Isometric exercise above but not below an individual’s pain threshold influences pain perception in people with lateral epicondylalgia

Coombes, Brooke Kaye, Wiebusch, Matheus, Heales, Luke, Stephenson, Aoife and Vicenzino, Bill (2016) Isometric exercise above but not below an individual’s pain threshold influences pain perception in people with lateral epicondylalgia. Clinical Journal of Pain, 32 12: 1069-1075. doi:10.1097/AJP.0000000000000365


Author Coombes, Brooke Kaye
Wiebusch, Matheus
Heales, Luke
Stephenson, Aoife
Vicenzino, Bill
Title Isometric exercise above but not below an individual’s pain threshold influences pain perception in people with lateral epicondylalgia
Journal name Clinical Journal of Pain   Check publisher's open access policy
ISSN 1536-5409
0749-8047
Publication date 2016-02-17
Year available 2016
Sub-type Article (original research)
DOI 10.1097/AJP.0000000000000365
Open Access Status Not Open Access
Volume 32
Issue 12
Start page 1069
End page 1075
Total pages 18
Place of publication Philadelphia, United States
Publisher Lippincott Williams and Wilkins
Language eng
Subject 2728 Clinical Neurology
2703 Anesthesiology and Pain Medicine
Abstract 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 (10x15 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 timexcondition (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.
Formatted abstract
OBJECTIVE:: To examine the acute effects of isometric exercise of different intensities on pain perception in individuals with chronic lateral epicondylalgia.

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

RESULTS:: 24 individuals with unilateral lateral epicondylalgia of median 3-month duration participated. Pain intensity during contraction was significantly higher during supra-threshold exercise than infra-threshold exercise (Mean difference in NRS 1.0, 95%CI 0.4, 1.5, P=0.002). Pain intensity during supra-threshold 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 supra-threshold exercise, compared to infra-threshold exercise (P=0.01) and control (P<0.001) conditions, while infra-threshold exercise and control conditions were comparable. Thirty minutes later, pain levels remained significantly higher for supra-threshold exercise compared to infra-threshold exercise (P=0.043). Pressure pain threshold and pain free grip showed no significant effects of time, condition, or time by condition (P>0.05).

DISCUSSION:: Individuals with lateral epicondylalgia demonstrated increased pain intensity following 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.
Keyword Anesthesiology
Clinical Neurology
Anesthesiology
Neurosciences & Neurology
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Biomedical Sciences Publications
School of Health and Rehabilitation Sciences Publications
 
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