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A randomized controlled trial of exercise versus wait list in chronic tennis elbow (lateral epicondylosis)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
2011 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 116, no 4, 269-279 p.Article in journal (Refereed) Published
Abstract [en]

Background.

Chronic tennis elbow (lateral epicondylosis) is a common disorder. Like other chronic soft tissue pain conditions it is often difficult to treat successfully. The effects of exercise have been discussed but no convincing evidence has been put forward so far, and a simple protocol for exercise is lacking.

Aims of the study.

This study is a randomized, controlled, clinical trial of the effect of exercise versus expectation (wait-list) on pain, muscle strength, function, and quality of life in patients with longstanding lateral epicondylosis.

Methods.

Eighty-one subjects with tennis elbow lasting for more than three months were randomly allocated to an exercise group (n=40) or a reference group (n=41). The exercise group performed daily exercise, with weekly load increase, for three months. The reference group was wait listed, but otherwise followed in the same way. Outcome measures were pain during maximum voluntary muscle contraction (Cozen´s test) and pain during maximum muscle elongation with a load (modified Empty-can-test), muscle strength measured with a Chatillon MSE 100 hand-held dynamometer, and the Disability of the Arm, Shoulder and Hand (DASH) and the Gothenburg Quality of Life questionnaires.

Results

.The exercise group had greater and faster regression of pain, both during muscle contraction and muscle elongation, than the reference group (p=0.0005 and p=0.0016, respectively). There was a non-significant muscle strength difference between the groups, but no differences regarding DASH scores or quality of life measures.

Conclusions

.Exercise appears to be superior to expectation in reducing pain in chronic lateral epicondylosis.

Place, publisher, year, edition, pages
2011. Vol. 116, no 4, 269-279 p.
Keyword [en]
exercise, chronic, pain, tennis elbow, epicondylitis, RCT, epicondylosis, tendinosis, tendinitis
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:uu:diva-159954DOI: 10.3109/03009734.2011.600476ISI: 000296794100008OAI: oai:DiVA.org:uu-159954DiVA: diva2:447858
Available from: 2011-10-13 Created: 2011-10-12 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Chronic Tennis Elbow: Aspects on Pathogenesis and Treatment in a Soft Tissue Pain Condition
Open this publication in new window or tab >>Chronic Tennis Elbow: Aspects on Pathogenesis and Treatment in a Soft Tissue Pain Condition
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives: To study the treatment practice of chronic tennis elbow (TE) among general practitioners (GPs) and physiotherapists (PTs), the effects of a simple, graded home exercise regime versus expectation, the effects of eccentric versus concentric exercise, and the involvement of the substance P – NK1 receptor system in the peripheral, painful tissue of chronic TE patients by positron emission tomography (PET).

Materials and methods: A postal survey regarding therapeutic methods used in patients with chronic TE was sent to 129 GPs and 77 PTs, 81 subjects with chronic TE were randomly and blindly assigned to either an exercise group or a wait list group, 120 subjects were randomly assigned to either eccentric or concentric exercise and ten subjects were examined by PET and the NK1 specific radioligand [11C]GR205171.

Results: High proportions of GPs and PTs used ergonomic counselling and stretching in the treatment of chronic TE. The majority of GPs prescribed passive anti-inflammatory measures such as sick leave and anti-inflammatory medication. Many PTs prescribed dynamic, particularly eccentric, exercise. Graded dynamic exercise according to a simple low-cost protocol, has better effect on pain than a wait-and-see attitude. Adjusted for outcome affecting variables, eccentric graded exercise has quicker effect than concentric graded exercise. During PET scan with the NK1 specific radioligand [11C]GR205171, voxel volume and signal intensity of this volume was significantly higher in the affected than the unaffected arm in subjects with unilateral chronic TE.

Conclusions: GPs and PTs used many treatments to a similar extent but differed regarding the use of exercise. Chronic TE responds favourably to graded dynamic exercise aimed specifically at the painful tissue. The exercise should stress the eccentric work phase. The substance P – NK1 receptor system seems to play a part in the peripheral, painful tissue of a chronic, soft tissue pain condition such as chronic TE.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2011. 65 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 712
Keyword
tennis elbow, pain, chronic, soft tissue, imaging, PET, RCT, survey, treatment, exercise, eccentric, concentric, epicondylosis, epicondylitis, tendinosis, tendinitis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-160051 (URN)978-91-554-8187-2 (ISBN)
Public defence
2011-11-25, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Projects
Epi-X
Available from: 2011-11-03 Created: 2011-10-13 Last updated: 2011-11-10Bibliographically approved

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Peterson, MagnusButler, StephenEriksson, MargarethaSvärdsudd, Kurt

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