Non‐operative treatment regime including eccentric training for lateral humeral epicondylalgia

Abstract

In a pilot study 38 patients with lateral humeral epicondylalgia were randomly allocated to two treatment groups. Group S (stretching) was treated with a contract-relax-stretching program while group E (eccentric exercise) underwent an eccentric exercise program. Both groups also received forearm bands and wrist support nightly. The programs were carried out daily at home during 12 weeks. Evaluation before and 3, 6 and 12 months after treatment, included subjective assessment of symptoms using visual analogue scales and grip strength measurements. Thirty-five patients were available for follow-up. Five patients, three in group S and two in group E, did not complete the programs due to increased pain while 30 (86%) reported complete recovery or improvement. Reduced pain and increased grip strength were seen in both treatment groups but 12 out of 17 patients (71%) in group E rated themselves as completely recovered as compared to 7 out of 18 (39%) in group S (P=0.09), and in group E the increase in grip strength after 6 months was statistically significantly larger than in group S. In a second study the eccentric training regime was used in a consecutive series of 129 patients with lateral epicondylalgia. The patients were divided into two groups with one group consisting of patients with less than one year duration of symptoms and the other comprised patients with a duration of symptoms for more than one year. The results of treatment were evaluated in the same way as in the pilot study, and also after 3.4 years using the scoring system by Verhaar et al. At the end of the treatment period statistically significant improvements were seen in all VAS recordings and in grip strength. After 3.4 years 38% had excellent, 28% good, 25% fair and 9% poor results according to the score. In the self-rated outcome 54% regarded themselves as completely recovered, 43% improved, 2% unchanged and 2% worse. No significant differences were seen between patients with a duration of symptoms for more than one year compared to patients with symptoms for less than one year. The eccentric training regime can considerably reduce symptoms in a majority of patients with lateral humeral epicondylalgia, regardless of duration, and is possibly superior to conventional stretching.

Eccentric training for shoulder abductors improves pain, function and isokinetic performance in subjects with shoulder impingement syndrome: a case series

“…Good clinical results of eccentric training for the supraspinatus and deltoid muscles 11 and for the rotator cuff 12 were demonstrated in subjects with painful SIS. Other studies have also shown successful results with eccentric training in different types of tendinopathies [13][14][15][16] .…”

“…Many studies have suggested the use of eccentric exercise in the preventive care or rehabilitation 11,13,15,18,[47][48][49] . Eccentric exercises have also been advocated as efficient in the treatment of several tendon disorders because this type of exercise accelerates tenocytes metabolism and may speed repair 18,50 .…”

Effects of Taping on Wrist Extensor Force and Joint Position Reproduction Sense of Subjects With and Without Lateral Epicondylitis

“…Pienimaki compared the long-term outcomes of progressive exercise and ultrasound, and found that progressive exercise showed beneficial long-term effects in terms of pain alleviation and the ability to work 21) .Svernlov found that people who participated in strengthening or stretching programs had a statistically significant increase in grip strength 23) . Forearm braces significantly decrease muscle activation in the ECRB, but they do not improve muscle fatigue, pain, and pain-free grip strength [27][28][29][30] .…”

“…Very acute injury may require short-term rest and ice 7) . A wide variety of non-surgical treatments are available, including ultrasound, non-steroidal anti-inflammatory drugs, corticosteroid injections, a forearm brace or orthotics, stretching, eccentric exercise, and taping 2,[20][21][22][23][24] . Oral and topical non-steroidal antiinflammatory drugs and corticosteroid injection may be helpful for breaking the pain cycle 25) .Smidt compared the efficacy of physiotherapy and corticosteroid injections and found that corticosteroid injection was superior to all other therapies; however, corticosteroid treatment was associated with a high recurrence rate 26) .…”

A different approach to the management of greater trochanter pain syndrome

“…This approach focused on improving lumbar spine stability and control as well as the eccentric strengthening of the GM muscle. Clinical trails have supported the use of eccentric strengthening as a treatment modality for tendinosis (Adolfson 2001, Jonsson et al 2005, Silbernagel et al 2001. This also proved to be the case with the patient.…”