- •We aimed to understand how the application of exercises in a graded manner affect the treatment outcomes in terms of pain and function in Lateral Elbow Tendinopathy (LET).
Prospective Case Series.
Variety of studies inquired the effectiveness of exercise treatment in LET (Lateral Elbow Tendinopathy). The research on the effectiveness of these approaches are still ongoing and very much needed due to the uncertainty of the subject.
We aimed to understand how the application of exercises in a graded manner affect the treatment outcomes in terms of pain and function.
This study is completed by 28 patients with LET and it was planned as a prospective case series. Thirty participants were included to participate in the exercise group. Basic Exercises (Grade 1) were performed for four weeks. Advanced Exercises (Grade 2) were performed for another four weeks. The VAS (Visual Analog Scale), pressure algometer, the PRTEE (Patient-Rated Tennis Elbow Evaluation) and a grip strength dynamometer were used to measure outcomes. The measurements were performed at baseline, at the end of four weeks and at the end of eight weeks.
Investigation of the pain scores revealed that all VAS scores (p < 0.05, ES = 1.35; 0.72; 0,73 activity, rest, and night respectively) and pressure algometer results were improved both during basic (p < 0.05, ES = 0.91) and advanced exercises (p < 0.05, ES = 0,41). PRTEE scores were found to be improved in patients with LET after basic and advanced exercises (p > 0.001, ES = 1.15; p > 0.001, ES = 1.56 respectively). The grip strength only changed after basic exercises (p = 0.003, ES = 0.56).
The basic exercises were beneficial for both pain and function. However, advanced exercises are required for obtaining further improvements in terms of pain, function, and grip strength.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Hand Therapy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Lateral elbow tendinosis: a review of diagnosis and management in general practice.Br J Gen Pract. 2018; 68: 548-549
- 24—Elbow, wrist, and hand tendinopathies.in: Wietlisbach C.M. Cooper’s Fundamentals of Hand Therapy. Third Edition. Mosby, St. Louis2020: 311-319
- Lateral epicondylosis: a literature review to link pathology and tendon function to tissue-level treatment and ergonomic interventions.J Hand Ther. 2021; 34: 263-297
- Innervation pattern at the undersurface of the extensor carpi radialis brevis tendon in recalcitrant tennis elbow.J Orthop Sci. 2013; 18: 528-535
- Current concepts of elbow-joint disorders and their treatment.J Orthop Sci. 2013; 18: 1-7
- Comparison of effectiveness of supervised exercise program and Cyriax physiotherapy in patients with tennis elbow (lateral epicondylitis): a randomized clinical trial.ScientificWorldJournal. 2012; 939645: 1-8
- Lateral elbow tendinopathy: evidence of physiotherapy management.World J Orthop. 2016; 7: 463-466
- 59—Lateral epicondylitis/tendinosis.in: Morrey B.F. Sanchez-Sotelo J. Morrey M.E. Morrey’s the Elbow and Its Disorders. Fifth Edition. Elsevier, Philadelphia2018: 574-581
- Modeled evidence of force reduction at the extensor carpi radialis brevis origin with the forearm support band.J Hand Surg. 2003; 28: 279-287
- A rational management of tennis elbow.Sports Med. 1990; 9: 173-191
- Chapter 22—Lateral epicondylitis.in: Frontera W.R. Silver J.K. Rizzo T.D. Essentials of Physical Medicine and Rehabilitation. Fourth Edition. Elsevier, Internet2020: 124-127
- Clinically Important change in the visual analog scale after adequate pain control.Acad Emerg Med. 2003; 10: 1128-1130
- Lateral epicondylitis: the condition and current management strategies.Br J Hosp Med (London, England). 2005; 80: 647-651
- An exercise programme for the management of lateral elbow tendinopathy.Br J Sports Med. 2005; 39: 944-947
- Reliability of the Southampton examination schedule for the diagnosis of upper limb disorders in the general population.Ann Rheum Dis. 2002; 61: 1103-1106
- Interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis.Arch Phys Med Rehabil. 2002; 83: 1145-1150
- Validation of the Patient-rated tennis elbow evaluation questionnaire.J Hand Ther. 2007; 20: 3-10
- Psychometric properties and cross-cultural adaptation of the Patient-Rated Tennis Elbow Evaluation (PRTEE); a systematic review and meta-analysis.Disabil Rehabil. 2022; 44: 5402-5417
- Reliability of a patient rated forearm evaluation questionnaire for patients with lateral epicondylitis.J Hand Ther. 1999; 12: 31-37
- Update: the patient-rated forearm evaluation questionnaire is now the patient-rated tennis elbow evaluation.J Hand Ther. 2005; 18: 407-410
- Validation of the patient-rated tennis elbow evaluation questionnaire.J Hand Ther. 2007; 20: 3-11
- Reliability and validity of Turkish version of the patient rated tennis elbow evaluation.Rheumatol Int. 2010; 30: 1049-1054
- Grip and pinch strength: normative data for adults.Arch Phys Med Rehabil. 1985; 66: 69-74
- Carpal tunnel syndrome: reassessment of long-term outcomes with the use of the Paine® retinaculatome during surgery through a palmar incision.Acta Ortop Bras. 2005; 13: 225-228
- Effect sizes for interpreting changes in health status.Med Care. 1989; 27: 178-189
- Prospective evaluation of the effectiveness of a home-based program of isometric strengthening exercises: 12-month follow-up.Clin Orthop Surg. 2010; 2: 73-178
- Lateral epicondylitis of the elbow.EFORT Open Rev. 2016; 1: 391-397
- Lateral epicondylitis of the elbow.Rev Bras Ortop. 2015; 47: 414-420
- Treatment of lateral epicondylitis.Am J Occup Ther. 1991; 45: 340-343
- Progressive strengthening and stretching exercises and ultrasound for chronic lateral epicondylitis.Physiotherapy. 1996; 82: 1-9
- Corticosteroid or placebo injection combined with deep transverse friction massage, mills manipulation, stretching and eccentric exercise for acute lateral epicondylitis: a randomised, controlled trial.BMC Musculoskelet Disord. 2015; 16: 122
- Non-operative treatment regime including eccentric training for lateral humeral epicondylalgia.Scand J Med Sci Sports. 2001; 11: 328-334
- A new exercise for tennis elbow that works! N.Am J Sports Phys Ther. 2010; 5: 189-193
- Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis.Knee Surg Sports Traumatol Arthrosc. 2001; 9: 42-47
- Effects of eccentric training on hand strength in subjects with lateral epicondylalgia: a randomized-controlled trial.Scand J Med Sci Sports. 2012; 22: 797-803
- Eccentric strengthening for chronic lateral epicondylosis: a prospective randomized study.Sports Health. 2011; 3: 500-503
- Chronic tendinopathy: effectiveness of eccentric exercise.Br J Sports Med. 2007; 41 (99): 188-198
- A randomized controlled trial of eccentric vs conccentric graded exercise in chronic tennis elbow.(lateral elbow tendinopathy).Clin Rehabil. 2014; 28: 862-872
Published online: March 11, 2023
Accepted: November 1, 2022
Received in revised form: October 20, 2022
Received: January 7, 2022
Publication stageIn Press Corrected Proof
© 2023 Published by Elsevier Inc.