Eccentric exercise in the treatment of tennis elbow
Date First Published:
September 22, 2006
Last Updated:
March 22, 2007
Report by:
Michael Callaghan & Emma Wilkinson, Research Physiotherapist (Manchester Royal Infirmary)
Three-Part Question:
In [adults with lateral epicondylitis] is [eccentric exercise more beneficial than other non invasive treatments] at [decreasing pain and improving function]
Clinical Scenario:
A 31 year old male presents with a 3 month history lateral epicondylitis. You are planning to use standard treatments of electrotherapy, ICE, and exercises to improve his symptoms. You have heard from a colleague about an exercise regime based on eccentric muscle contractions and you wonder if there is any evidence of greater efficacy than the usual treatments.
Search Strategy:
MEDLINE 1966-02/07, CINAHL 1982 –02/07, AMED 1985-02/07, SPORTDiscus 1830-02/07, EMBASE 1996-02/07, via the OVID interface. Cochrane Database Feb 2007; PEDro database Feb 2007
Search Details:
MEDLINE, CINAHL, AMED, SPORTSDiscus EMBASE, the Cochrane database: [{(lateral epicondylitis.mp OR exp tendinopathy OR exp tennis elbow] AND [(exp eccentric contraction OR exp exercise OR exp therapeutic exercise OR exp physical therapy techniques or physiotherapy.mp)] LIMIT to human AND English language
Cochrane Database and PEDro database: lateral epicondylitis
Cochrane Database and PEDro database: lateral epicondylitis
Outcome:
7 papers and 1 abstract were retrieved. Only 3 papers and the abstract were relevant to the 3 part question. There is a Cochrane protocol registered but not converted to a review (Smidt 2004).
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Non-operative treatment regime including eccentric training for lateral humeral epicondyalgia. Svernlov,B. Adolfsson,L 2001 Sweden | Gp 1 (n=15) Stretching Exercise Gp 2 (n=15) Eccentric Exercise |
Pilot, RCT | 1. VAS | 1. NSS Between Gps | Main study follow on (n=129) observational only. Results @3,6,12 mths |
| 2. Self report change | 2. NSS Between Gps@ 3 – 6mth, @ 12mth all pts improved or resolved. | ||||
| 3. Grip (Kg) | 3. @ 6mth Gp 1 54.2 v Gp 2 67.9Kg (P<.05). Other test times NSS | ||||
| Treatment of recurrent tendinitis by isokinetic eccentric exercises. Croisier JL, Forthomme, B., Foidart-Dessalle,M. Godon,B, Crielaard,JM. 2001 France | N = 15 lateral epicondylitis All received Eccentric exercise |
Single group study comparing to uninjured side. | 1. Pain VAS | 1. mean decrease of 5/10 | Generally insufficient data to perform detailed analysis |
| 2. Strength | 2. torque diff between injured/uninjured side = NSS | ||||
| 3. Return to activity | 3. 13/15 subjects moderate/marked/ complete decrease in symptoms | ||||
| 4. Ultrasound scan | 4. no data available | ||||
| Adapted eccentric training in chronic lateral epicondylitis rehabilitation Croisier, Jl., Foidart,M. Crielaard,JM., Forthomme,B 2005 France | N = 76 lateral epicondylitis 2 groups of treatment Eccentric exercise v conventional physio treatment (TENS, ICE, ultrasound therapy, frictions, stretching) |
Abstract | 1. VAS | 1. After 20 treatments Eccentric group less pain than control (P < 0.01) | Abstract only. Patients assigned, not randomised. Control group had other multiple treatments No detailed results data available |
| 2. Return to offending activity | 2. Return with complete or marked relief of symptoms 74% of treatment group v 33% control group | ||||
| 3. Strength | 3. No data available | ||||
| 4. Ultrasound scan | 4. Improved tendon structure 89% treatment group v 60% control group. | ||||
| A controlled clinical pilot trial to study the effectiveness of ice as a supplement to the exercise programme for the management of lateral elbow tendinopathy Manias P, Stasinopoulos,D 2006 UK/Greece | N = 40 lateral epicondylitis Gp 1 = Eccentric Exercise Gp 2 = Ecc Exercise & ICE |
Clinical trial. Parallel group design |
1.VAS | 1. Gp 1= 8.8 – 1.9@wk4 +1.5@wk16; Gp. 2 = 8.6 - 1.7 @ Wk4 + 1.6@wk16. NSS between Gps. But within Gps p < 0.0005 | Sequential allocation not randomisation No power calculation |
Author Commentary:
There is one study in abstract form directly comparing eccentric exercise with standard physiotherapy for tennis elbow. This reveals some limited evidence of the benefit of eccentric exercise, but detailed critique cannot be made on the abstract. There is some other limited data from full papers that eccentric training is no better than either ICE and/or stretching treatments.
Bottom Line:
Present limited evidence suggests that eccentric exercise is no better than other standard physiotherapy treatments for chronic lateral epicondylitis.
References:
- Svernlov,B. Adolfsson,L. Non-operative treatment regime including eccentric training for lateral humeral epicondyalgia.
- Croisier JL, Forthomme, B., Foidart-Dessalle,M. Godon,B, Crielaard,JM.. Treatment of recurrent tendinitis by isokinetic eccentric exercises.
- Croisier, Jl., Foidart,M. Crielaard,JM., Forthomme,B. Adapted eccentric training in chronic lateral epicondylitis rehabilitation
- Manias P, Stasinopoulos,D. A controlled clinical pilot trial to study the effectiveness of ice as a supplement to the exercise programme for the management of lateral elbow tendinopathy