Muhsen A1,2, Moss P1, Gibson W3, Walker B4, Schug S5, Wright A1
1Curtin University, School of Physiotherapy and Exercise Science, Perth, Australia, 2Hashemite University, School of Physical and Occupational Therapy, Zarqa, Jordan, 3University of Notre Dame Australia, School of Physiotherapy, Fremantle, Australia, 4Murdoch University, School of Health Professions, Perth, Australia, 5University of Western Australia, Department of Anaesthesiology, Perth, Australia
Background: Recent research evidence suggests that Conditioned Pain Modulation CPM and Manual Therapy (MT) produce a natural form of analgesia. They appear to share similar neuro-physiological mechanisms involving activation of endogenous analgesia (EA) systems. We propose a paradigm to positively influence the levels of CPM and MT analgesia thorough a period of aerobic physical exercise in individuals with a musculoskeletal pain state.
Purpose: To determine the effect of moderate and high intensity aerobic exercise on CPM and MT analgesic responses in a patient population with Lateral Epicondylalgia (LE).
Methods: A gender stratified convenience sample of 68 participants with LE was recruited for this study. Pressure pain threshold (PPT) was initially measured at the elbow and wrist of the symptomatic side. Participants were then randomly allocated to receive either moderate (50% HRmax, n=34) or high intensity (75% HRmax, n=34) aerobic exercise (without crossover) using a cycle ergometer. Each participant was required to complete two 15min aerobic exercise sessions at the same intensity. All participants were then assessed for CPM and MT analgesic responses in a random order, in two separate test sessions (i.e. two study days) separated by three days. PPT responses were measured at baseline, immediately after the completion of the aerobic exercise, during, and after immersing the other arm in a cold water bath (10°C) (CPM) and during and after cervical lateral glide (CLG) mobilisation. All PPT responses were obtained from the two testing sites by the same main investigator (ICC (3,4)=0.99), who was blinded to the exercise group allocation. Linear mixed models were used to evaluate differences in CPM and MT responses between the exercise groups, controlling for the patient rated tennis elbow evaluation (PRTEE) scores, global physical activity questionnaire (GPAQ) scores and gender.
Results: Both aerobic exercise groups demonstrated a significant increase in PPT measured at wrist and elbow sites immediately post cycling (EIA), during and immediately post cold water immersion and CLG (P 0.001). There were significant differences in PPT measures between the groups overtime, with higher levels of analgesia observed for the high intensity group during (P 0.001) and post (P 0.001) cold water immersion (CPM) and CLG (MT) measured over the wrist and elbow sites.
Conclusion(s): A 15min session of aerobic exercise positively influences CPM and MT analgesia in people with LE. Further research is recommended into the effect of long term high intensity aerobic exercise on CPM and MT responses.
Implications: This study has improved our understanding of mechanisms of action of MT analgesia. The addition of aerobic exercise can potentiate MT analgesia in clinical settings.
Keywords: aerobic exercise, conditioned pain modulation, manual therapy analgesia
Funding acknowledgements: PhD project funded by the Hashemite University, Jordan. Also supported by the School of Physiotherapy and Exercise Science, Curtin University.
Purpose: To determine the effect of moderate and high intensity aerobic exercise on CPM and MT analgesic responses in a patient population with Lateral Epicondylalgia (LE).
Methods: A gender stratified convenience sample of 68 participants with LE was recruited for this study. Pressure pain threshold (PPT) was initially measured at the elbow and wrist of the symptomatic side. Participants were then randomly allocated to receive either moderate (50% HRmax, n=34) or high intensity (75% HRmax, n=34) aerobic exercise (without crossover) using a cycle ergometer. Each participant was required to complete two 15min aerobic exercise sessions at the same intensity. All participants were then assessed for CPM and MT analgesic responses in a random order, in two separate test sessions (i.e. two study days) separated by three days. PPT responses were measured at baseline, immediately after the completion of the aerobic exercise, during, and after immersing the other arm in a cold water bath (10°C) (CPM) and during and after cervical lateral glide (CLG) mobilisation. All PPT responses were obtained from the two testing sites by the same main investigator (ICC (3,4)=0.99), who was blinded to the exercise group allocation. Linear mixed models were used to evaluate differences in CPM and MT responses between the exercise groups, controlling for the patient rated tennis elbow evaluation (PRTEE) scores, global physical activity questionnaire (GPAQ) scores and gender.
Results: Both aerobic exercise groups demonstrated a significant increase in PPT measured at wrist and elbow sites immediately post cycling (EIA), during and immediately post cold water immersion and CLG (P 0.001). There were significant differences in PPT measures between the groups overtime, with higher levels of analgesia observed for the high intensity group during (P 0.001) and post (P 0.001) cold water immersion (CPM) and CLG (MT) measured over the wrist and elbow sites.
Conclusion(s): A 15min session of aerobic exercise positively influences CPM and MT analgesia in people with LE. Further research is recommended into the effect of long term high intensity aerobic exercise on CPM and MT responses.
Implications: This study has improved our understanding of mechanisms of action of MT analgesia. The addition of aerobic exercise can potentiate MT analgesia in clinical settings.
Keywords: aerobic exercise, conditioned pain modulation, manual therapy analgesia
Funding acknowledgements: PhD project funded by the Hashemite University, Jordan. Also supported by the School of Physiotherapy and Exercise Science, Curtin University.
Topic: Musculoskeletal: upper limb
Ethics approval required: Yes
Institution: Curtin University
Ethics committee: Human Research Ethics Committee
Ethics number: HRE2017-0198-02
All authors, affiliations and abstracts have been published as submitted.
