Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review

F, Cullinane; Boocock, Mark; Trevelyan, Fiona C

doi:10.1177/0269215513491974

Cited by 115 publications

(95 citation statements)

References 31 publications

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“…Furthermore, the use of blood-based preparations has produced increasing levels of post-injection pain in comparison to CSI [1]. Therefore, many clinicians still use local anaesthetics with different injections in LE including ABI [31].…”

Section: Discussionmentioning

confidence: 99%

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A Systematic Review to Compare Three Injection Modalities in the Management of Pain and Function for Patients with Chronic Lateral Epicondylalgia

Elmajee¹,

Gaskell²,

Watts³

et al. 2016

Orthop Muscular Syst

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Aim: To provide an evidence-based scientific report on the efficacy of three common injection treatment modalities for Lateral Epicondylalgia (LE). These injections are contemporary and frequently used in clinical practice. Objective:To systematically locate and appraise RCTs (Randomised Controlled Trials) of three comparative injection modalities (Corticosteroid Injection (CSI), Platelets Rich Plasma (PRP), and Autologous Blood Injection (ABI) and to review their efficacy in the management of pain and dysfunction associated with LE. Search strategy:RCTs that compare at least two of the three injections modalities and published from January 2005 to September 2015 were systematically searched. The following online search engines were utilised: The Cochrane Central Register of Controlled Trials (Central), Web of Sciences, PubMed, CINAHL, MEDLINE, and Academic Search Premier. The following search terms were used: "tennis elbow", "lateral epicondylitis", "corticosteroid injection", "autologous blood injection", "platelets rich plasma" and "randomised controlled trial". The terms "tennis elbow" or "lateral epicondylitis" or "lateral epicondylalgia" were combined with each one of the injection modalities and the term "randomised controlled trial". Methodological assessment was conducted by applying Sign 50 tool and The Cochrane Collaboration's tool for assessing risk of bias. This systematic review protocol was conducted according to the standards presented in the Cochrane Handbook and recommendations in the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement.Results: Seven RCTs were included within this review. Overall methodological quality was high, mostly level I studies. Three RCTs compared the effects of PRP and ABI, three studies concerned the comparison between PRP and CSI, and one RCT related to the effectiveness of ABI and CSI. Conclusion:Corticosteroid injections failed to demonstrate long-lasting significant clinical effects in chronic LE. However, PRP and ABI were shown to have a progressive and increasing effect from 6 months to one year following the injections. PRP and ABI demonstrated comparable effects in terms of pain and function. Further studies are warranted to justify the higher costs associated with the use of PRP.

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Section: Discussionmentioning

confidence: 99%

“…Physiotherapy modalities such as eccentric loading can improve clinical outcomes in resistant cases of LE, either in isolation or as an adjunct to other therapies including ABI [31].…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review to Compare Three Injection Modalities in the Management of Pain and Function for Patients with Chronic Lateral Epicondylalgia

Elmajee¹,

Gaskell²,

Watts³

et al. 2016

Orthop Muscular Syst

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show abstract

“…Previous studies have reported the effectiveness of therapeutic approaches such as medication, electrical and thermal modalities, cold massage, cross friction massage, and steroid transcutaneous injection on chronic lateral epicondylitis [4,5,[9][10][11]. However, these therapeutic approaches would have temporary effects and has some side effects.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical rehabilitation settings have supported that therapeutic eccentric exercise is an effective therapeutic approaches to reduce the symptoms associated with overuse syndrome such as chronic lateral epicondylitis [4,5]. Previous studies have noted alternative activation, increased or decreased activation of the extensor carpi radialis, but they have not noted the extensor carpi radialis brevis (ECRB) although chronic lateral epicondylitis is affected to increase pain at the insertion site of the ECRB muscle, middle finger, and during wrist extension [4,6,7].…”

Section: Introductionmentioning

confidence: 99%

Effect of flexion degrees in elbow joint on muscle activation of the extensor carpi radialis and biceps brachii muscles in healthy young adults

Kim

2016

PTRS

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Objective: Chronic lateral epicondylitis is a condition which becomes sore and tender on the lateral side of the elbow joint damaged from overuse and repetitive use of the extensor muscles of the forearm. The purpose of this study was to investigate the effects of flexion degrees in the elbow joint on extensor carpi radialis longus and brevis and biceps brachii muscles in individuals with healthy young adults. The main purpose of this study was to suggest the feasibility of optimal elbow angle during therapeutic eccentric exercise with resistance for strengthening of wrist extensors. Design: Cross-sectional study. o , and 90 o during eccentric exercise with weight loading in wrist extensors, extensor carpi radialis longus and brevis and biceps brachii muscles using surface electromyography. Results: The muscle activation of extensor carpi radialis showed a negative relationship with the degrees of elbow joint flexion. With increasing elbow flexion angles, the ECRL muscle activation amount was significantly lower (p<0.05). In contrast, the muscle activation of the ECRB muscle activation amount was significanlty higher (p<0.05). Conclusions: This study suggests that the eccentric exercise of wrist extension with selected activation of wrist extensor muscles according to elbow flexion positions, and suggests that the extensor carpi radialis longus and brevis will need to be strengthened for preventing and treating chronic lateral epicondylitis regardless of degrees of elbow joint flexion.

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“…Encouraging clinical outcome of wrist muscle strengthening programmes designed to restore the balance between wrist extensor and flexor groups has supported this theory (Cullinane et al, 2014;Raman et al, 2012;105 Tyler et al, 2014).…”

Section: Implications For the Assessment Of Forearm Muscle Function 70mentioning

confidence: 98%

Electromyographic assessment of forearm muscle function in tennis players with and without Lateral Epicondylitis

Alizadehkhaiyat

Frostick

2015

Journal of Electromyography and Kinesiology

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There is no consensus about the main aetiology of Lateral Epicondylitis (LE) or Tennis Elbow. While electromyographic assessment of alterations in neuromuscular control and activation patterns of forearm muscles has received increasing interest as potential intrinsic factors in non-tennis players, there has been insufficient attention in tennis players. The purpose of present review was to search the 5 literature for the electromyographic studies of forearm muscles in tennis players in order to 1) identify related implications for LE, 2) highlight key technical and methodological shortcomings, and 3) suggest potential pathways for future research.An electronic search of PubMed, Scopus, Web of Science, and Google Scholars (1980 to October 2014) was conducted. Titles, abstracts, and full-text articles were screened to identify "peer-reviewed" 10 studies specifically looking into "electromyographic assessment of forearm muscles" in "tennis players". After screening 104 articles, 13 original articles were considered in the main review involving a total of 216 participants (78% male, 22% female). There were indications of increased extensor activity in all tennis strokes and less experiences single-handed players, however with insufficient evidence to support their relationship with the development of LE. Studies varied widely 15 in study population, sample size, gender, level of tennis skills, electrode type, forearm muscles studied, EMG recording protocol, EMG normalisation, and reported parameters. As a result, it was not possible to present combined results of existing studies and draw concrete conclusions in terms of clinical implications of findings. There is a need for establishment of specific guidelines and recommendations for EMG assessment of forearm musculature in terms of electrode and muscle 20 selection. Further studies of both healthy controls and tennis players suffering from TE with adequate sample sizes and well-defined demographics are warranted.3

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Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review

Abstract: The majority of consistent findings support the inclusion of eccentric exercise as part of a multimodal therapy programme for improved outcomes in patients with lateral epicondylitis.

Cited by 115 publications

References 31 publications

A Systematic Review to Compare Three Injection Modalities in the Management of Pain and Function for Patients with Chronic Lateral Epicondylalgia

A Systematic Review to Compare Three Injection Modalities in the Management of Pain and Function for Patients with Chronic Lateral Epicondylalgia

Effect of flexion degrees in elbow joint on muscle activation of the extensor carpi radialis and biceps brachii muscles in healthy young adults

Electromyographic assessment of forearm muscle function in tennis players with and without Lateral Epicondylitis

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