Physiotherapy treatment of lateral epicondylitis: A systematic review

Abstract

BACKGROUND: Lateral epicondylitis is a tendinopathy with a prevalence of between 1–3% of the population aged 35–54 years. It is a pathology with a favorable evolution, but with frequent recurrences (which imply an economic extra cost). OBJECTIVE: The objective of this review was to determine the efficacy of physiotherapy treatment for the treatment of epicondylitis and, if any, to identify the most appropriate techniques. METHODS: A systematic search was carried out in October 2020 in the databases of PubMed, Cinahl, Scopus, Medline and Web of Science using the search terms: Physical therapy modalities, Physical and rehabilitation medicine, Rehabilitation, Tennis elbow and Elbow tendinopathy. RESULTS: Nineteen articles were found, of which seven applied shock waves, three applied orthoses, three applied different manual therapy techniques, two applied some kind of bandage, one applied therapeutic exercise, one applied diacutaneous fibrolysis, one applied high intensity laser, and one applied vibration. CONCLUSIONS: Manual therapy and eccentric strength training are the two physiotherapeutic treatment methods that have the greatest beneficial effects, and, furthermore, their cost-benefit ratio is very favorable. Its complementation with other techniques, such as shock waves, bandages or Kinesio® taping, among others, facilitates the achievement of therapeutic objectives, but entails an added cost.

Effectiveness of High-Intensity Laser Therapy Plus Ultrasound-Guided Peritendinous Hyaluronic Acid Compared to Therapeutic Exercise for Patients with Lateral Elbow Tendinopathy

“…When patients were able to perform the eccentric exercises without experiencing any pain or discomfort, the load was increased using free weights or therabands. The starting and final positions of eccentric exercises, the increase in the load, and the degree of mild or disabling pain could not be standardized but were tailored to each patient [ 11 ]. The static stretching exercises for LET were performed slowly with the elbow in extension, forearm in pronation, wrist in flexion, and ulnar deviation according to the patient’s tolerance to achieve the best stretching position result for the ECRB tendon.…”

“…The static stretching exercises for LET were performed slowly with the elbow in extension, forearm in pronation, wrist in flexion, and ulnar deviation according to the patient’s tolerance to achieve the best stretching position result for the ECRB tendon. This position was held for 30–45 s before and after each set of eccentric exercises [ 11 ].…”

“…However, no consensus about the best treatment for improving pain and function in people with LET has been reached. Among rehabilitative approaches, manual therapy and TE showed positive effects on people with LET in terms of pain relief and increased tendon strength [ 11 , 12 ]. Among physical modalities commonly used for LET, laser therapy was previously demonstrated to improve grip strength, pain, and functional ability at midterm follow-up (5 to 26 weeks) compared to placebo [ 8 ].…”

Clinical and radiological effects of Corticosteroid injection combined with deep transverse friction massage and Mill’s manipulation in lateral epicondylalgia–A prospective, randomized, single-blinded, sham controlled trial

“…A clinical commentary by Vicenzino B et al found evidence for the use of elbow manipulation and therapeutic exercise for LE on a short-term basis [ 9 ]. Manual therapy and eccentric strength training are the two physiotherapeutic treatment methods that have the greatest beneficial effects in treating LE [ 10 ]. In manual therapy both Cyriax approach (Deep transverse friction massage with Mill’s manipulation) and Mulligan mobilization with movement (MWM) decreased pain and improved functional status in lateral epicondylitis patients [ 11 ].…”

Comparison between acupotomy and corticosteroid injection for patients diagnosed with different classifications of tennis elbow: a randomized control trial

“…Some experts suggested that corticosteroid injection should not be used to treat most patients with tennis elbow who exhibit a symptom duration of less than 12 months and that this approach might be less beneficial to the long-term outcomes of the patient [11]. In the long term, physiotherapy became the best option, followed by a wait-and-see policy, but the recovery period was still long [12]. While Houck et al reported that autologous blood and platelet-rich plasma are effective treatments in the intermediate term [13].…”