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Isometric Exercise Above but not Below an Individual's Pain Threshold Influences Pain Perception in People With Lateral Epicondylalgia

PainSci » bibliography » Coombes et al 2016
updated
Tags: treatment, elbow, strength, sports, rehab, bad news, tendinosis, arm, limbs, exercise, self-treatment, injury, pain problems, overuse injury

One article on PainSci cites Coombes 2016: Tennis Elbow Guide

PainSci notes on Coombes 2016:

Some other tests of isometric exercise have shown valuable pain reduction (Rio et al) in tendinopathy just from applying some tension to the tendon for a while (isometric contraction). Unfortunately, that approach didn’t work out so well in this test for lateral epicondylagia (tennis elbow): pain was either unaffected or actually worsened (with strong isometric contractions).

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: To examine the acute effects of isometric exercise of different intensities on pain perception in individuals with chronic lateral epicondylalgia.

MATERIALS AND METHODS: Participants performed 3 experimental tasks completed in a randomized order on separate days: control (no exercise) and isometric wrist extension (10×15 s) at load 20% below (infrathreshold), and 20% above (suprathreshold) an individual's pain threshold. Self-reported pain intensity (11-point numeric rating scales), pressure pain threshold, and pain-free grip were assessed by a blinded examiner before, immediately after, and 30 minutes after task performance. Relation analysis between pain ratings and clinical variables, including pain and disability and kinesiophobia was performed.

RESULTS: Twenty-four individuals with unilateral lateral epicondylalgia of median 3-month duration participated. Pain intensity during contraction was significantly higher during suprathreshold exercise than infrathreshold exercise (mean difference in numeric rating scale 1.0; 95% confidence interval, 0.4-1.5; P=0.002). Pain intensity during suprathreshold exercise was significantly correlated with pain and disability (R=0.435, P=0.034) and kinesiophobia (R=0.556, P=0.005). Pain intensity was significantly higher immediately after performance of suprathreshold exercise, compared with infrathreshold exercise (P=0.01) and control (P<0.001) conditions, whereas infrathreshold exercise and control conditions were comparable. Thirty minutes later, pain levels remained significantly higher for suprathreshold exercise compared with infrathreshold exercise (P=0.043). Pressure pain threshold and pain-free grip showed no significant effects of time, condition, or time×condition (P>0.05).

DISCUSSION: Individuals with lateral epicondylalgia demonstrated increased pain intensity after an acute bout of isometric exercise performed at an intensity above, but not below, their individual pain threshold. Further investigation is needed to determine whether measurement of an individual's exercise induced pain threshold may be important in reducing symptom flares associated with exercise.

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