A controlled clinical pilot trial to study the effectiveness of ice as a supplement to the exercise programme for the management of lateral elbow tendinopathy

Abstract

Background:The use of ice as a supplement to an exercise programme has been recommended for the management of lateral elbow tendinopathy (LET). No studies have examined its effectiveness.Objectives:To investigate whether an exercise programme supplemented with ice is more successful than the exercise programme alone in treating patients with LET.Methods:Patients with unilateral LET for at least four weeks were included in this pilot study. They were sequentially allocated to receive five times a week for four weeks either an exercise programme with ice or the exercise programme alone. The exercise programme consisted of slow progressive eccentric exercises of wrist extensors and static stretching of the extensor carpi radialis brevis tendon. In the exercise programme/ice group, the ice was applied after the exercise programme for 10 minutes in the form of an ice bag to the facet of the lateral epicondyle. Patients were evaluated at baseline, at the end of treatment, and three months after the end of treatment. Outcome measures used were the pain visual analogue scale and the dropout rate.Results:Forty patients met the inclusion criteria. At the end of treatment there was a decline in visual analogue scale of about 7 units in both groups compared with baseline (p<0.0005, pairedttest). There were no significant differences in the magnitude of reduction between the groups at the end of treatment and at the three month follow up (p<0.0005, independentttest). There were no dropouts.Conclusions:An exercise programme consisting of eccentric and static stretching exercises had reduced the pain in patients with LET at the end of the treatment and at the follow up whether or not ice was included. Further research to establish the relative, absolute, and cost effectiveness as well as the mechanism of action of the exercise programme is needed.

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

“…The exercise programme in both groups was carried out in home. Although a home exercise programme can be performed any time during the day without requiring supervision from a therapist, our clinical experience has shown that patients fail to comply with the regimen of home exercise programmes [20]. Although many ways can be recommended to improve the compliance of patients with the home exercise programme such as phone calls, exercise monitors and better self -management education, it is believed that this problem can be really solved by the supervised exercise programmes performed in a clinical setting under the supervision of a therapist.…”

“…Furthermore, eccentric exercises were performed at a low speed in every treatment session because this allows tissue healing [4]. Ice was recommended at the end of the treatment but research has shown that ice as a supplement to an eccentric exercise programme offers no benefit to patients with tendinopathy [20]. Finally, the avoidance of painful activities is crucial for tendon healing, because training during the treatment period increases patients' symptoms and delays tendon healing [36].…”

“…The mild and disabling pain was monitored asking the subject to rate the pain on VAS before and after treatment. Mild pain was defined below 4 on VAS whereas disabling pain was defines above 8 on VAS [20][21][22]. When subjects were able to perform the exercises without experiencing any minor pain or discomfort, the load was increased using free weights.…”

Ejercicio terapéutico para epicondilalgia lateral: revisión sistemática

“…Sobre la base de los criterios de selección de nuestra RS, sólo 36 artículos fueron incluidos (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)27,29,31,(33)(34)(37)(38)(39)(40)(43)(44)(45)61,(73)(74)(75)(82)(83)(84). El riesgo de sesgo se evaluará utilizando la herramienta propuesta en el "Cochrane Handbook" para Ensayos Clínicos Aleatorizados (91).…”

“…Es necesario establecer que existe una evidencia insuficiente con respecto a su efectividad a largo plazo (43) . Pero cabe destacar, que por más que existan tratamientos con diferentes mecanismos teóricos de acción, todos tienen un mismo objetivo, en reducir el dolor y mejorar la función (44). Sin embargo; estudios han señalado que a pesar de la resolución de síntomas mediante tratamientos conservadores permanece el déficit sensoriomotor (45), cuyas alteraciones se encuentran presentes de forma bilateral en pacientes con EL (46,47).…”