The Somatic Connection  |   October 2014
How to Win the Match Against Tennis Elbow: A Comparison of Different Techniques
Author Affiliations
  • Michael A. Seffinger, DO
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California
  • Anna M. Halbeisen, DO
    Presbyterian Intercommunity Hospital, Downey Campus in California
Article Information
The Somatic Connection   |   October 2014
How to Win the Match Against Tennis Elbow: A Comparison of Different Techniques
The Journal of the American Osteopathic Association, October 2014, Vol. 114, 812-813. doi:
The Journal of the American Osteopathic Association, October 2014, Vol. 114, 812-813. doi:
Trivedi P, Sathiyavani D, Nambi G, Khuman R, Shah K, Bhatt P. Comparison of active release technique and myofascial release technique on pain, grip strength & functional performance in patients with chronic lateral epicondylitis. Int J Physiother Res. 2014;2(3):488-494.  
Lateral epicondylitis, commonly referred to as tennis elbow, is an overuse injury of the lateral humeral epicondyle. Pain from this lesion may refer to the wrist. Traditional treatments include rest, ice, nonsteroidal anti-inflammatory drugs, steroid injections, bracing, physical therapy, and iontophoresis. Researchers in Gujarat, India, investigated the effectiveness of 2 alternative therapies for chronic lateral epicondylitis: active release technique (ART) and myofascial release technique (MFR). 
As defined in the study, ART is the “application of deep digital tension over tenderness.” During application of ART, the patient was asked “to actively move the tissue from [a] shortened to a lengthened position” to theoretically break tissue adhesions. The authors defined MFR as “the application of a low load, long duration stretch to the myofascial complex, intended to restore optimal length, decrease pain and improve function.” 
Thirty-six patients aged 30 to 45 years with symptomatic chronic epicondylitis were referred from outpatient clinicians. Notable exclusion criteria were history of trauma, surgery, cervical or upper limb dysfunction, steroid injection, and receipt of physiotherapy in the previous 3 months. During the study period, patients continued normal activities and avoided other forms of treatment. Patients were assigned to 1 of 3 groups: (1) the control group received conventional physiotherapy, which included pulsed ultrasound therapy and graduated stretching and strengthening exercises, (2) the ART group received ART plus conventional physiotherapy, and (3) the MFR group received MFR and conventional physiotherapy. Participants received 3 treatment sessions per week for 4 weeks. Active release technique was applied to “the extensor carpi radialis longus and brevis muscles by applying pressure to the muscles distal to their attachment at the elbow.” To release adhesions between the muscle planes, the therapist moved the pressure proximally as the patient extended the elbow and pronated and flexed the wrist. Myofascial release technique entailed 3 procedures. The first began with treating the common extensor tendon to the extensor retinaculum of the wrist, beginning at the humerus. The therapist engaged the periosteum using his fingertips and moved distally to the common extensor tendon toward the retinaculum while the patient slowly flexed and extended the elbow. The second procedure used a similar technique applied to the ulna using alternating ulnar and radial deviation. The third procedure involved engaging the periosteum at specific bony landmarks and applying a line of tension in a lateral and distal direction to spread the radius and ulna apart. 
Outcome measures were Numeric Pain Rating Scale, hand grip strength, and Patient-Rated Tennis Elbow Evaluation taken at baseline and 4 weeks after intervention. Results demonstrated that all 3 groups showed significant improvement after 4 weeks (P<.001), but MFR showed the most improvement in all 3 outcome measures. 
This study can help osteopathic researchers to design beneficial regimens for the management of chronic lateral epicondylitis. However, a larger sample size is needed to validate these findings. Additionally, further comparison of counterstrain and muscle energy techniques may prove useful to determine which has the most benefit in this patient population.