Treating Lateral Epicondylopathy With Dry Needling and Exercise: A Case Series.

CONTEXT: Lateral epicondylopathy (LE) is a common overuse injury affecting elbow, wrist, and hand function. It is characterized by weakness and pain in the muscles and tendons of the forearm responsible for the extension of your wrist and fingers. Trigger point dry needling is a technique reported to be beneficial in managing pain and dysfunction after LE diagnosis. LE is also commonly treated with conservative treatment, such as joint and soft tissue mobilization, self-care home programs, and anti-inflammatory use. We explored a different dry needling approach consisting of in situ dry needling with electric stimulation combined with targeted therapeutic exercise to treat LE in 3 cases. CASE PRESENTATION: Three patients were referred for dry needling once a week for 6 weeks and home-based exercise therapy for LE. They were clinically evaluated using grip strength, a visual analog scale to assess pain, and Patient-Rated Tennis Elbow Evaluation Test scores. These were measured at 4 time points (weeks 0, 2, 4, and 6). MANAGEMENT AND OUTCOMES: The dry needling intervention incorporated 8 locations in the upper-extremity with 2 electric stimulation channels. The patients had reduced pain as measured by a visual analog scale, increased function as measured by the Patient-Rated Tennis Elbow Evaluation Test, and increased grip strength over 6 weeks. CONCLUSIONS: This case series illustrates the use of dry needling and a home exercise program to provide a favorable outcome in a patient with LE. Patients had an 80% to 100% reduction in pain and similar improvements in function that were significantly beyond the minimum clinically important difference. This dry needling approach is a safe and effective treatment of LE in the short term.

Physiotherapy treatment of lateral epicondylitis: A systematic review.

BACKGROUND: Lateral epicondylitis is a tendinopathy with a prevalence of between 1-3% of the population aged 35-54 years. It is a pathology with a favorable evolution, but with frequent recurrences (which imply an economic extra cost). OBJECTIVE: The objective of this review was to determine the efficacy of physiotherapy treatment for the treatment of epicondylitis and, if any, to identify the most appropriate techniques. METHODS: A systematic search was carried out in October 2020 in the databases of PubMed, Cinahl, Scopus, Medline and Web of Science using the search terms: Physical therapy modalities, Physical and rehabilitation medicine, Rehabilitation, Tennis elbow and Elbow tendinopathy. RESULTS: Nineteen articles were found, of which seven applied shock waves, three applied orthoses, three applied different manual therapy techniques, two applied some kind of bandage, one applied therapeutic exercise, one applied diacutaneous fibrolysis, one applied high intensity laser, and one applied vibration. CONCLUSIONS: Manual therapy and eccentric strength training are the two physiotherapeutic treatment methods that have the greatest beneficial effects, and, furthermore, their cost-benefit ratio is very favorable. Its complementation with other techniques, such as shock waves, bandages or Kinesio® taping, among others, facilitates the achievement of therapeutic objectives, but entails an added cost.

Tennis elbow, study protocol for a randomized clinical trial: needling with and without platelet-rich plasma after failure of up-to-date rehabilitation.

BACKGROUND: The conservative management of lateral epicondylitis is known to be a difficult-to-treat annoying condition. A treatment with platelet-rich plasma (PRP) is often performed, but its efficacy remains controversial. METHODS: This study is a single-center, randomized double-blind controlled trial, preceded by a case series. All the 232 planned patients of the case series will undergo an up-to-date comprehensive rehabilitation program, including focused extracorporeal shock waves therapy. This rehabilitation program is expected to have a maximum success rate 75%. It is therefore aimed to allocate a minimum of 58 patients with rehabilitation failure into the 1:1 randomized trial. Stratification is planned on age and lesion pattern. The masking will be quadruple (Participant, Care Provider, Investigator & Outcome Assessor). The patients will undergo an ultrasound (US)-guided needling combined with either PRP (intervention group) or saline (control group). The primary endpoint will be the pain improvement from baseline (month 0) at 3 months on a 0-10 visual analog scale (VAS) during a maximal strength isometric contraction of the extensor carpialis brevis muscle. The main secondary endpoints will include the rehabilitation success rate and improvements from baseline at 3, 6, and 12 months of the following outcomes: (i) Single Assessment Numeric Evaluation (SANE) score, (ii) Patient-Rated Tennis Elbow Evaluation (PRTEE) score, (iii) maximal grip strength on Jamar test, and (iv) the ultrasonographic evaluation of the US of the epicondylar tendons. DISCUSSION: The study results will provide insight into the effect of PRP as adjuvant therapy to tendon fenestration, and may contribute to identify the best preceding and concomitant rehabilitation protocol. TRIAL REGISTRATION: ClinicalTrials.gov NCT03987256. Registered on 20 August 2019.

Continuous shortwave diathermy with exercise reduces pain and improves function in Lateral Epicondylitis more than sham diathermy: A randomized controlled trial.

INTRODUCTION: Lateral epicondylitis or tennis elbow, causes significant pain and disability in the upper extremity. Conservative approaches include using thermal and electrical agents. The aim of this study was to explore the effectiveness of shortwave diathermy on pain, function and grip strength of patients with chronic lateral epicondylitis. A randomized placebo-controlled design with concealed allocation, assessor blinding and intention-to-treat analysis was conducted. METHODS: Fifty patients suffering from lateral epicondylitis for more than 3 months, without any systemic diseases or history of other pathologies, were divided into two groups. In both groups, the patients were instructed to perform specific stretching and strengthening exercises. In addition, the patients in the experimental group, received 15 min of 40-60 W, continuous short wave diathermy while sham diathermy was applied for the control group. The primary outcome measure was pain and the secondary outcome measures were functional ability and pain free grip strength. Outcomes were assessed at the base line, after the 5th and the 10th session of treatment as well as after 3 months. RESULTS: Mixed ANOVA analysis showed significant improvement in both groups. Meanwhile, there was a significant interaction effect of time and group on all outcome measures implying the greater improvement in pain, function and grip strength in the group receiving real diathermy. CONCLUSIONS: Adding continuous short wave diathermy to a specific regimen of exercises, reduces pain and improves function in patients suffering from chronic lateral epicondylitis more than sham diathermy and exercise. TRIAL REGISTRATION: IRCT2016042321139N4.

Comparison of the effects of short-duration wrist joint splinting combined with physical therapy and physical therapy alone on the management of patients with lateral epicondylitis.

BACKGROUND: Lateral epicondylitis (i.e., tennis elbow) is a condition caused by overuse of the arm, which can result in elbow pain. Recent evidence has shown wrist joint splinting as an effective intervention for people with lateral epicondylitis. AIM: The purpose of this study was to compare the effect of a 3 week wrist joint splinting and physical therapy intervention versus a standard physical therapy intervention on pain, wrist range of motion (ROM), and grip strength in people with lateral epicondylitis. DESIGN: Randomized clinical trial. SETTING: University hospital outpatient clinics. POPULATION: Forty participants diagnosed with lateral epicondylitis. METHODS: The participants were randomized into 2 groups. The standard care group followed a treatment program consisting of stretching exercises for the wrist extensors, ultrasonic therapy, and deep friction massage on the proximal attachment of the wrist extensor muscles. The intervention group followed a standard wrist joint splinting program in addition to the physical therapy program that the standard care group received. Participants in both groups received treatment 3 times per week for 3 weeks. The outcome measures were pain intensity, wrist extension ROM, wrist flexion ROM, and grip strength. Each outcome measure was assessed at baseline and after completion of the intervention. RESULTS: There were no significant between-group differences at baseline. After the treatment period, the intervention group showed statistically significant improvement in pain intensity. Other outcomes also improved including wrist flexion ROM, wrist extension ROM, and grip strength in comparison to the standard care group. CONCLUSIONS: Using wrist joint splinting in addition to physical therapy for a short duration is effective for improving pain intensity. The evidence from this study indicates that wrist joint splinting and physical therapy may also be effective for improving wrist ROM and grip strength in the treatment of patients with lateral epicondylitis, although more research is need in this area. CLINICAL REHABILITATION IMPACT: Wrist joint splinting is an effective intervention that can be applied in clinical rehabilitation practices for people with lateral epicondylitis.

Effects of eight-week "gyroscopic device" mediated resistance training exercise on participants with impingement syndrome or tennis elbow.

BACKGROUND: Rehabilitation of injuries in the upper extremity and reestablishment of muscle strength throughout the range of motion in overhead movements, are the major concerns of athletes and coaches in the sports field. PURPOSE: To determine the effect of eight-week "gyroscopic device" mediated resistance training exercise on grip strength, wrist and shoulder strength and proprioception, and upper extremity performance, in participants with impingement syndrome or tennis elbow. DESIGN AND METHODS: For this study, in a university rehabilitation clinic 45 volleyball players (aged 22-28) purposefully were selected and divided into 3 groups: shoulder impingement (group I), tennis elbow (group II), and control (group III). The experimental groups performed the "gyroscopic device" mediated resistance training, three sessions a week over 8 wks. Grip strength, wrist and shoulder strength and proprioception, and upper extremity performance were measured before and after implementation of the intervention (eight-week resistance training using a "gyroscopic device") using a hand hold dynamometer, isokinetic dynamometer, and Y balance test respectively. RESULTS: After 8 weeks of "gyroscopic device" exercise, improvement in the shoulder, wrist and grip strength, shoulder and wrist proprioception and performance scores of both experimental groups was significant. There were no significant differences between study groups I and II, both groups, however, demonstrated significant differences when compared to the control group, but between group I and the control group, and between group II and the control group, the difference was significant. However, no significant change was seen in the control group. CONCLUSIONS: Due to the significant effects of the "gyroscopic device" mediated exercise on grip strength, wrist and shoulder strength and proprioception, and performance of the upper extremity, use of the exercise can be recommended for subjects with impingement syndrome or tennis elbow impairment in measured variables. More research is needed to confirm the result of this study.

Current physiotherapy practice in the management of tennis elbow: A service evaluation.

BACKGROUND: Tennis elbow is a common painful condition that may affect daily function and ability to work. Physiotherapy is the most commonly used primary intervention but there is a wide range of treatment options within the umbrella of physiotherapy. Our aim was to report on the treatments that are currently used by physiotherapists in a UK National Health Service (NHS) setting. METHODS: A retrospective service evaluation was conducted at two NHS hospital trusts by reviewing patient attendance records over a 1-year period. All patients with tennis elbow were included, except those referred for postoperative rehabilitation. Patient notes were analysed using a predefined assessment template. RESULTS: A total of 65 patient records were identified, with patients having a mean age 48 years and mean symptom duration of 5.4 months. The mean treatment duration was 64 days, over 3.7 sessions. The most commonly used treatments were education and exercise, although the type and dosing of exercise varied greatly. Passive modalities such as ice, taping, manual therapy, acupuncture and electrotherapy were still used. CONCLUSIONS: Wide variations in treatment approaches were identified. There was no consistency in the choice of modality used, the type of exercise or the dose of exercise prescribed. The use of passive modalities and corticosteroid injections was found to remain commonplace, despite a lack of supporting research evidence. There is a clear need for evidence-based guidance for physiotherapists treating patients with tennis elbow.

Does Kinesiotaping improve pain and functionality in patients with newly diagnosed lateral epicondylitis?

PURPOSE: This study aimed to compare the short-term effects of kinesiotaping and extracorporeal shock wave therapy (ESWT) along with physiotherapy on pain, functionality, and grip strength in patients with newly diagnosed lateral epicondylitis undergoing rehabilitation. METHODS: Forty-five voluntary patients (mean age 48 years) were randomly assigned to three groups. Patients in all groups received physiotherapy consisting of a cold pack and transcutaneous electrical nerve stimulation five times per week for a total of 15 sessions and a home exercise programme including stretching and eccentric strength exercises. In the second group, patients received kinesiotaping 5 days a week for 3 weeks. In the third group, ESWT was applied three times for 3 weeks. Patients were assessed by visual analogue scale for pain intensity, pain-free grip strength using a hand dynamometer, Cyriax Resisted Muscle Test, and Patient-Rated Tennis Elbow Evaluation Scale. All measurements were collected at baseline and after treatment. RESULTS: There were no significant differences in the demographic characteristics of the patients in all groups at baseline. Intra-group analysis revealed that pain intensity decreased, whereas maximum grip strength and functionality increased in all groups at the end of the treatment (p < 0.05). Inter-group analysis revealed that the kinesiotaping group yielded better results in decreasing pain intensity than the other groups (p < 0.05). The kinesiotaping group (p < 0.001) and ESWT group (p = 0.002) yielded better results in improving functionality than the physiotherapy group. There were significant differences in recovering pain-free grip strength in the kinesiotaping group (p < 0.05). CONCLUSION: Kinesiotaping was found to be effective for decreasing pain intensity, recovering grip strength, and improving functionality in patients with lateral epicondylitis undergoing rehabilitation. LEVEL OF EVIDENCE: Therapeutic study, Level II.

Efectos de la estimulación interfibrilar contrairritante musculoesquelética en epicondilalgias de jugadores de pádel amateurs. Estudio piloto / Effects of the musculoskeletal interfibrillar counterirritattion stimulation technique on amateur paddle-tennis players’ epicondylalgia. Pilot study

Objetivo: Analizar la eficacia de la técnica de estimulación interfibrilar contrairritante musculoesquelética en jugadores de deportes de raqueta con epicondilalgia y puntos gatillo miofasciales (PGM) activos. Material y métodos: Se trata de un estudio piloto diseñado como ensayo clínico (prospectivo) aleatorizado a doble ciego. Se contó con jugadores de pala o raqueta que cumplían los siguientes criterios de inclusión: tener una edad comprendida entre 18 y 60 años (ambos incluidos), tener dolor en la zona del epicóndilo lateral y tener un PGM activo central en la musculatura epicondílea. La muestra fue de 68 sujetos, de los cuales 61 completaron el estudio; 30 del grupo intervención (aplicación de la técnica) y 31 del grupo control (aplicación de un vendaje simple). La variable principal fue la algometría (umbral de dolor a la presión sobre el PGM) y las secundarias fueron la escala analógica visual (EVA 0-10) y el Patient-Rated Tennis Elbow Evaluation. Resultados: Los valores de algometría y los valores de EVA muestran que hubo una disminución del dolor en ambos grupos, aunque sin diferencias estadísticamente significativas entre ellos. La comparación de los porcentajes iniciales y finales EVA≥4 tampoco muestra diferencias entre grupos, pero la comparación antes/después de ambos grupos es estadísticamente significativa (p<0,05). Conclusiones: La técnica de estimulación interfibrilar contrairritante musculoesquelética, aplicada en PGM centrales de la musculatura epicondílea en sujetos con epicondilalgia que practican deportes de raqueta/pala, no parece ser más efectiva que la aplicación de un vendaje simple sobre la zona

Objective: To analyse the effectiveness of the musculoskeletal interfibrillar counterirritattion stimulation technique (MICS) in racquet sports players with epicondylalgia and active myofascial trigger points (MTrPs). Material and methods: This is a pilot study designed as double-blind randomized clinical trial (prospective). It featured paddle or racquet sport players who met the following inclusion criteria: to be aged between 18 and 60 (inclusive), to have pain in the lateral epicondyle and to have a central active MTrP in the epicondylar musculature. The sample consisted of 68 subjects, of whom 61 completed the study; divided into 30 for the Intervention group (technique application) and 31 for the Control group (simple bandage). The primary variable was algometry (pain threshold to pressure on the MTrPs) and secondary variables were the VAS (visual analogue scale, 0-10) and the Patient-Rated Tennis Elbow Evaluation. Results: Algometry values and VAS values show that there was a decrease in pain in both groups, but no statistically significant differences between them. The comparison of the initial and final percentages VAS≥4 also do not show differences between groups, but improvement of both groups is statistically significant (P<.05). Conclusions: The musculoskeletal interfibrillar counterirritattion stimulation technique applied in the central MTrPs of epicondylar muscles in subjects with epicondylalgia who play racquet sports/paddle does not seem to be more effective than the application of a simple bandage over the area

The effectiveness of exercise for the management of musculoskeletal disorders and injuries of the elbow, forearm, wrist, and hand: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration.

OBJECTIVE: The purpose of this systematic review was to evaluate the effectiveness of exercise compared to other interventions, placebo/sham intervention, or no intervention in improving self-rated recovery, functional recovery, clinical, and/or administrative outcomes in individuals with musculoskeletal disorders and injuries of the elbow, forearm, wrist, and hand. METHODS: We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Paired reviewers independently screened studies for relevance and assessed the risk of bias using the Scottish Intercollegiate Guidelines Network criteria. We synthesized the evidence using the best evidence synthesis methodology. RESULTS: We identified 5 studies with a low risk of bias. Our review suggests that, for patients with persistent lateral epicondylitis, (1) adding concentric or eccentric strengthening exercises to home stretching exercises provides no additional benefits; (2) a home program of either eccentric or concentric strengthening exercises leads to similar outcomes; (3) home wrist extensor strengthening exercises lead to greater short-term improvements in pain reduction compared to "wait and see"; and (4) clinic-based, supervised exercise may be more beneficial than home exercises with minimal improvements in pain and function. For hand pain of variable duration, supervised progressive strength training added to advice to continue normal physical activity provides no additional benefits. CONCLUSION: The relative effectiveness of stretching vs strengthening for the wrist extensors remains unknown for the management of persistent lateral epicondylitis. The current evidence shows that the addition of supervised progressive strength training does not provide further benefits over advice to continue normal physical activity for hand pain of variable duration.

Infiltraciones de sangre autóloga y plasma enriquecido en plaquetas en el tratamiento de la epicondilitis. Una revisión sistemática / Infiltrations of autologous blood and platelet rich plasma in the treatment of epicondylitis. a systematic review

Objetivo. Evaluar la eficacia de la terapia con sangre autóloga o plasma enriquecido en plaquetas (PEP) en el tratamiento de la epicondilitis. Estrategia de búsqueda. Revisión sistemática de la literatura en las principales bases de datos. Artículos en español e inglés sin límite de tiempo. Palabras clave usadas: Epicondilitis y sangre autóloga; Epicondilitis y plasma enriquecido en plaquetas. Selección de los estudios. Ensayos clínicos aleatorizados y estudios de cohorte. Se seleccionaron un total de 11 artículos. Síntesis de resultados. La terapia con sangre autóloga o PEP es más efectiva para la disminución del dolor y mejora de la función que la infiltración con corticoides. Esta superioridad se muestra a medio y largo plazo. El PEP es superior a la sangre autóloga a medio plazo. El coste estimado de estos tratamientos es superior al uso de corticoides Conclusiones. Ambos tratamientos parecen superiores al patrón oro que podemos considerar la inyección de corticoides (AU)

Objective. To evaluate the efficacy of therapy with autologous blood or platelet rich plasma (PRP) in the treatment of epicondylitis. Research Strategy. A systematic revision of the literature in the main databases was performed of articles in Spanish and English without any time limits. Keywords used were: Epicondylitis and autologous blood; Epicondylitis and platelet-rich plasma. Study selection. Randomized clinical trials and cohort studies. A total of 11 articles were selected. Synthesis of results. Autologous blood therapy or PRP is more effective for pain reduction and function improvement than corticosteroid injections. This advantage is seen in both the mid and long term. PRP is superior to autologous blood in the mid term. The estimated cost of these treatments is higher than that of the use of corticosteroids. Conclusions. Both treatments seem superior to corticosteroid injections, which had been considered to be the gold standard (AU)

Comparison of effectiveness of supervised exercise program and Cyriax physiotherapy in patients with tennis elbow (lateral epicondylitis): a randomized clinical trial.

OBJECTIVE: To compare the effectiveness of supervised exercise program and Cyriax physiotherapy in the treatment of tennis elbow (lateral epicondylitis). DESIGN: Randomized clinical trial. SETTING: Physiotherapy and rehabilitation centre. SUBJECTS: This study was carried out with 20 patients, who had tennis elbow (lateral epicondylitis). INTERVENTION: Group A (n = 10) had received supervised exercise program. Group B (n = 10) was treated with Cyriax physiotherapy. All patients received three treatment sessions per week for four weeks (12 treatment sessions). OUTCOME MEASURES: Pain was evaluated using a visual analogue scale (VAS), and functional status was evaluated by completion of the Tennis Elbow Function Scale (TEFS) which were recorded at base line and at the end of fourth week. RESULTS: Both the supervised exercise program and Cyriax physiotherapy were found to be significantly effective in reduction of pain and in the improvement of functional status. The supervised exercise programme resulted in greater improvement in comparison to those who received Cyriax physiotherapy. CONCLUSION: The results of this clinical trial demonstrate that the supervised exercise program may be the first treatment choice for therapist in managing tennis elbow.

Effectiveness of myofascial release in the management of lateral epicondylitis in computer professionals.

OBJECTIVE: To investigate whether myofascial release (MFR) reduces the pain and functional disability of lateral epicondylitis (LE) in comparison with a control group receiving sham ultrasound therapy in computer professionals. DESIGN: Randomized, controlled, single blinded trial. SETTING: Nonprofit research foundation clinic in Kerala, India. PARTICIPANTS: Computer professionals (N=68) with LE. INTERVENTIONS: MFR group or control group. The techniques were administered by certified MFR practitioners and consisted of 12 sessions per client over 4 weeks. MAIN OUTCOME MEASURE: The Patient-Rated Tennis Elbow Evaluation (PRTEE) scale was used to assess pain severity and functional disability. The primary outcome measure was the difference in PRTEE scale scores between week 1 (pretest score), week 4 (posttest score), and follow-up at week 12 after randomization. RESULTS: The simple main effects analysis showed that the MFR group performed better than the control group in weeks 4 and 12 (P<.005). Patients in the MFR and control groups reported a 78.7% and 6.8% reduction, respectively, in their pain and functional disability in week 4 compared with that in week 1, which persisted as 63.1% in the follow-up at week 12 in the MFR group. CONCLUSIONS: This study provides evidence that MFR is more effective than a control intervention for LE in computer professionals.

[Treatment of epicondylitis - a current review]. / Die Therapie der Epicondylitis - eine aktuelle Übersicht.

Lateral epicondylitis or tennis elbow is a common injury, which affects not only people who play tennis but occurs with many different activities. It reflects overuse of the extensor muscles of the forearm. There are some other pathologies which have to be separated from epicondylitis. The choice of different treatments is hard to overlook and there are only a few good clinical trials which support one treatment option by means of evidence based medicine. During the acute phase topical NSAIR, steroid injections, ultrasound and acupuncture are helpful. There is no consensus about the effectiveness of physiotherapy, orthoses, laser, electrotherapy or botulinumtoxininjections. During the chronic phase none of the different treatment modalities is effective according to criterias of evidence based medicine. By now, it has not been proven whether patients profit during that time of physiotherapy, orthoses, extracorporeal shock wave therapy or an operation. Whether orthobiological treatment options may play a role in the future is presently uncertain.

Posterior interosseous nerve palsy as a complication of friction massage in tennis elbow.

Friction massage is a commonly used physical therapy that is usually safe and without complication. We report an unusual case of posterior interosseous nerve palsy that arose after friction massage. Electrophysiologic findings confirmed a focal neuropathy 4-6 cm distal to the lateral epicondyle. The neurologic symptoms resolved completely 2 mos after discontinuation of friction massage. This case experience broadens the spectrum of etiologies of posterior interosseous nerve palsy. Nerve conduction studies may be a useful adjunct to a thorough physical examination to confirm the diagnosis and is important to prognostic evaluation, if unexplained neurologic symptoms develop after certain physical therapy procedures. Further treatment includes avoiding compression and observation.

Development of a clinical prediction rule to identify initial responders to mobilisation with movement and exercise for lateral epicondylalgia.

The aim of this post hoc analysis was to develop a preliminary clinical prediction rule (CPR) for identifying patients with lateral epicondylalgia (LE) likely to respond to mobilisation with movement and exercise (PT). Currently practitioners do not have an evidence-based means to identify such patients a priori. Potential predictive factors were recorded at baseline and reference measures at 3 weeks after treatment was initiated. Participants (n=64) received standardised PT. After 3 weeks, participants were categorised as having experienced 'improvement' or 'no improvement' with treatment. Factors with univariate relationship (p<0.15) to 'improvement' were entered into a step-wise logistic regression model. Receiver operator characteristic curves were used to calculate cut-off points for continuous variables. Analyses resulted in a CPR that included: age (<49 years, +LR=2.6) as well as pain free grip strength on the affected (>112N, +LR=2.3) and unaffected side (<336N, +LR=2.1). Probability of improvement rose from 79 to 100% if all three were positive. The CPR did not predict outcome for wait and see (n=57), indicating it was more accurate for PT. This post hoc analysis has created a Level IV CPR that with further validation will help practitioners identify responders. Future studies are required to validate the rule.

An alternative approach to treating lateral epicondylitis. A randomized, placebo-controlled, double-blinded study.

OBJECTIVE: To investigate the effect of noxious level electrical stimulation on pain, grip strength and functional abilities in subjects with chronic lateral epicondylitis. DESIGN: Randomized, placebo-control, double-blinded study. SETTING: Physical Therapy Department, North Georgia College and State University. SUBJECTS: Eighteen subjects with chronic lateral epicondylitis between the ages of 24 and 72 years participated in this study. Subjects were randomly assigned into treatment or placebo groups. INTERVENTIONS: Subjects received six sessions of low-frequency electrical stimulation over the palpated tender points. The intensity of electrical stimulation was set at 0 in the placebo group. MAIN MEASUREMENTS: Grip strength, functional status, pain intensity and limited activity due to pain were assessed before and after treatment. Six-month follow-up data were collected in treatment group only. RESULTS: Both clinically and statistically significant improvements in average grip strength were found (treatment group: 28% increase; placebo group: 2.5% decrease; P=0.04), functional activity (treatment group: 110% increase; placebo group: 22% increase; P= 0.003), pain intensity (treatment group: 3.1 point decrease; placebo group: 0.2 point increase; P=0.01) and activity limitation due to pain (treatment group: 4.1 points increase; placebo group: 1.9 point decrease; P= 0.003) between the treatment and placebo groups. Follow-up data showed that 100% of subjects maintained the improved function, and 83% remained pain-free for at least six months post treatment. CONCLUSION: The results of this study indicated that symptoms of chronic lateral epicondylitis could be effectively treated by noxious level low-frequency electrical stimulation.