A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia

Bisset, Leanne; Paungmali, Aatit; Vicenzino, Bill; Beller, Elaine

doi:10.1136/bjsm.2004.016170

Cited by 367 publications

(328 citation statements)

References 80 publications

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“…The findings of our review are in accordance with the previously published systematic reviews by Bisset et al [20] and Trudel et al [11] which evaluated the effectiveness of physiotherapy and conservative treatments in the management of LET, respectivelyMoreover, a systematic review of no dose response parameters was carried out in the above both reviews, as we did in our review.…”

Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

“…These treatments have different theoretical mechanisms of action, but all have the same aim, to reduce pain and improve function. Such a variety of treatment options suggests that the optimal treatment strategy is not known, and more research is needed to discover the most effective treatment in patients with LET [11,[18][19][20].Iontophoresis has attracted much interest in the last 20-25 years as it has been applied to common musculoskeletal conditions such as LET. Iontophoresis is a therapeutic technique that involves the introduction of ions into the body tissues by means of a direct electrical current [11].…”

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Effectiveness of Iontophoresis for Lateral Elbow Tendinopathy

Stasinopoulos¹

2012

J Nov Physiother

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Novel Physiotherapies Dimitrios et al., J Nov Physiother 2013, S2 http://dx.doi.org/10.4172/2165 IntroductionLateral elbow tendinopathy (LET), commonly referred to as lateral epicondylitis, lateral epicondylalgia, lateral epicondylosis and/or tennis elbow is one of the most common lesions of the arm. However, LET is the most appropriate term to use in clinical practice because all the other terms make reference to inappropriate a etiological, anatomical and pathophysiological terms [1]. The condition is usually defined as a syndrome of pain in the area of the lateral epicondyle [2][3][4], that may be degenerative or failed healing tendon response rather than inflammatory [5]. Hence, the increased presence of fibroblasts, vascular hyperplasia, proteoglycans and glycosaminoglycans together with disorganized and immature collagen may all take place in the absence of inflammatory cells [5]. The origin of the extensor carpi radialis brevis (ECRB) is the most commonly affected structure [5]. It is generally a work-related or sport-related pain disorder. The dominant arm is commonly affected, the peak prevalence of LET is between 30 and 60 years of age [2,6] and the disorder appears to be of longer duration and severity in women [2,6,7] The main complaints of patients with LET are pain and decreased function [2,[8][9][10][11][12] both of which may affect daily activities. Diagnosis is simple, and a therapist should be able to reproduce this pain in at least one of three ways: (1) digital palpation on the facet of the lateral epicondyle, (2) resisted wrist extension and/or resisted middle-finger extension with the elbow in extension, and (3) by getting the patient to grip an object [1,[8][9][10].Although the signs and symptoms of LET are clear and its diagnosis is easy, to date, no ideal treatment has emerged. Many clinicians advocate a conservative approach as the treatment of choice for LET [2,[8][9][10][11]. Physiotherapy is a conservative treatment that is usually recommended for LET patients [11,13,14]. A wide array of physiotherapy treatments have been recommended for the management of LET [11,[15][16][17]. These treatments have different theoretical mechanisms of action, but all have the same aim, to reduce pain and improve function. Such a variety of treatment options suggests that the optimal treatment strategy is not known, and more research is needed to discover the most effective treatment in patients with LET [11,[18][19][20].Iontophoresis has attracted much interest in the last 20-25 years as it has been applied to common musculoskeletal conditions such as LET. Iontophoresis is a therapeutic technique that involves the introduction of ions into the body tissues by means of a direct electrical current [11]. Iontophoresis has several advantages as a treatment technique in than it is a painless, sterile, noninvasive technique for introducing ions into the tissue that has been demonstrated to have positive effect on the healing process [15]. Its effectiveness has been evaluated in two previously published sys...

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Effectiveness of Iontophoresis for Lateral Elbow Tendinopathy

Stasinopoulos¹

2012

J Nov Physiother

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“…Its effectiveness has been evaluated in four previously published systematic reviews, which have addressed the effectiveness of conservative treatments for LET [9,10,12,13]. The conclusion of these four systematic reviews was that there was a lack of scientific evidence supporting physiotherapy treatments such as ultrasound for LET and demonstrate the importance of improving the current physiotherapy management of LET.…”

Section: Introductionmentioning

confidence: 99%

Are there Effective Ultrasound Parameters in the Management of Lateral Elbow Tendinopathy? A Systematic Review of the Literature

Stasinopoulos¹

2013

Int J Phys Med Rehabil

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“…In many patients, tendinopathy presents gradually following prolonged periods of overuse, with most demonstrating long-standing symptoms recalcitrant to traditional therapies (e.g. nonsteroidal anti-inflammatory drugs, corticosteroids) (1)(2)(3). The underlying histology is best characterized as a "failed healing" response, with ongoing, unsuccessful attempts by the tendon to restore the normal tissue structure (4,5).…”

Section: Introductionmentioning

confidence: 99%

Neuropeptides in tendinopathy

Scott

Bahr²

2009

Front Biosci

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Tendinopathy is a clinical syndrome of pain, tendon thickening, and increased blood flow. The current review highlights evidence supporting an underlying role of neuropeptides in the etiology, clinical presentation, and treatment of painful overuse tendinopathy. Painful tendons demonstrate an increased presence of Substance P-containing nerves which are strongly implicated as a potential source of pain, but which also play important roles in the tendon's attempt to self-repair. Recent findings have identified potential roles of additional sensory and autonomic neuropeptides which regulate pain, tissue remodeling, and vascular flow, including acetylcholine, noradrenaline and neuropeptide Y. Neuropeptide production within tendons is stimulated by mechanical load and exercise, and both direct and indirect neuropeptide effects may be responsible for the potential benefits of heavy-load eccentric loading. A model is presented which delineates the physiologic basis for signalling pathways between tenocytes, mast cells and sensory and autonomic nerves, with implications for understanding the mechanisms of traditional as well as emerging treatment strategies including sclerosing therapy and nitric oxide.

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A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia

Cited by 367 publications

References 80 publications

Effectiveness of Iontophoresis for Lateral Elbow Tendinopathy

Effectiveness of Iontophoresis for Lateral Elbow Tendinopathy

Are there Effective Ultrasound Parameters in the Management of Lateral Elbow Tendinopathy? A Systematic Review of the Literature

Neuropeptides in tendinopathy

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