Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis?
Epicondylitis is most commonly seen elbow problems in adults, can be occuring both laterally and medially, characterized by pathologic changes in the musculotendinosus origins and caused by mostly overuse activities. For treatment; therapeutic modalities as exercises such as stretching and eccentric loading and mobilisation are considered. The objective of this review was to assess the evidence for effectiveness of exercise therapy and mobilisation techniques for both medial and lateral epicondylitis.
One review and 12 RCTs, all studying lateral epicondylitis, were included. Different therapeutic regimes were evaluated: stretching, strengthening, concentric/eccentric exercises and manipulation of the cervical or thoracic spine, elbow or wrist.
Moderate evidence for the short-term effectiveness was found in favour of stretching plus strengthening exercises versus ultrasound plus friction massage. Moderate evidence for short-term and mid-term effectiveness was found for the manipulation of the cervical and thoracic spine as add-on therapy to concentric and eccentric stretching plus mobilisation of wrist and forearm. For all other interventions only limited, conflicting or no evidence was found.
Although not yet conclusive, these results support the belief that strength training decreases symptoms in tendinosis. The short-term analgesic effect of manipulation techniques may allow more vigorous stretching and strengthening exercises resulting in a better and faster recovery process of the affected tendon in lateral epicondylitis. > From: Hoogvliet, et al., Br J Sports Med (2013) (Epub ahead of print). All rights reserved to BMJ Publishing Group Ltd.
The Pubmed summary of the article can be found here.
In the YouTube clip a dissection of the forearm and hand can be viewed.