Exercise type in the treatment of tennis elbow
This RCT compared the effectiveness of eccentric exercise, eccentric-concentric (isotonic) and combined isotonic-isometric exercise for treatment of lateral elbow tendinopathy (LET). The results found all exercise programs reduced pain and improved function with the combined isotonic-isometric group producing the largest effect.
34 amateur tennis players with a mean age of 43 were included in the study and received 5 treatments per week for 4 weeks. In all groups 3 sets of 15 reps with 1-minute rest intervals were performed as well as wrist extensor stretching before and after treatment. The exercise start position was the elbow on the bed in full extension, forearm in pronation, wrist in an extended position and hand hanging over the edge. Eccentrics involved a count of 30 to full flexion. The combined isotonic-isometric group included a 45-second hold at the start positon. Load was increased using free weights when no pain during exercise was experienced.
Previous systematic reviews have favoured eccentrics in the management of LET. The authors hypothesized that LET is often related to forceful grip activities requiring isometric contraction, which may be more beneficial than eccentric contraction and further enhance the analgesic effect. The study’s limitations include a small sample size, no placebo group, no long-term follow-up and problems with blinding and other possible treatments the patients may have received. More research is needed to confirm these results.
> From: Stasinopoulos et al., J Hand Ther 30 (2017) 13-19. All rights reserved to Elsevier Inc. Click here for the online summary.