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Efficacy of Mobilization With Movement (MWM) in Lateral Epicondylalgia: Role of Pain Mechanisms- a Narrative Review.

Background and objectives: Lateral Epicondylalgia (LE) is one of the most common repetitive strain injuries. Though various pharmacological and non pharmacological management strategies for LE have been described, there is paucity of high level evidence supporting their effectiveness. Mobilization with Movement (MWM) is a group of manual therapy techniques which claim to provide immediate pain free improvement of range of motion and functional activities. This review aims to explore the pain mechanisms underlying LE, the mechanisms underlying the effect of MWM and the clinical studies looking into effectiveness of MWM in LE. Search strategy – A comprehensive search was carried out on the following electronic databases – PubMed, CINAHL, AMED, Web of Science, ScienceDirect, Cochrane Database of Clinical Trials, EMBASE. The date restrictions from January 1992 till present were applied. The search terms used were ‘Mobilization’, ‘Mulligan’s, ‘MWM’, ‘Mobilization with movement’, ‘tennis elbow’, ‘lateral epicondylalgia’, ‘lateral epicondylitis’, ‘pain mechanisms’. Selection Criteria: Randomized control trials assessing the effectiveness of MWM in LE, diagnostic studies assessing the pain mechanisms in LE and studies examining the effects of MWM were included. Case series, single case studies, unpublished reports were not included. Data Collection & Analysis: Studies were divided into three categories – diagnostic studies for assessing the pain mechanisms in LE, Studies examining the mechanisms for the effectiveness of MWM and Clinical studies on the effectiveness of MWM in LE. Results: The review indicates that degeneration plays a major role in the presentation of LE, while inflammatory component has not been found in any of the biopsy studies. MWM produces an endogenous opioid mediated form of analgesia. The clinical studies have shown that there is a significant immediate hypoalgesic effect of MWM in LE.