Efficacy of physical therapy for the treatment of lateral epicondylitis: a meta-analysis.

Christoph Weber,Veronika Thai,Oliver Christ,Katharina Groover,Katrin Neuheuser

doi:10.1186/s12891-015-0665-4

Abstract

BackgroundPhysical therapy for the treatment of lateral epicondylitis (LE) often comprises movement therapies, extracorporeal shockwave therapy (ECSWT), low level laser therapy (LLLT), low frequency electrical stimulation or pulsed electromagnetic fields. Still, only ECSWT and LLLT have been meta-analytically researched.MethodsPUBMED, EMBASE and Cochrane database were systematically searched for randomized controlled trials (RCTs). Methodological quality of each study was rated with an adapted version of the Scottish Intercollegiate Guidelines Network (SIGN) checklist. Pain reduction (the difference between treatment and control groups at the end of trials) and pain relief (the change in pain from baseline to the end of trials) were calculated with mean differences (MD) and 95 %-Confidence intervals (95 % CI).ResultsOne thousand one hundred thirty eight studies were identified. One thousand seventy of those did not meet inclusion criteria. After full articles were retrieved 16 studies met inclusion criteria and 12 studies reported comparable outcome variables. Analyses were conducted for overall pain relief, pain relief during maximum handgrip strength tests, and maximum handgrip strength. There were not enough studies to conduct an analysis of physical function or other outcome variables.ConclusionsDifferences between treatment and control groups were larger than differences between treatments. Control group gains were 50 to 66 % as high as treatment group gains. Still, only treatment groups with their combination of therapy specific and non-therapy specific factors reliably met criteria for clinical relevance. Results are discussed with respect to stability and their potential meaning for the use of non-therapy specific agents to optimize patients’ gain.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0665-4) contains supplementary material, which is available to authorized users.

Highlights

Physical therapy for the treatment of lateral epicondylitis (LE) often comprises movement therapies, extracorporeal shockwave therapy (ECSWT), low level laser therapy (LLLT), low frequency electrical stimulation or pulsed electromagnetic fields
The aim of this study was to meta-analyse the empirical evidence for physical treatments for LE and give practitioners an estimate of what benefits patients might expect from various treatments, both based on treatment specific and non-specific agents
The remaining nine studies were included in the analysis; three investigated LLLT, four ECSWT, one low frequency electrical stimulation and one pulsed electromagnetic field therapy (PEMF)

Summary

Introduction

Physical therapy for the treatment of lateral epicondylitis (LE) often comprises movement therapies, extracorporeal shockwave therapy (ECSWT), low level laser therapy (LLLT), low frequency electrical stimulation or pulsed electromagnetic fields. Only ECSWT and LLLT have been meta-analytically researched. The injury of the common extensor tendon originating from the lateral epicondyle is better known as tennis elbow. Both names are misleading though, since it is neither an inflammatory condition, nor does it only occur in tennis players. Other sports and jobs involving highly repetitive movements are strong contributors to the overuse-injury. It mostly affects people 40 years and older.

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