Research Article Open Access
Volume 4 | Issue 2 | DOI: https://doi.org/10.33696/rehabilitation.4.029

Manual Therapy Improves Immediate Blood Flow and Tissue Fiber Alignment of the Forearm Extensors

  • 1President, Therapist, Elevated Performance and Rehabilitation, 1710E. 5600S., Ogden, UT 84403 USA
  • 2Director, Graduate School, Illinois State University, Director for Graduate Athletic Training Education, Campus Box 4040,Normal, IL 61790 USA
  • 3Professor, School of Allied Health, Oklahoma State University Center of Health Sciences, Department of Athletic Training,1111 West 17th Street, Tulsa, OK 74107 USA
+ Affiliations - Affiliations

Corresponding Author

Timothy E Speicher, timspeicher@prt-i.com

Received Date: July 21, 2022

Accepted Date: August 15, 2022


Background: Manual therapy is commonly used by clinicians to improve blood flow and tissue fiber orientation. Hypothesis/Purpose: Using diagnostic ultrasound, the purpose of the study was to examine how the application of Positional Release Therapy (PRT), instrumented assisted soft tissue mobilization (IASTM), therapeutic ultrasound (US) and a combination of all three, affect lateral elbow immediate blood flow and tissue fiber alignment. Study Design: Controlled laboratory study. Methods: Twenty-five participants (26.0 ± 4.5 years; 69.3 ± 4.3 cm; 81.8 ± 16.9 kg) received PRT =13, US =12, IASTM =13, and a combination treatment = 12. Results: Blood flow was significantly higher following PRT (691.54 ± 1237.16 mm2) compared to IASTM (18.73 ± 227.10 mm2) (p=0.050; ES=0.073 (0.16-1.5) and US (-10.09 ± 479.26 mm2) (p=0.042; ES=0.72 (-0.03-1.29), but no different from the combination intervention (627.64 ± 820.22 mm2) (p=0.849). Seventy-five percent of elbows in the PRT intervention showed improvement in blood flow, 54% in the IASTM group, 45% in US, and 73% in the combination group. Tissue fiber alignment was significantly better following IASTM (-5756.00 ± 8156.19 mm2) compared to PRT (-1552.54 ± 3896.58 mm2) (p=0.042; ES=0.66 (-0.01 – 1.31), but no difference was demonstrated among the other interventions (p>0.066). All elbows (100%) that received IASTM showed improved tissue orientation, 77% in the PRT group, 64% in US and 64% in the combination group. Conclusion: Manual therapy, particularly PRT and IASTM, seem to be better at increasing blood flow and muscle fiber orientation, respectively. Level of Evidence: II.


Lateral epicondylalgia, Tennis elbow, Myofascial release, Perfusion

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