again! The links you put surely helped.

From a practice point of view, some countries recognise consultant physiotherapists as those who have a PhD, or are very experienced in their field (over 20 years of practice). However, it may not apply to all fields. As Stephen M. Shaffer suggested, the question needs to be narrowed.

Task-based interventions are highly effective for gait and ambulation among patients with chronic CVA and TBI provided that a sufficient intensity is maintained.

Dear Salameh

It uses depends on the patient load. Otherwise. It used in musculoskeletal cases with high demand on where 100+ MSK cases.

Every subject and specialty has hundreds if not thousands of journals. 

 I will recommend the following helpful websites can be useful to choose your target journal

http://jane.biosemantics.org/

I would also like to warn you about the latest scam in academics called predatory Journals which are mostly fraud bogus online journals who charge  money for publication within days but do not offer any peer review Please visit https://thinkchecksubmit.org/ to get an idea about predatory journals and how to avoid them

Good luck with the submission

I think that Expiratory exercise will increase the Transpleural pressure this will help to make the pressure at the point to prevent atelectasis

In my view, due to the COVID-19, we are realizing the full potential of the web-based physical Activity and exercising at home. It appears that the pandemic has demonstrated that the internet can expand the scope of educational and professional care and include people who possibly were not comfortable in a traditional physical activity setting. People will cherish more PA, including RT, even in non traditional setting.

You can see on North American Association of Neurology and Neurosurgery Guidelines

Following any means to treat OA. Strengthening of the quadriceps muscles goes a long way.

Look into the Noi group research. ~Maureen

Yes it can.

PT can help in reducing knee pain due to various periarticular structures.

Marginal effects have been observed. There is also a strong placebo effect.

Excellent question! There's been a recent surge in AI-mediated auditing and AI-supported diagnosis of many conditions. Several studies demonstrated that these methods of imaging analysis and pattern recognition can reliably improve the diagnostic accuracy when compared to a human-based assessment (e.g. in classification of fractures , dermatological assessment , or MRI interpretation , , .

The research on guiding diagnosis, improving accuracy, and clinical outcomes has been somewhat less popular, perhaps because of ethical limitations, poor availability of datasets, and confusing standardisation of symptomatology.

To my knowledge, the first AI use in a large scale auditing of diagnostic accuracy has been done in Frontotemporal dementia (by us):

This field has, in my opinion, an enormous potential of automation and dramatic improvement in quality of care, for the fraction of resources needed to conduct a full-scale audit.

Naturally, human issues still persist: the implementation of AI requires good note-keeping and universality of databases (which is very difficult to achieve!) and any potential benefits must be implemented by responsible teams and clinicians (same problem as in conventional audits).

Nevertheless, this area of research offers an exciting new route of getting the clinical answers right where we need them.

Hi

May this paper can help you

Jung, M., & Jang, C. (2013). Awareness on Occupational Therapy by the People Involved in Rehabilitation of Persons with Disabilities. Journal of The Korean Society of Integrative Medicine, 1(2), 105-117.

My PostureScreen Mobile is great way to measure standing posture, movement screens, etc. You can message me at joe@PostureCo.com if you have any questions. https://www.postureanalysis.com/posturescreen-research-reliability-and-utility/

I have treated several patients over the years with chronic upper and lower limb compartment syndrome confirmed with dynamic pressure monitoring. I have never regretted not openly decompressing chronic compartment syndrome, the pain goes away. I don’t think there is any good case for conservative management.

Consider measuring the changes and impact on sleep, appetite,mood swings etc

James

I think I am complicating this analysis unnecessarily. I like your suggestion. We will simply express the results in terms of odds and not odds ratio. Thank you again for helping with this!

Yes i also agree that there is gap in research to find out the post surgery pulmonary complication which i think might have a difference in outcomes.

Hi all, there's a good summary of the most recently published studies on the Feldenkrais Method in the editorial of the Feldenkrais Journal. It mentions the systematic reviews that have been mentioned here, as well as research published after those reviews: http://iffresearchjournal.org/volume/5/introduction-editorial

It's worth quoting in full a portion of that editorial: "One ongoing challenge in investigating the outcomes of the Feldenkrais Method is that it is very difficult to 'blind' trials for practices like Feldenkrais (for example, for participants to not know whether they are receiving the “intervention” or not). Even with sham interventions, participants will often be able to guess fairly accurately which is the real intervention and which is the sham (Licciardone and Russo 2006). This lack of blinding is one of the reasons that the evidence in Feldenkrais outcome studies frequently receives a lower level of evidence rating. Buchanan draws on work by Mehling, DiBlasi, and Hecht (2005) to suggest ways that this risk of bias can be dealt with in studies of practices like the Feldenkrais Method."

I'm training to be a practitioner in the method and have found immense value in it. Practitioners are careful to state that Feldenkrais is a learning method and not a therapeutic or exercise modality. Nonetheless, the basis for the method is the basis that a specific attention to movement can reorganize (albeit perhaps temporarily) the sensorimotor cortex. With this in mind, I wonder if "objective" evidence for the efficacy of the method may be strengthened with fMRI and other brain activity studies; I have only seen one by Verrel et al (2015), which is mentioned in that editorial. I would be interested in hearing more about work done in this domain.

Thank you Simon! I am developing some materials designed to provide easy access and the "communication ramp" required for Aphasia - we are going on 4 years teaching a sub-set of The Aphasia Tones (TM) choir. It has dawned on me this might a very good access point for anyone looking to learn or just enjoy making music 'late in life', with minimal music expertise and/or as part of a rehab plan. [If I can make headway here, I will move on to drum circle style rhythm facilitation; and/or possibly ukelele seeking the easiest and most adaptable entry into music for elders or anyone with disability, etc.] At risk of rambling - but some background: Personally, I learned harmonica because I broke my knee at age 27, PhD fresh in hand (ending my hopes for a run at gentleman's/Masters bike racing). Harmonica was the rehab to heal my broken spirit. If you have any interest in the project, keep in touch, one of my partners in creating the materials is Tomlin Leckie, based in Edinburgh; After lots of screening; I am taking his well-structured basic harp e-learning program just to learn his approach and see what materials would be most useful for our application, he has a psych background and is interested in the rehab application. Another inspirational and educational model for me is David Harp who does "Harmonica and Mindfulness Breathing" workshops, a bit more spiritual and meditative, he has taught millions of people meditation, mindfulness and/or harmonica - but does hold formal training in psych, though he operates more in the human potential movement outside of academia.

The research gaps provide new research ideas.

From a thorough desk research a researcher can identify the existing research gaps. Then the identified research gaps need to be filled (for example using hypothetico deductive approach). So there should be a link between the research objectives, research questions and the identified research gaps.

You can get an idea about the research gaps in the article by Iddagoda & Opatha (2017). This is available in the ResearchGate and the reference is given below.

Reference

Iddagoda, Y. A., & Opatha, H. H. D. N. P. (2017). Identified Research Gaps in Employee Engagement. International Business Research, 10(2), 63.

Good Luck

you want to say: if one patient's orthosis can be used by another?

Hi Fahad,

Please read the following article: Tannor AY(2013). Millenium development goals and rehabilitation in Ghana. International Journal of Therapy And Rehabilitation, 20(10), p. 477 https://doi.org/10.12968/ijtr.2013.20.10.477. It may offer some help.

Kind regards,

Auwal

Hi Georg

This is a very good question. A recent survey of doctors in the UK shows that 80% of general practitioners were unfamiliar with physical activity guidelines, and only 43% were confident in discussing physical activity with patients.

I hope the following reference is useful: 

Chatterjee, R., et al. (2017). "GPs' knowledge, use, and confidence in national physical activity and health guidelines and tools: a questionnaire-based survey of general practice in England." British Journal of General Practice.

In addition, our research team has recently surveyed a small group physiotherapists and physiologists who work with respiratory patients, and found that approximately 1/3 are not confident in discussing/prescribing exercise. Our paper will be published soon. 

Regards

Owen

there is a mechanical association....

however it becomes relevant when there is a predisposing  factor like altered bio mechanics / .....

Complex  

Hability tests must be associated with endurance tests

No able to  discuss

Dear Julia,

If the SPPB is being performed in an acute phase after hip fracture it's understandable the difficult of the patients, and it will be biased as a measure of sarcopenia. I believe that handgrip strength is a good alternative as suggested above.

Kind Regards,

Alessandra

I would look at the textbook by Dr. Stuart McGill "Low back disorders: Evidenced-based prevention and rehabilitation" (3rd ed).  Dr. McGill, in my opinion, is likely one of the most prolific scholars in the study of low back disorders from a biomechanical perspective.  I agree that core is a term that has an unclear definition but certainly has some traction in the popular press.

Please let me know if this citation (and reference below) is useful to you.

“Why joints pop

Like nearly all the joints in your body, the knee joint is covered by a protective membrane containing synovial fluid. This fluid lubricates the joint, allowing it to move smoothly and easily.

Occasionally, tiny gas bubbles build up in this fluid. When the joint moves, the bubbles are released, causing the nearby ligaments to emit a snap or pop sound. The technical term for this phenomenon is crepitus, which also describes all grinding or crackling sounds and sensations in the body.

When to be concerned about joints popping

Most of the time, this popping and creaking of joints is harmless. However, crepitus is also a symptom of the joint degeneration that leads to osteoarthritis.

 You should worry about joint popping if:

•It's occurring frequently in one location

•It's accompanied by pain

•It's accompanied by joint swelling, tenderness, or stiffness

•You're also having pain as a result of prolonged joint movement, such as when walking

If you're experiencing pain when a joint pops or you have any other of the symptoms listed above, talk with your doctor. If your symptoms and test results indicate it, your doctor may diagnose osteoarthritis and start treatment. Treatments for osteoarthritis can ease pain, improve mobility, and slow disease progression—especially if it's caught early.”

Reference:

Dennis

Dennis Mazur

I suggest that you might also add to you PT and OT team a person who has been working with geriatrics as Orientation and Mobility person or Teacher of Visually Impaired because they have experience with implications of visual impairment.  Check your statistics of visual impairments in persons in geriatric age range in Canada, I am not familiar with your statistics but here at least 50 percent will present with some type of visual impairment.  I work with geriatric developmentally delayed in a Habilitation Therapy group and find the collaboration with our teams is very rewarding.  I am an internationally certified orientation and mobility specialist and have lots of experience with geriatric persons with visual impairment and sometimes hearing impairment.  Recognizing the limitations of specific visual impairments on interpreting the environment is a great part of providing optimal therapy.

Kenalea Johnson

dear Syed, that is the link to Julie Tuplers website, I suggest going to Diana Lee's for a more evidence based approach. http://dianelee.ca/  

I think Eccentric resistance training ll be more handy because it has low energy cost

Dear Mr. Long,

Thank you for your post and the reference cited.

Unfortunately, I have to disagree with the evidence presented. Osteoarthrosis (in English literature “osteoarthritis”) is a degenerative joint disease but may have different origin (etiology). The most important point here is what is the primum movens for this variety of pathological conditions. The majority of osteoarthrosis types are of secondary nature i.e. DDH, intrarticular fractures or cartilage injuries, static disorders, sports overloading (pure mechanical causes !), state after femoral head osteonecrosis (M. Chandler), metabolic and endocrine disorders, etc. All these are non-inflammatory conditions. The most important factor for degeneration of the joint is the mechanical overloading leading to progressive cartilage wear and damage.

In the paper of CJ Malemud (2015) the accent is placed on the accompanying synovitis which is often encountered in the so-called activated osteoarthrosis. Yes, I agree that in similar cases the inflammation of synovia adds an inflammatory effect and promotes the progression of degeneration. But this is not always the case and it is a secondary pathophysiological moment.

Yes, RA and other rheumatic or bacterial conditions are certainly arthritis types because the primary moment is inflammation or infection. However, when the inflammation subsides or heals, the joint disease goes on the pathophysiolocal pathway of degeneration, and may be accepted as a postarthritic osteoarthrosis.

Unfortunately, this terminological misuse and embarrassment in the English-speaking literature and practice is nourished by some famous medical dictionaries. You may read in Dorland’s Illustrated Medical Dictionary the following terms and explanations:

- osteoarthritis - “noninflammatory degenerative joint disease… characterized by degeneration of the articular cartilage, hypertrophy of the bone at the margins, and changes in the synovial membrane…”

and also:

- osteoarthrosis – “chronic arthritis of noninflammatory character”

What is it ? What is correct ?

In my opinion this awkward situation may be compared for example with the never-happening misuse of “spondylitis” instead of “spondylosis”, and “discitis” instead of “ discosis” which are clearly and correctly differentiated in the medical literature and practice. Such a misuse is unbelievable.

 Thank you for all the information, Matej. I appreciate your concern for this. Network for Excellence in Health Innovation seems very important.  Research companies also share that MH facilities mostly do not survey for consumer satisfaction and effectiveness. This is all a terrible shame, and we should continue advocating for these causes.

a balanced back training in erecct posture-abdominal contraction,both arms upwards,one of the leg spread back wards.

Yes there are exercises for MSDs for office workers  but they are again very specific according to the work station, work schedule and dimensions of MSDs. However some head, neck, upper extremity and few lower extremity are generally asked for the office workers, although not tested scientifically.

Hi Charlie!

I have found some related articles to your question:

and attached files.

Best regards,

Tim.

At the risk of being unpopular, surely two important elements of the dissertation process are (a) developing your own question with (b) tutorial guidance from your supervisor.

Is this what you are looking for ?

We are running a study to compare interactive home exergame programme delivered trough a system based on the microsoft Kinect . Details below.

This will follow patient engagement through a set of defined metrics and then explore the cause of non adherence.

Please contact me for further details

Hi Matias,

I think you should find some data in these articles.

I Hope this will help you.

Hello Mary,

Thanks for your reply and Suggested Articles, Thanks Again

Hi, 

i am studying the effects of electric current on wound healing with the Naturepulse device from Globe AMT company, and i came across few articles that used low frequency, similar to the one use in PEMF. Here is two articles. 

Regards

Dear Steven,

One of the best way to measure physiotherapy process and outcome of patient documentation is using quality indicators (QIs).QIs are related to structures, process or outcomes. QIs are preferably derived from guideline-based recommendations and phrased as percentages of patients for whom a certain recommendation was adhered to.

I send you some examples of studies as part of PhD studies in our institute (Scientific Institute for Quality of Healthcare of the Radboud University Nijmegen [The Netherlands]).

Hopefully this will help you in your study.

Best wishes,

Rob Oostendorp. 

 Dear Lode,

Impact on Participation and Autonomy Questionnaire (IPA) is a self- report outcome instrument that describes participation and autonomy from the perspective of the participant.  The questionnaire consists of 39 items that measure participation in accordance with the definition to ICF.  The response options in the IPA are: 0=very good, 1=good, 2=fair, 3=poor and 4=very poor. The results can be analyzed both regarding the assessments of the five domains (autonomy outdoors, autonomy indoors, family role, social relations, paid work and education) and the nine areas of different aspects of participation (mobility, self-care, activities in and around the house, looking after our money, leisure, social life and relationship, paid or voluntary work, helping and supporting other people and education/training). 

Cardol, M., de Haan, R.J., van den Bos, G.A., de Jong, B.A. and de Groot, I.J. (1999) The development of a handicap assessment questionnaire: The impact on participation and autonomy (IPA). Clin. Rehabil. 13, 411-419

In the article below we used the IPA which we can recommend.

Factors affecting participation after traumatic brain injury.

Larsson J, Björkdahl A, Esbjörnsson E, Sunnerhagen KS.

J Rehabil Med. 2013 Sep;45(8):765-70. doi: 10.2340/16501977-1184.

ABSTRACT

 Objective: The aim of this work was to explore the extent to which social, cognitive, emotional and physical aspects influence participation after a traumatic brain injury (TBI). Design/subjects: An explorative study of the patient perspective of participation 4 years after TBI. The cohort consisted of all patients (age range 18-65 years), presenting in 1999-2000, admitted to the hospital (n = 129). Sixty-three patients responded; 46 males and 17 females, mean age 41 (range 19-60) years.

Methods: Four years after the injury, the European Brain Injury Questionnaire (EBIQ), EuroQol-5D, Swedish Stroke Register Questionnaire and Impact on Participation and Autonomy (IPA) questionnaire were sent to the sample. Data were analysed with logistic regression.

Results: On the EBIQ, 40% of the sample reported problems in most questions. According to IPA, between 20% and 40% did not perceive that they had a good participation. The analyses gave 5 predictors reflecting emotional and social aspects, which could explain up to 70% of the variation in participation.

Conclusion: It is not easy to find single predictors, as there seems to be a close interaction between several aspects. Motor deficits appear to have smaller significance for participation in this late state, while emotional and social factors play a major role.

Best wishes, Eva

I recommend two kinds of treatments for pelvic floor strengthening .

one is electrotherapy ( interferential therapy with 4 cups accessories)patient is lying on his or her back and flexed his/her knee and then two cups attached to inner thighs and two lower abdomen and wires are attached so red leads cross one direction and black on the other direction so criss cross way. Both currents should intersect at the pelvic floor muscles and use this for 10 minutes.

2 :

exercises in supine and hold a swiss ball between his or her ankles and ask patient to lift it up and hold there for 10 secs.

Repeat this exercise with ball this time between thighs and hold it and push ball upward .and hold there for 10 secs then repeat 5 to 10 times. 3 -4 times a day.

                                         Good Luck

some axons may be neurapraixic and if it humans you can try ETOIMS to aid recovery of neurapraxia

Dear Shakil,

that's an interesting topic. What kind of research are you thinking about?

As my previous colleagues already said, you should define the condition of shortened lats. How do you test for this? You con probably find some help in the work by Shirley Sahrmann and by Kendall& Kendall (Muscle testing and function). LBP due to tight and shortened fascia thoracolumbalis and this again due to a short lats, that's quite tricky to show. You may think of intervening with a lats stretch (which has to be addressed specifically) compared to stretching of other muscles which also attache into the fascia thoracolumbalis.

Good luck for that study, I'm already interested in your methods and results

Markus

Hi, here are also some recent meta-analyses:

Downing, J., & Balady, G. J. (2011). The role of exercise training in heart failure. Journal of the American College of Cardiology, 58, 561-569.

Taylor, R. S., Davies, E. J., Dalal, H. M., Davis, R., Doherty, P., Cooper, C., et al. (2012). Effects of exercise training for heart failure with preserved ejection fraction: a systematic review and meta-analysis of comparative studies. International Journal of Cardiology, 162, 6-13.

or did you mean something particular by "physical therapy"?

Best regards,

Heike

Hi Patricia,

We deal with this issue in rehabilitation quite frequently (depending on the question) because there isn't often good pre-morbid information available. Emergency medicine deals with this issue also. I think that Martin is right that this is probably best solved as a design issue (i.e., find the best natural comparison "control" group that you can).  In rehab we often ask the person to reflect back and self-report what their status was like prior to the onset of illness or injury, although that has it own set of limitations.

Dear Mauro,

Thanks for your information. The assessment tools you suggested are very useful not just on my research but also on my daily clinical practice. I will apply it when I need to assess the ADL functions of my clients with dementia.

I'm currently conducting a research on the assessment tools for the physical performance of people with dementia, specifically on functional mobility and exercise tolerance. It would be interesting to see the results.

Many thanks,

Wayne 

@Guilliber Carlos Fonseca: Your English was perfectly understandable. :-)

@ Guilliber Carlos Fonseca and Hamdy Elsaid abd elhamed Elnawasry: 

Thank you for your article references. I have downloaded them. Having glanced over a few of them I can say with certainty that there are articles that will be of help to me. Thank you very much for your assistance! 

Kind regards,

Roy 

Dear Laura, 

Check these papers out: 

dear Parinyathip Thongduang

ihope the following site help you

best regards hamdy

Dear Allison,

I found some papers which deal with this subject.

I hope this helps.

dear Shima Rezaei 

i hope next research help you

best regared

hamdy

Surface skin contact only with a slight blunt needle which does not penetrate the skin is a good choice.  If the acupuncture is in a site not visible by the recepient. More tricky if they can see.  However, subjects should all be acupuncture naive individuals as those who have received it previously might be able to tell the difference between the actual penetration and the sham condition, which would introduce bias.

What you are describing Is safe, as the goal is to protect the surgical wounds aand repairs. The mobilisation of the ankle is correctly started about 15-21 days after surgery. removal of protective boot can be done about 6 weeks post op.

Hello,

Agreeing with statements above I would suggest not to rely exclusively on one even reliable for of assessment. Especially in the specific are like yours.

Regards

Shakil:

I think skills training requires a lot of demonstration and practice. Usually competency-based assessments are used in the latter scenario in which the student is assessed once and then again. If the assessor has any doubt that the student has fully demonstrated the skill to be deemed competent, then the student can be assessed a third time. If after the latter there is doubt, then the student has failed to be competent and would need to retake the module or course. I have attached a link of relevant studies here in RG.

Many thanks,

Debra

Rosi,

I don't mind sharing at all.  The primary rationale for our dosage and frequency were to make the treatments clinically feasible within our primary field of athletic training were providers sometimes have limited time with individual patients.  However, we also wanted to build in multiple treatment sessions so that we could potentially train/improve the sensory system on top of treating the symptoms.  Much of the literature suggests that while a single session, of shorter duration, could be effective, multiple treatments result in a more meaningful response in select outcomes.  This was our first effort to determine if the larger responses were train to altering motor control programs within the patient by improving the degrees of freedom available to them.  Based on these results, we believe that is possible and are now working on the next steps to confirm these results.  I hope this helps

Erik

Dear Juan, Tennis elbow or lateral epicondylitis is an acute or chronic inflammation of the tendons that join the forearm muscles on lateral epicondyle. The forearm muscles and tendons damaged from overuse — repeating the same strenuous motions again and again which leads to inflammation, pain and tenderness on the outside of the elbow.

So, the first line of management should be STOP OVERUSE of the affected muscle, joint or movement. There after one can plan to reduce inflammation and following management to normalized muscle and joint motion. 

I am not so clear about the stage of Tennis elbow which you are dealing with. Every stages will required Physiotherapy intervention differently. 

For instance - in acute inflammatory stage RICE/ PRICE/ PRINCE protocol will assist in speeding the healing but the same may not be beneficial in other stages.

The interventions will also be categorized according to specific symptoms.

Say for pain relief - Manual therapy [Soft tissue tech (MRT, MFR, NMIT, Cyriax tech etc)], joint tech (Matland, Mulligan, Kalterborn, Mills etc.), neural tech or any combination] or Electro-therapy (TENS, IFT, US, Electrical stimulation, thermotherapy etc.) or Therapeutic exercise [Stretching, strengthening (Concentric, essentric or isolytic)] or combination of any may be used.

Still, even after several systemic reviewed, there is NO strong consensus on Physiotherapy intervention to state that any particular combination is most effective. This may be due to the fact that every tennis elbow patients present their symptoms and activity level / types are different from other.

In general, symptom correction, improving muscular performance, joint function and correction of faulty bio-mechanics will help the patient to recover and minimized recurrence of the condition.

Regards