Astym treatmentvs.eccentric exercise for lateral elbow tendinopathy: a randomized controlled clinical trial

Abstract

Introduction. Patients with chronic lateral elbow (LE) tendinopathy, commonly known as tennis elbow, often experience prolonged symptoms and frequent relapses. Astym treatment, evidenced in animal studies to promote the healing and regeneration of soft tissues, is hypothesized to improve outcomes in LE tendinopathy patients. This study had two objectives: (1) to compare the efficacy of Astym treatment to an evidence-based eccentric exercise program (EE) for patients with chronic LE tendinopathy, and (2) to quantify outcomes of subjects non-responsive to EE who were subsequently treated with Astym treatment.Study Design. Prospective, two group, parallel, randomized controlled trial completed at a large orthopedic center in Indiana. Inclusion criteria: age range of 18–65 years old, with clinical indications of LE tendinopathy greater than 12 weeks, with no recent corticosteriod injection or disease altering comorbidities.Methods. Subjects with chronic LE tendinopathy (107 subjects with 113 affected elbows) were randomly assigned using computer-generated random number tables to 4 weeks of Astym treatment (57 elbows) or EE treatment (56 elbows). Data collected at baseline, 4, 8, 12 weeks, 6 and 12 months. Primary outcome measure: DASH; secondary outcome measures: pain with activity, maximum grip strength and function. The treating physicians and the rater were blinded; subjects and treating clinicians could not be blinded due to the nature of the treatments.Results. Resolution response rates were 78.3% for the Astym group and 40.9% for the EE group. Astym subjects showed greater gains in DASH scores (p = 0.047) and in maximum grip strength (p = 0.008) than EE subjects. Astym therapy also resolved 20/21 (95.7%) of the EE non-responders, who showed improvements in DASH scores (p < 0.005), pain with activity (p = 0.002), and function (p = 0.004) following Astym treatment. Gains continued at 6 and 12 months. No adverse effects were reported.Conclusion. This study suggests Astym therapy is an effective treatment option for patients with LE tendinopathy, as an initial treatment, and after an eccentric exercise program has failed.Registration/Funding. Ball Memorial Hospital provided limited funding. Trial registration was not required by FDAAA 801.Known about the Subject. Under the new paradigm of degenerative tendinopathy, eccentric exercise (EE) is emerging as a first line conservative treatment for LE tendinopathy. EE and Astym treatment are among the few treatment options aiming to improve the degenerative pathophysiology of the tendon. In this trial, Astym therapy, which has shown success in the treatment of tendinopathy, is compared to EE, which has also shown success in the treatment of tendinopathy.Clinical Relevance. There is a need for more effective, conservative treatment options. Based on the current efficacy study, Astym therapy appears to be a promising, non-invasive treatment option.

Astym Therapy Improves Function and Range of Motion Following Mastectomy

“…Once an area of potential dysfunctional tissue is located, the clinician applies appropriate pressures and shear forces to that tissue, aimed at initiating a reparative cellular response in dysfunctional tissue. 6 In vivo studies revealed that the Astym protocols improved tissue repair, increased limb function, and normalized movement patterns in an animal model. 7,8 Further, Astym treatment resulted in a significant increase in both fibroblast activation and fibroblast number, as well as the production of fibronectin, which together with interstitial collagens may interact to form a fibrillar component of the extracellular matrix.…”

“…6 It is evidenced in animal studies to engage the regenerative mechanisms of the body and promote healing of tissues. 7,8 It has also been found to reduce pain and increase function in people with soft tissue dysfunction.…”

“…6 Handheld instrumentation is applied topically to locate underlying dysfunctional soft tissue and then transfer particular pressures and shear forces to the dysfunctional tissue through specific protocols and patterns developed from scientific and clinical study. 6 The Astym instrumentation is designed to assess the presence of dysfunctional tissue by amplifying the tactile sensation of the underlying texture of the soft tissues in order to provide the treating clinician with indications where rough or improperly organized tissue is located. Once an area of potential dysfunctional tissue is located, the clinician applies appropriate pressures and shear forces to that tissue, aimed at initiating a reparative cellular response in dysfunctional tissue.…”

“…7,8 It has also been found to reduce pain and increase function in people with soft tissue dysfunction. 6,[9][10][11] The aim of Astym treatment is to engage the regenerative mechanisms of the body in order to resorb scar tissue, stimulate tissue turnover, and regenerate soft tissues. 6 Handheld instrumentation is applied topically to locate underlying dysfunctional soft tissue and then transfer particular pressures and shear forces to the dysfunctional tissue through specific protocols and patterns developed from scientific and clinical study.…”

“…6,[9][10][11] The aim of Astym treatment is to engage the regenerative mechanisms of the body in order to resorb scar tissue, stimulate tissue turnover, and regenerate soft tissues. 6 Handheld instrumentation is applied topically to locate underlying dysfunctional soft tissue and then transfer particular pressures and shear forces to the dysfunctional tissue through specific protocols and patterns developed from scientific and clinical study. 6 The Astym instrumentation is designed to assess the presence of dysfunctional tissue by amplifying the tactile sensation of the underlying texture of the soft tissues in order to provide the treating clinician with indications where rough or improperly organized tissue is located.…”