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

Abstract

IntroductionLateral Elbow Tendinopathy (LET) seems to be the most appropriate term to use in clinical practice because all the other terms such as lateral epicondylitis, lateral epicondylalgia, lateral epicondylosis and tennis elbow make reference to inappropriate aetiological, anatomical and Pathophysiological terms [1]. LET is one of the most common lesions of the arm work-related or sport-related pain disorder. The condition is usually defined as a syndrome of pain in the area of the lateral epicondyle [2] that may be degenerative or failed healing tendon response rather than inflammatory [3]. 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 [4]. The most commonly affected structure is the origin of the Extensor Carpi Radialis Brevis (ECRB) [4]. The dominant arm is commonly affected, the peak prevalence.The main complaint of patients with LET are pain and decreased function [2,3] 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 resisted middle-finger extension with the elbow in extension and (3) by getting the patient to grip an object [2,3,5].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 [2,3,[6][7][8]. Physiotherapy is a conservative treatment that is usually recommended for LET patients [2][3][4][5][6][7][8][9]. A wide array of physiotherapy treatments have been recommended for the management of LET [10][11][12][13][14]. 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.One of the most common physiotherapy treatments for LET is an exercise programme [2][3][4][5][6][7][8][9][10][11][12][13][14]. One consisting of eccentric exercises has shown good clinical results in LET [15] as well as in conditions similar to LET in clinical behavior and histopathological appearance, such as Patellar and Achilles tendinopathy [16]. Such an exercise programme is used as the first treatment option for our patients with LET [9,17]. Malliaras and his colleagues concluded that clinicians should Demosthenous M, et al., J Orthop Res Physiother 2017, 3: 036 DOI: 10.24966/ORP-2052 HSOA Journal of Orthopedic Research and Physiotherapy Review Article Abstract ObjectivesTo compare the effectiveness of eccentric-concentric training of wrist extensors and eccentric-concentric training combined with supinator strengthening in healthy subjects. MethodsA randomized clinical t...