Prolotherapy injections and physiotherapy used singly and in combination for lateral epicondylalgia: a single-blinded randomised clinical trial

Abstract

BackgroundLateral epicondylalgia (tennis elbow) is a common, debilitating and often treatment-resistant condition. Two treatments thought to address the pathology of lateral epicondylalgia are hypertonic glucose plus lignocaine injections (prolotherapy) and a physiotherapist guided manual therapy/exercise program (physiotherapy). This trial aimed to compare the short- and long-term clinical effectiveness, cost effectiveness, and safety of prolotherapy used singly and in combination with physiotherapy.MethodsUsing a single-blinded randomised clinical trial design, 120 participants with lateral epicondylalgia of at least 6 weeks’ duration were randomly assigned to prolotherapy (4 sessions, monthly intervals), physiotherapy (weekly for 4 sessions) or combined (prolotherapy+physiotherapy). The Patient-Rated Tennis Elbow Evaluation (PRTEE) and participant global impression of change scores were assessed by blinded evaluators at baseline, 6, 12, 26 and 52 weeks. Success rate was defined as the percentage of participants indicating elbow condition was either ‘much improved’ or ‘completely recovered.’ Analysis was by intention-to-treat.ResultsEighty-eight percent completed the 12-month assessment. At 52 weeks, there were substantial, significant improvements compared with baseline status for all outcomes and groups, but no significant differences between groups. The physiotherapy group exhibited greater reductions in PRTEE at 12 weeks than the prolotherapy group (p = 0.014).ConclusionThere were no significant differences amongst the Physiotherapy, Prolotherapy and Combined groups in PRTEE and global impression of change measures over the course of the 12-month trial.Trial registrationACTRN12612000993897.

Comparison of the effectiveness of extensor muscle strengthening exercise by itself, exercise with polydeoxyribonucleotide injection, and exercise with extracorporeal shockwave therapy in lateral epicondylitis: a randomized controlled trial

“…A combination therapy of several conservative treatments of LE could be more effective than a single therapy. There have been several attempts for combination therapy [ 17 , 18 ]. A single blinded randomized controlled trial reported that there were no significant differences amongst the physiotherapy, prolotherapy, and combined groups in the patient-related tennis elbow evaluation [ 17 ].…”

“…There have been several attempts for combination therapy [ 17 , 18 ]. A single blinded randomized controlled trial reported that there were no significant differences amongst the physiotherapy, prolotherapy, and combined groups in the patient-related tennis elbow evaluation [ 17 ]. Another randomized controlled trial about braces versus physical therapy or a combination of both indicated that brace treatment may be useful as an initial therapy, and that combination therapy has no additional advantages compared to physical therapy, but is superior to braces only for the short term [ 18 ].…”

Prolotherapy

“…The solution contained 20% glucose and 0.4% lidocaine, and no more than 5 mL was used. The study concluded that there were no differences in outcomes between groups for both short-term and long-term follow-up 11 .…”

Dextrose Effects on Platelet Count and Volume: Implications for Regenerative Medicine

“…Few clinical studies were done in the twentieth century after Hackett’s work. However, in the 2000s, interest was rekindled and several successful clinical trials of prolotherapy for the treatment of lumbar pain [ 2 ], knee osteoarthritis [ 3 ], and lateral epicondylitis [ 4 ] were completed.…”