The tolerance effect: its relevance to analgesia produced by physiotherapy interventions

Souvlis, Tina; Wright, Anthony

doi:10.1179/ptr.1997.2.4.227

Cited by 4 publications

(1 citation statement)

References 77 publications

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“…A similar response has also been demonstrated with MWM of the elbow joint 35 . In a number of follow-up studies, which used methods to discern involvement of endogenous opioids, such as naloxone blockade and tolerance 34,35,43,69,70 , the hypoalgesic effect was found to be non-opioid in nature. Subsequently, an animal study of knee manipulation for capsaicin-induced foot hyperalgesia reported that the substrates of the hypoalgesic effect were nonopioid in nature, involving both serotonergic-and noradrenergic-mediated descending pain inhibition pathways 71 .…”

Section: Physiological Rationalementioning

confidence: 99%

Joint Manipulation in the Management of Lateral Epicondylalgia: A Clinical Commentary

Vicenzino¹,

Cleland²,

Bisset³

2007

Journal of Manual & Manipulative Therapy

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Lateral epicondylalgia or tennis elbow is a prevalent musculoskeletal disorder that is characterized by lateral elbow pain often associated with gripping tasks. The underlying pathology remains to be fully elucidated; however, evidence indicates that the disorder does not involve an inflammatory process but rather impairments of the pain and motor systems as well as morphological changes in the structure of both the extensor carpi radialis brevis muscle and tendon. Although the most efficient management approach remains controversial, there is a growing body of literature reporting the effects and underlying mechanisms of joint manipulation in the management of lateral epicondylalgia. Evidence exists demonstrating that joint manipulation directed at the elbow and wrist as well as at the cervical and thoracic spinal regions results in clinical alterations in pain and the motor system. In addition to presenting this evidence, this paper describes proposed underlying physiological mechanisms of joint manipulation associated with the observed clinical effects. We propose that this information will be useful for the physical therapist in making clinical decisions regarding the selection of treatment technique for the management of patients with lateral epicondylalgia.

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