Chronic Lateral Epicondylitis: Comparative Effectiveness of a Home Exercise Program Including Stretching Alone versus Stretching Supplemented with Eccentric or Concentric Strengthening

Martinez-Silvestrini, Julio A.; Newcomer, Kathryn E.; Schaefer, Michael P.; Kortebein, Patrick; Arendt, Katherine W.

doi:10.1197/j.jht.2005.07.007

Cited by 177 publications

(167 citation statements)

References 36 publications

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“…All of the subsequent RCTs identified are recent publications 18,164,166,172 In addition, seven RCTs were identified that were included in an intermediate-/low-quality systematic review. 137,141,149,151,157,162,163 An updated, good-quality systematic review of exercises for LET is needed before stronger recommendations can be made; however, we suggest that some consideration should also be given to conducting large-scale, good-quality RCTs of clearly defined exercise modalities with sufficient follow-up periods (to 1 year).…”

Section: Exercisesmentioning

confidence: 99%

What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

Long

Briscoe

Cooper

et al. 2015

Health Technology Assessment

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BackgroundLateral elbow tendinopathy (LET) is a common complaint causing characteristic pain in the lateral elbow and upper forearm, and tenderness of the forearm extensor muscles. It is thought to be an overuse injury and can have a major impact on the patient’s social and professional life. The condition is challenging to treat and prone to recurrent episodes. The average duration of a typical episode ranges from 6 to 24 months, with most (89%) reporting recovery by 1 year.ObjectivesThis systematic review aims to summarise the evidence concerning the clinical effectiveness and cost-effectiveness of conservative interventions for LET.Data sourcesA comprehensive search was conducted from database inception to 2012 in a range of databases including MEDLINE, EMBASE and Cochrane Databases.Methods and outcomesWe conducted an overview of systematic reviews to summarise the current evidence concerning the clinical effectiveness and a systematic review for the cost-effectiveness of conservative interventions for LET. We identified additional randomised controlled trials (RCTs) that could contribute further evidence to existing systematic reviews. We searched MEDLINE, EMBASE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Web of Science, The Cochrane Library and other important databases from inception to January 2013.ResultsA total of 29 systematic reviews published since 2003 matched our inclusion criteria. These were quality appraised using the Assessment of Multiple Systematic Reviews (AMSTAR) checklist; five were considered high quality and evaluated using a Grading of Recommendations, Assessment, Development and Evaluation approach. A total of 36 RCTs were identified that were not included in a systematic review and 29 RCTs were identified that had only been evaluated in an included systematic review of intermediate/low quality. These were then mapped to existing systematic reviews where further evidence could provide updates. Two economic evaluations were identified.LimitationsThe summary of findings from the review was based only on high-quality evidence (scoring of > 5 AMSTAR). Other limitations were that identified RCTs were not quality appraised and dichotomous outcomes were also not considered. Economic evaluations took effectiveness estimates from trials that had small sample sizes leading to uncertainty surrounding the effect sizes reported. This, in turn, led to uncertainty of the reported cost-effectiveness and, as such, no robust recommendations could be made in this respect.ConclusionsClinical effectiveness evidence from the high-quality systematic reviews identified in this overview continues to suggest uncertainty as to the effectiveness of many conservative interventions for the treatment of LET. Although new RCT evidence has been identified with either placebo or active controls, there is uncertainty as to the size of effects reported within them because of the small sample size. Conclusions regarding cost-effectiveness are also unclear. We consider that, although updated or new systematic reviews may also be of value, the primary focus of future work should be on conducting large-scale, good-quality clinical trials using a core set of outcome measures (for defined time points) and appropriate follow-up. Subgroup analysis of existing RCT data may be beneficial to ascertain whether or not certain patient groups are more likely to respond to treatments.Study registrationThis study is registered as PROSPERO CRD42013003593.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Exercisesmentioning

confidence: 99%

What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

Long

Briscoe

Cooper

et al. 2015

Health Technology Assessment

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“…LET is often related to forceful grip activities requiring isometric contraction of the wrist flexors and extensors [30]. Perhaps isometric contractions would be more beneficial than eccentric ones in lateral epicondylitis [30]. A case study showed that the combination of eccentric training with isometric contraction had positive effects in LET [31].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of the Effectiveness of Eccentric - Concentric Training of Wrist Extensors and Eccentric - Concentric Training Combined With Supinator Strengthening in Healthy Population

Stasinopoulos¹

2017

ORP

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IntroductionLateral Elbow Tendinopathy (LET) seems to be the most appropriate term to use in clinical practice because all the other terms such as lateral epicondylitis, lateral epicondylalgia, lateral epicondylosis and tennis elbow make reference to inappropriate aetiological, anatomical and Pathophysiological terms [1]. LET is one of the most common lesions of the arm work-related or sport-related pain disorder. The condition is usually defined as a syndrome of pain in the area of the lateral epicondyle [2] that may be degenerative or failed healing tendon response rather than inflammatory [3]. Hence, the increased presence of fibroblasts, vascular hyperplasia, Proteoglycans and Glycosaminoglycans together with disorganized and immature collagen may all take place in the absence of inflammatory cells [4]. The most commonly affected structure is the origin of the Extensor Carpi Radialis Brevis (ECRB) [4]. The dominant arm is commonly affected, the peak prevalence.The main complaint of patients with LET are pain and decreased function [2,3] both of which may affect daily activities. Diagnosis is simple, and a therapist should be able to reproduce this pain in at least one of three ways: (1) Digital palpation on the facet of the lateral epicondyle, (2) Resisted wrist extension and resisted middle-finger extension with the elbow in extension and (3) by getting the patient to grip an object [2,3,5].Although the signs and symptoms of LET are clear and its diagnosis is easy, to date, no ideal treatment has emerged. Many clinicians advocate a conservative approach as the treatment of choice for LET [2,3,[6][7][8]. Physiotherapy is a conservative treatment that is usually recommended for LET patients [2][3][4][5][6][7][8][9]. A wide array of physiotherapy treatments have been recommended for the management of LET [10][11][12][13][14]. These treatments have different theoretical mechanisms of action, but all have the same aim, to reduce pain and improve function. Such a variety of treatment options suggests that the optimal treatment strategy is not known and more research is needed to discover the most effective treatment in patients with LET.One of the most common physiotherapy treatments for LET is an exercise programme [2][3][4][5][6][7][8][9][10][11][12][13][14]. One consisting of eccentric exercises has shown good clinical results in LET [15] as well as in conditions similar to LET in clinical behavior and histopathological appearance, such as Patellar and Achilles tendinopathy [16]. Such an exercise programme is used as the first treatment option for our patients with LET [9,17]. Malliaras and his colleagues concluded that clinicians should Demosthenous M, et al., J Orthop Res Physiother 2017, 3: 036 DOI: 10.24966/ORP-2052 HSOA Journal of Orthopedic Research and Physiotherapy Review Article Abstract ObjectivesTo compare the effectiveness of eccentric-concentric training of wrist extensors and eccentric-concentric training combined with supinator strengthening in healthy subjects. MethodsA randomized clinical t...

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“…stretching is more effective in the management of chronic lateral epicondylitis in his randomized control trial [33]. a study on "functional treatment of tennis elbow: a comparative study between an elbow support and physical therapy".…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Fascial Manipulation on Pain, Grip Strength, and Functional Performance in Chronic Lateral Epicondylitis Patients

Kannabiran¹,

Manimegalai²,

Nagarani³

2017

Orthop Muscular Syst

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Fascial manipulation is an effective tool in the management of the musculoskeletal disorders. This can be used to address pain, grip strength, functional performance in tennis elbow (lateral epicondylitis patients) patients. The specific objective of the study was to evaluate the efficacy of fascial manipulation in tennis elbow its role in decreasing pain , improving the grip strength and overall functional performance is also evaluated. A total of twenty samples participated in the study. Reduction in pain intensity was significant, gaining the fascial connection of the neuromusculoskeletal system may also assist patients in accepting why movement of body parts distant from the site of symptoms may be used as a treatment approach to manipulate fascial tissues. Fascial manipulation techniques are passive manipulations on selected points that focus on restoring the ability of the fascial system to tolerate the normal compressive, friction, and tensile forces associated with daily and sport activities. Question: Role of fascial manipulation in management of chronic lateral epicondylitis.Design: Pre -post experimental study design.Participants: Chronic lateral epicondylitis (tennis elbow) who have pain, decreased grip strength and disturbed functional performance in the Age group 25-40 include both sexes (male and female).Intervention: Fascial manipulation technique on two centers of coordination and one center of fusion, stretching and ultrasound therapy.Outcome measures: Pain and functional performance using Patient Rated Tennis Elbow Evaluation (PRTEE) questionnaire, grip strength was measured using hand dynamometer. Results and conclusion:The result concluded that fascial manipulation is more effective than ultrasound therapy with stretching in the management of lateral epicondylitis subjects and hence it can be effectively used to reduce pain, increase grip strength and functional performance in lateral epicondylitis (tennis elbow) patients.

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Chronic Lateral Epicondylitis: Comparative Effectiveness of a Home Exercise Program Including Stretching Alone versus Stretching Supplemented with Eccentric or Concentric Strengthening

Cited by 177 publications

References 36 publications

What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

Comparison of the Effectiveness of Eccentric - Concentric Training of Wrist Extensors and Eccentric - Concentric Training Combined With Supinator Strengthening in Healthy Population

Effectiveness of Fascial Manipulation on Pain, Grip Strength, and Functional Performance in Chronic Lateral Epicondylitis Patients

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