Lateral Epicondyle Tendinopathy Toolkit: Section D - Summary of the Evidence: Difference between revisions
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Revision as of 12:42, 1 November 2022
Original Editor - Rishika Babburu for BC Physical Therapy Tendinopathy Task Force:
Dr. Joseph Anthony, Paul Blazey, Dr. Allison Ezzat, Dr. Angela Fearon, Diana Hughes, Carol Kennedy, Dr. Alex Scott, Michael Yates and Alison Hoens
Top Contributors - Rishika Babburu, Evan Thomas, Kim Jackson, Vidya Acharya, Lucy Aird and Wanda van Niekerk
This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (1/11/2022)
PURPOSE, SCOPE & DISCLAIMER: The purpose of this document is to provide physical therapists with a summary of the evidence for interventions commonly used to manage tendinopathy of the lateral epicondyle. This decision-making tool is evidence-informed and where there is insufficient evidence, expert-informed. It is not intended to replace the clinician’s clinical reasoning skills and inter-professional collaboration.‘Acute’ refers primarily to symptoms of less than 3 months duration and ‘chronic’ to greater than 3 months. For studies which (1) included participants with symptoms that encompassed both acute and chronic stages or (2) did not clarify the duration of symptoms, the results have been reported within the ‘chronic’ stage.
Introduction[edit | edit source]
Clinicians want to provide evidence-informed management of tendinopathy but many struggle with accessing, appraising and synthesizing the vast array of literature available on this topic. This section forms part of the Lateral Epicondyle Tendinopathy toolkit project created by the BC (British Columbia) Physical Therapy Knowledge-Broker facilitated project team. The evidence below has been modified for Physiopedia and produced in collaboration with the authorship team to support the information found in the toolkit.
Abbreviations[edit | edit source]
CAT = Critically Appraised Topic | CS = Case Study | LET = Lateral Epicondyle Tendinopathy |
LLLT = Low Level Laser Therapy | MA = Meta-Analysis | MWM = Mobilization with Movement |
NR = Narrative Review | NSAID = Non-Steroidal Anti-Inflammatory Drug | OS = Observational Study |
RCT = Randomized Controlled Trial | SR = Systematic Review | SWT = Shock Wave Therapy |
US = Ultrasound | WALT = World Association of Laser Therapy | DN= DryNeedling |
EO= Expert Opinion | AP= Acupuncture |
*Numbers in parentheses in the "Clinical Research Evidence" rows represent the number of individual studies included in each review article.
Explanation of Clinical Implications[edit | edit source]
When researching treatment options it is important to consider the clinical implications. The following interventions have been reviewed and graded according to the supporting evidence. See the table below for an explanation.
Strongly consider: | High level/high quality evidence that this should be included in treatment. |
Consider: | Consistent lower level/lower quality or inconsistent evidence that this should be included in treatment. |
May consider: | No clinical evidence but expert opinion and/or plausible physiological rationale that this should be included in treatment. |
Consider NOT: | High level/high quality evidence that this should not be included in treatment. |
Manual Therapy[edit | edit source]
Manual Therapy is defined as an advanced specialty area of physical therapy practice that is based on manual examination and treatment techniques integrated with exercise, patient education, and other physical therapy modalities to address pain, loss of function, and wellness.
Elbow Joint Mobilizations - SRs[1][2][3][4][5][6][7][8][9] RCTs[10][11]EOs[12][13] | ||
---|---|---|
Stage of pathology | Acute | Chronic |
Clinical research evidence |
1 SR |
9 SR 2 RCT |
Peer-Reviewed Published Expert Opinion |
Yes |
Yes |
Take home message |
There is minimal clinical evidence to support or refute the use of elbow mobilization in the acute stage. |
There is a large amount of clinical evidence supporting the use of elbow mobilizations, (MWM and Mill’s Manipulation). Moderate effect sizes are demonstrated across all timeframes (immediate, short and long term). MWM shows favorable outcomes for pain, grip strength and function. Mill’s manipulation demonstrated effectiveness for pain but not pain free grip strength. The use of Mill’s manipulation for improved function is unclear. Some clinical evidence supports the use of radial head mobilization and neural tension techniques. There is weak support for the use of wrist-specific MWM to treat LET. |
Clinical implication |
May consider using MWM or Mill’s Manipulation in the management of acute LET. |
Strongly consider using mobilization/manipulation of the elbow, particularly MWM in the treatment of chronic LET. The effects should be apparent within the first few treatments. Effects appear to be enhanced by the addition of exercise. (See Section F for details) May consider using MWM of the wrist . |
Spinal ManipulationTechniques SRs-[14] RCTs [15][16][17][18][19][20]EO [13] | ||
Stage of pathology | Acute | Chronic |
Clinical research evidence |
1 SR |
1 SR 6 RCT |
Peer-Reviewed Published Expert Opinion |
Yes |
Yes |
Take home message |
There is minimal clinical evidence or expert opinion on the use of spinal mobilization/manipulation for patients with acute LET. |
Credible clinical evidence supports the use of cervical and thoracic mobilization/manipulation into the treatment of LET for improved pain, increased PPT, grip strength and function in the short-term. In one study a stronger effect was produced when delivered with a supportive and empathetic approach. Neuromobilization techniques (radial nerve) have been shown to have a positive effect on pain |
Clinical implication |
May consider using spinal mobilization (cervical and/or thoracic) for patients with acute LET. |
Consider using cervical/thoracic mobilization/manipulation/ neuromobilization techniques in those with cervical and/or thoracic signs even if they do not report spinal symptoms in addition to local treatment to the elbow including exercise. (See Section F for details) |
Stage of pathology | Acute | Chronic |
Clinical research evidence |
1 SR |
2 SR 3 RCT |
Peer-Reviewed Published Expert Opinion |
Yes |
Yes |
Take home message |
Limited clinical evidence supports the use of soft tissue techniques as a stand alone treatment. |
There is weak clinical evidence to support the use of soft tissue techniques such as frictions, in combination with other treatment modalities. Note: most of the studies which examined the effect of frictions included the use of Mill’s manipulation +/- exercise. |
Clinical implication |
May consider using deep and superficial massage for immediate pain relieving effect in acute LET. |
May consider using soft tissue techniques (such as deep transverse friction massage) as part of a multimodal treatment regime for chronic LET. (See Section F for details) |
Exercise[edit | edit source]
Exercise is a physical activity that is planned and is performed with the goal of attaining or maintaining physical fitness. A proper rehabilitation program involves exercise prescription which must be both relevant and effective. The currently available evidence is mentioned in the table below.
Exercise | ||
---|---|---|
Stage of pathology | Acute | Chronic |
Clinical research evidence |
1 N-RCT |
4 SR 4 RCT |
Peer-Reviewed Published Expert Opinion |
Yes |
Yes |
Take home message |
There is a small amount of clinical evidence to support the use of exercise (strength, stretching, general fitness) in the acute stage |
There is a large amount of clinical evidence to support the use of exercise (strengthening and stretching) in the chronic stage. Almost all exercise studies showed improvement whether it was concentric, eccentric or isometric strengthening. While there is some evidence that commencing with eccentric exercises may provide superior pain relief, providing an exercise that the patient can tolerate (isometric, concentric or eccentric) is likely more important than the type of exercise. There is some evidence that stretching may provide pain relief. There is mixed evidence that in-person sessions or supervised home exercise programs are superior to unsupervised programs in providing positive outcomes. |
Clinical implication |
May consider using exercise in the management of acute LET |
Strongly consider using local and upper limb kinetic chain exercise in the chronic stage as per clinical assessment findings. No single type of exercise appears to be superior to another for LET rehab May consider the use of pain-free as opposed to painful exercise interventions in more irritable or severe cases. |
SRs [26][27][28][29]RCTs[30][31][32][33]Non-RCTs[34]EO[13][35]
Acupuncture[edit | edit source]
Definition of acupuncture: May include Traditional Chinese Medicine approach, or Western medical-anatomical approach for acupoint selection. AP is differentiated from Dry Needling, although the same fine filament needle is employed, and there may be areas of crossover in point selection and technique.
Acupuncture aims to restore the homeostatic balance by the insertion of fine acupuncture needles that influences the flow of Qi (pronouced as chee).Conventional acupuncture involves the use of single-use, pre-sterilised disposable needles of varying widths, lengths and materials that pierce the skin at the acupuncture points. Trigger point acupuncture may also be used to facilitate relaxation in specific muscles following traumas, for longer-term unresolved muscle pain, or as a means of increasing muscle length in order to aid stretch and rehabilitation.
Acupuncture[36] | ||
---|---|---|
Stage of pathology | Acute | Chronic |
Clinical research evidence |
1 SR |
3 SRs 1 RCT |
Peer-Reviewed Published Expert Opinion |
No |
Yes |
Take home message |
There are a lack of studies to support Acupuncture specifically with acute lateral epicondyle tendinopathy. What does exist is weak and inconclusive. What evidence does exist suggests benefits offered are for pain specifically. |
Available evidence focuses on a Western Acupuncture approach for the diagnosis and treatment of LET. Study designs are heterogeneous with no consistency on acu-point selection or technique. Acupuncture is suggested as efficacious at reducing pain. All follow-ups were in the short term, with no description of benefit for lasting effect. |
Clinical implication |
May consider acupuncture in acute LET for short term pain improvement |
May consider acupuncture for short-term pain management in patients with chronic LET |
DryNeedling[edit | edit source]
Definition of dry needling: Intervention using thin filament needles to penetrate the skin that stimulates myofascial trigger points (MTrP), muscular, neural and connective tissue for management of neuromusculoskeletal disorders.
Stage of
pathology |
Acute | Chronic | |||
---|---|---|---|---|---|
Clinical
research evidence |
1 other | 1 SR | |||
Peer-
Reviewed Published Expert Opinion |
Yes | Yes | |||
Take home
message |
Lack of studies identified
that are explicit to acute LET. There is physiological rationale for delaying DN in the inflammatory phase of injury if the tissue irritability is high. |
Clinical evidence provides low-moderate support for the use of
DN for short-term benefits for pain, function and grip strength. | |||
Clinical
implication |
May consider DN in acute LET
for short term benefit of pain and function. |
May consider DN in chronic LET for short term benefit
of pain, function and grip strength. |
Low Level Laser Therapy (LLLT)[edit | edit source]
Light Amplification by Stimulated Emission of Radiation is abbreviated as LASER. Low Level Laser Therapy (LLLT) is a non-invasive light source treatment that generates a single wavelength of light. It is believed to affect the function of connective tissue cells by accelerating repair and reducing inflammation.
Stage of pathology | Acute | Chronic |
---|---|---|
Clinical research evidence |
3 RCT |
8 SR 3 RCT |
Peer-Reviewed Published Expert Opinion |
Yes |
Yes |
Take home message |
Laser at 905 nm may be effective when used in accordance with the WALT guidelines, with some studies showing benefit when used in combination with exercise. |
Laser at 904 nm and possibly 832 nm or 830 nm may be effective when used in accordance with the WALT guidelines. Many of the studies demonstrate efficacy when used in combination with other treatments. Dosage is essential to effective treatment. |
Clinical implication |
Consider using laser (LLLT) at 905 nm with dosage as recommended by WALT guidelines. (See Section G for details for details) |
Consider using laser (LLLT) at 904 nm with dosage as recommended by WALT guidelines. (See Section G for details) |
SRs[2][3][43][44][45][7][46][47]RCTs [48][49][50][51][52][53][54][55]EO[13]
High intensity laser (class IV)[edit | edit source]
State
of Pathology |
Acute | Chronic |
---|---|---|
Clinical
research evidence |
3 RCT | |
Peer-
Reviewed Published Expert Opinion |
No | |
Take home
message |
Lack of studies identified
that are explicit to acute lateral epicondyle tendinopathy |
Class IV Laser (12W, 1,064 nm) at 100 - 150J per treatment
may be effectivein reducing pain, increasing hand grip strength and improving QDASH score. |
Clinical
implication |
No Recommendation | Consider using HILT with dosage as
recommended. 9 or 10 treatments over 3 weeks. |
Ultrasound (US)[edit | edit source]
Ultrasound is a form of mechanical energy . The normal human sound range is from 16 Hz to something approaching 15-20,000 Hz (in children and young adults). The frequencies used in Ultrasound therapy are typically between 1.0 and 3.0 MHz (1 MHz = 1 million cycles per second).US therapy helps in tissue healing, speed the rate of healing & enhance the quality of the repair.
In thermal mode, US will be most effective in heating the dense collagenous tissues and will require high intensity, preferably in continuous mode. The non‑thermal effects of US are attributed primarily to a combination of and acoustic streaming.
Stage of pathology | Acute | Chronic |
---|---|---|
Clinical research evidence |
2 RCT |
6 SR 8 RCT |
Peer-Reviewed Published Expert Opinion |
--- |
--- |
Take home message |
Weak evidence exists to support the effectiveness of US in the management of acute LET. 1 MHz or 3 MHz, 0.5 – 1.0 W/cm2 5-10 minutes (pulsed 1:2-1:4 suggested). |
Weak evidence for effectiveness of US in the management of chronic LET. 1 MHz or 3 MHz, 1.0 – 2.0 W/cm2 5-12 minutes.
|
Clinical implication |
May consider using US in the management of acute LET. |
May consider using US in the management of chronic LET. |
Extracorporeal Shock Wave Therapy (SWT)*: Focused and Radial[edit | edit source]
Shockwaves are sound waves that have specific physical characteristics, including nonlinearity, high peak pressure followed by low tensile amplitude, short rise time, and short duration (10 ms). They have a single pulse, a wide frequency range (0-20 MHz), and a high pressure amplitude (0-120 MPa).These characteristics produce a positive and negative phase of shockwave. The positive phase produces direct mechanical forces, whereas the negative phase generates cavitation and gas bubbles that subsequently implode at high speeds, generating a second wave of shockwaves. Therapeutic ultrasound utilises high frequency sound waves, while SWT utilises lower frequency waves.
Stage of pathology | Acute | Chronic |
---|---|---|
Clinical research evidence |
2 RCT |
5 SR 2 RCT 1 other |
Peer-Reviewed Published Expert Opinion |
--- |
--- |
Take home message |
There is a small amount of support for the use of SWT in the acute phase. In the acute phase, physiological rationale suggests SWT may be effective for short term pain modulation |
SWT is a treatment option for chronic LET that has failed to respond to other physical interventions. Dosage may be arbitrarily categorized as low energy <0.2 mJ/mm2 (approx. 4 Bars max); high energy >0.2 mJ/mm2. Low energy protocols apply to both radial and focused SWT devices and may be better tolerated with outcomes similar to high energy focused devices. Systematic reviews with meta-analyses of SWT have pooled heterogeneous study designs. As a result, the evidence remains conflicting regarding the effectiveness of SWT for LET. |
Clinical implication |
May Consider using SWT for acute LET for short term pain modulation. |
Consider using radial or focused, low energy SWT for chronic LET for subjects that have failed to respond to other conservative treatment. Dosage intensity should be based on patient tolerance.
0.06-0.2 mJ/mm2 (approx. 1-4 Bars) 4-20 Hz 1500-2500 shocks 3-5 weekly sessions
|
*Electric generation of SWT is measured as Energy Flux Density (EFD) in mJ/mm²; Pneumatic (pulsed-pressure) SWT is measured in Bars.
Iontophoresis[edit | edit source]
Stage of pathology | Acute | Chronic |
---|---|---|
Clinical research evidence |
1 RCT |
1 SR |
Peer-Reviewed Published Expert Opinion |
--- |
--- |
Take home message |
Single study supports the delivery of corticosteroid (Dexamethasone) by iontophoresis to treat acute lateral elbow pain for short term pain reduction, allowing the subject to participate in an earlier increase in exercise activity or return to work. Iontophoresis may have advantages over injection (less pain, decreased trophic changes in tissue), but may not be as cost effective. |
Evidence regarding the potential efficacy for chronic LE of iontophoresis (with dexamethasone, prednisolone, diclofenac, lidocaine or salicylate) is insufficient to base a clinical recommendation. |
Clinical implication |
Consider a trial of iontophoresis with Dexamethasone for short-term pain control for acute LET. Recommended dosage: 0.4% Dexamethasone Sodium Phosphate (aqueous) 40-80 mA-min 4-6 sessions, alternate days **Physician prescription required. |
No Recommendation |
Orthotic Devices[edit | edit source]
Orthotic Device is externally applied device used to compensate for impairments of the structure and function of the neuro-muscular and skeletal systems. Elbow Orthosis encompasses the elbow joint.[56] Orthotic Devices such as Braces, sleeves or splints are used in rehabilitation of lateral epicondyle tendinopathy.
Stage of pathology | Acute | Chronic |
---|---|---|
Clinical research evidence |
2 SR |
2 SR |
Peer-Reviewed Published Expert Opinion |
--- |
--- |
Take home message |
There is weak evidence (1SR) that orthotic devices (brace, sleeve or splint) may reduce immediate pain compared to placebo. There is weak evidence (1SR) that a counterforce brace may reduce pain in the short term (<6 weeks). |
A placebo-controlled RCT showed that addition of a counterforce brace to exercise-based rehabilitation may result in improved pain and function in the short and long terms. |
Clinical implication |
May consider the use of an orthotic for patients with LET. Counterforce braces appear to offer some benefit, especially in the early phase of rehabilitation. |
May consider the use of an orthotic for patients with LET. Counterforce braces appear to offer some benefit, especially in the early phase of rehabilitation. |
Taping[edit | edit source]
Taping is used as one of the means of rehabilitation or prophylaxis in instances where support and stability are needed, as a first-aid tool, for the prevention of injury and protection of an injured anatomical structure while healing is taking place.
TAPING | ||
---|---|---|
Stage of pathology | Acute | Chronic |
Clinical research evidence |
--- |
2 RCT 1 N-RCT |
Peer-Reviewed Published Expert Opinion |
Yes |
Yes |
Take home message |
--- |
Two placebo controlled trials, and two experimental studies have demonstrated efficacy of taping for providing immediate pain relief. Taping has not been consistently shown to benefit strength. Studies have often been conducted alongside an exercise intervention. |
Clinical implication |
May consider taping as an adjunct to other treatments in the acute management of LE. |
Consider a trial of taping for patients with chronic LET to reduce pain. |
Resources[edit | edit source]
- Lateral Epicondyle Tendinopathy Toolkit page
- Section B - Clinical Assessment of LET
- Section C - Outcome Measures
- Section D - Summary of the Evidence
- Section E - Exercise Prescription
- Section G - LASER Dosage Calculation
- Section F - Manual Therapy
- UBC Lateral Epicondyle Tendinopathy (LET) Toolkit
References[edit | edit source]
- ↑ Smidt N. et al. Effectiveness of physiotherapy for lateral epicondylitis: a systematic review. Annals of Medicine. 2003; 35(1): 51-62.
- ↑ 2.0 2.1 Trudel D, et al. Rehabilitation for patients with lateral epicondylitis: a systematic review. Journal of Hand Therapy. 2004 ; 17(2): 243-266
- ↑ 3.0 3.1 Bisset L, Paungmali A, Vicenzino B, et al. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. British Journal of Sports Medicine. 2005; 39, 411-422.
- ↑ Herd CR, Meserve BB. A systematic review of the effectiveness of manipulative therapy in treating lateral epicondylalgia. Journal of Manual & Manipulative Therapy. 2008; 16(4): 225-237
- ↑ Barr S, Cerisola F, Blanchard V. Effectiveness of corticosteroid injections compared with physiotherapeutic interventions for lateral epicondylitis: A systematic review. Physiotherapy. Dec 2009; 95(4): 251-265.
- ↑ Pagorek S. Effect of manual mobilization with movement on pain and strength in adults with chronic lateral epicondylitis. Journal of Sport Rehabilitation. 2009; 18(3): 448-457.
- ↑ 7.0 7.1 Bisset L, Coombes B, Vicenzino B. Tennis elbow. BMJ Clin Evid. 2011 Jun 27;2011:1117.
- ↑ Hoogvliet, P., et al. Does Effectiveness of Exercise Therapy and Mobilisation Techniques Offer Guidance for the Treatment of Lateral and Medial Epicondylitis? A Systematic Review. British Journal of Sports Medicine 47.17 (2013): 1112.
- ↑ Locado A. et al. Do joint mobilizations assist in the recovery of lateral elbow tendinopathy? A systematic review and meta-analysis. Journal of Hand Therapy. 2019; 32: 262-276.
- ↑ Reyhan A., Sindel D., Dereli E. The effects of Mulligan’s mobilization with movement technique in patients with lateral epicondylitis. Journal of Back and Musculoskeletal Rehabilitation. 2020; 33: 99–107.
- ↑ Struijs, PAA, et al. Manipulation of the wrist for management of lateral epicondylitis: A randomized pilot study. Physical Therapy. July 2003; 83(7): 608-616.
- ↑ Vicenzino B, Teys PA. Mulligan's mobilization-with-movement, positional faults and pain relief: Current concepts from a critical review of literature. Manual Therapy. 2007; (12): 98-108.
- ↑ 13.0 13.1 13.2 13.3 Bisset, LM, and B. Vicenzino. Physiotherapy Management of Lateral Epicondylalgia. Journal of Physiotherapy 61.4 (2015): 174-81
- ↑ Hoogvliet, P., et al. Does Effectiveness of Exercise Therapy and Mobilisation Techniques Offer Guidance for the Treatment of Lateral and Medial Epicondylitis? A Systematic Review. British Journal of Sports Medicine 47.17 (2013): 1112
- ↑ Cleland JA, Flynn TW, Palmer JA. Incorporation of manual therapy directed at the cervicothoracic spine in patients with lateral epicondylalgia: a pilot clinical trial. Journal of Manual & Manipulative Therapy. 2005; 13(3): 143-151.
- ↑ Fernández-Carnero J, Fernández-De-Las-Peñas C, et al. Immediate hypoalgesic and motor effects after a single cervical manipulation in subjects with lateral epicondylalgia. Journal of Manual & Manipulative Therapy. 2008; 31(9): 675-681.
- ↑ Fernández-Carnero J, Cleland A. Examination of motor and hypoalgesic effects of cervical vs. thoracic spine manipulation in patients with lateral epicondylalgia: A clinical trial. Journal of Manual & Manipulative Therapy. 2011; 34(7): 432-440
- ↑ Kucuksen, S., et al. Muscle Energy Technique Versus Corticosteroid Injection for Management of Chronic Lateral Epicondylitis: Randomized Controlled Trial with 1-Year Follow-Up. Archives of Physical Medicine and Rehabilitation 94.11 (2013): 2068-74
- ↑ Muhsen A. et al. The Association Between Conditioned Pain Modulation and Manipulation-induced Analgesia in People With Lateral Epicondylalgia. Clin J Pain. 2019; 35: 435–442
- ↑ Yilmaz K. et al. Investigating the effects of neuromobilization in lateral epicondylitis. Journal of Hand Therapy; 2020. Volume 35 (1), 97 - 106
- ↑ Loew LM, Brosseau L, Tugwell P, Wells GA, Welch V, Shea B, Poitras S, De Angelis G, Rahman P. Deep transverse friction massage for treating lateral elbow or lateral knee tendinitis. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD003528.
- ↑ Joseph M, Taft J, et al. Deep friction massage for the treatment of tendinopathy: A systematic review of a classic treatment in the face of a new paradigm of understanding. Journal of Sports Rehabilitation. 2012; 21: 343-353
- ↑ Law LAF, et al. Massage reduces pain perception and hyperalgesia in experimental muscle pain: A randomized, controlled trial. Journal of Pain. Aug 2008; 9(8): 714-721
- ↑ Ajimsha, MS, Chithra, S, Thulasyammal, RP. Effectiveness of Myofascial Release in the Management of Lateral Epicondylitis in Computer Professionals. Archives of Physical Medicine & Rehabilitation. 2012; 93(4): 604-609.
- ↑ López-de-Celis et al. Effectiveness of diacutaneous fibrolysis for the treatment of chronic lateral epicondylalgia: a randomized clinical trial. Clinical Rehabilitation. 2018; 32(5): 644–653.
- ↑ Raman J, MacDermid J, Grewal R. Effectiveness of Different Methods of Resistance Exercises in Lateral Epicondylosis—A Systematic Review. Journal of Hand Therapy. Jan-Mar 2012; 25(1): 5-26.
- ↑ Cullinane, Frances L., Mark G. Boocock, and Fiona C. Trevelyan. Is Eccentric Exercise an Effective Treatment for Lateral Epicondylitis? A Systematic Review. Clinical Rehabilitation. 28.1 (2014;2013;): 3-19.
- ↑ Chen Z, Baker NA. Effectiveness of eccentric strengthening in the treatment of lateral elbow tendinopathy: A systematic review with meta-analysis. Journal of Hand Therapy. 2021 Jan 1;34(1):18-28
- ↑ Menta R, Randhawa K, Côté P, Wong JJ, Yu H, Sutton D, Varatharajan S, Southerst D, D'Angelo K, Cox J, Brown C. The effectiveness of exercise for the management of musculoskeletal disorders and injuries of the elbow, forearm, wrist, and hand: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration. Journal of manipulative and physiological therapeutics. 2015 Sep 1;38(7):507-20
- ↑ Peterson M, Butler S, Eriksson M, Svardsudd K. A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis). Uppsala Journal of Medical Science. 2011; 116: 269-279.
- ↑ Anitha A, Prachi G. Effectiveness of Eccentric Strengthening of Wrist Extensors along with Conventional Therapy in Patients with Lateral Epicondylitis. Research Journal of Pharmacy and Technology. 2018 Dec 1;11(12):5340-4.
- ↑ Coombes BK, Wiebusch M, Heales L, Stephenson A, Vicenzino B. Isometric exercise above but not below an individual’s pain threshold influences pain perception in people with lateral epicondylalgia. The Clinical journal of pain. 2016 Dec 1;32(12):1069-75
- ↑ Vuvan V, Vicenzino B, Mellor R, Heales LJ, Coombes BK. Unsupervised Isometric Exercise versus Wait-and-See for Lateral Elbow Tendinopathy. Medicine and science in sports and exercise. 2020 Feb 1;5
- ↑ Lee, S., Y. Ko, and W. Lee. Changes in Pain, Dysfunction, and Grip Strength of Patients with Acute Lateral Epicondylitis Caused by Frequency of Physical Therapy: A Randomized Controlled Trial. Journal of Physical Therapy Science 26.7 (2014): 1037-40
- ↑ Day, JM, Lucado, AM, Uhl, TL., A comprehensive rehabilitation program for treating lateral elbow tendinopathy. International Journal of Sports Physical Therapy, 2019: 14 (5), 818-834
- ↑ 36.0 36.1 Cox J, Varatharajan S, Côté P, et al. Effectiveness of Acupuncture Therapies to Manage Musculoskeletal Disorders of the Extremities: A Systematic Review.JOSPT. 2016 46:6, 409-429
- ↑ Tang H, et al. Acupuncture for lateral epicondylitis: A systematic review. Evidence-Based Complementary and Alternative Medicine. 2015. Article ID 861849:1-13.
- ↑ Martin C. Acupuncture as a treatment for chronic pain from epicondylitis: a rapid systematic review. WorkSafeBC Evidence-based Practice Group. 2019.
- ↑ Zhou Y, et al. Effectiveness of Acupuncture for lateral epicondylitis: A systematic review and meta-analysis of randomized controlled trials. Pain Research and Management. 2020. Article ID 8506591:1-10.
- ↑ Gadau M, et al. A multi-center international study of acupuncture for lateral elbow pain: Results of a randomized controlled trial. Eur J Pain. 2020. 24:1458-1470.
- ↑ Navarro-Santana M, et al. Effects of trigger point dry needling on lateral epicondylalgia of musculoskeletal origin: a systematic review and meta-analysis. Clinical Rehab. 2020. 34(11):1327-1340.
- ↑ Hadi, D. Functional and pain improvement in tennis elbow with dry needling as alternative treatment: case series. touchREVIEWS in Neurology. 2021;17(1):60-3
- ↑ Bjordal J M, Lopes-Martins R A B, Joense J, et al. A systematic review with procedural assessments and meta-analysis of Low Level Laser Therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskeletal Disorders. 2008; 9(75)
- ↑ Chang W-D, Wu J-H, Yang W-J, et al. Therapeutic effects of low-level laser on lateral epicondylitis from differential interventions of Chinese-Western medicine: systematic review. Photomedicine and Laser Surgery. 2010; 28(3): 327-336.
- ↑ Tumilty S, Munn J, McDonough S, et aL. Low level laser treatment of tendinopathy: a systematic review with meta-analysis. Photomedicine and Laser Surgery. 2010; 28(1): 3-16.
- ↑ Dingemanse, R., et al. Evidence for the Effectiveness of Electrophysical Modalities for Treatment of Medial and Lateral Epicondylitis: A Systematic Review. British Journal of Sports Medicine 48.12 (2014): 957
- ↑ Mamais, I., Papadopoulos, K., Lamnisos, D., et al. Effectiveness of Low Level Laser Therapy (LLLT) in the treatment of Lateral elbow tendinopathy (LET): an umbrella review. Laser therapy. 2018. 27(3), 174-186.
- ↑ Stasinopoulos D, Stasinopoulos I, Pantelis M, et al. Comparing the effects of exercise program and low-level laser therapy with exercise program and polarized polychromatic non-coherent light (bioptron light) on the treatment of lateral elbow tendinopathy. Photomedicine and Laser Surgery. 2009; 27(3): 513-520.
- ↑ Emanet S K, Altan L I, & Yurtkuran M. Investigation of the effect of GaAs laser therapy on lateral epicondylitis. Photomedicine and Laser Surgery. 2010; 28(3): 397-403.
- ↑ Skorupska E, Lisinski P, & Samborski W. The effectiveness of the conservative versus myofascial pain physiotherapy in tennis elbow patients: Double-blind randomized trial of 80 patients. Journal of Musculoskeletal Pain. 2012; 20(1): 41-50.
- ↑ Roberts, DB., Kruse., RJ., Stoll, SF. The Effectiveness of Therapeutic Class IV (10 W) Laser Treatment for Epicondylitis. Lasers in Surgery and Medicine. 2013. 45.5: 311-7.
- ↑ Dundar, U., et al. Effectiveness of High-Intensity Laser Therapy and Splinting in Lateral Epicondylitis; a Prospective, Randomized, Controlled Study. Lasers in medical science 30.3 (2015): 1097-107
- ↑ Akkurt, E., Kucuksen, S., Yılmaz, H., et al. Long term effects of high intensity laser therapy in lateral epicondylitis patients. Lasers in medical science. 2016. 31(2), 249-253
- ↑ Salli A, Akkurt E, Izki AA, et al. Comparison of High Intensity Laser and Epicondylitis Bandage in the Treatment of Lateral Epicondylitis. Arch Rheumatol. 2016;31(3):234-238
- ↑ Kaydok, E., Ordahan, B., Solum, S., et al. Short-term efficacy comparison of high-intensity and low-intensity laser therapy in the treatment of lateral epicondylitis: a randomized double-blind clinical study. Archives of Rheumatology, 2020. 35(1), 60.
- ↑ "Prosthetics and orthotics". iso.org. International Organization for Standardization.