Progressive Strengthening and Stretching Exercises and Ultrasound for Chronic Lateral Epicondylitis

Abstract

Summary Thirty-nine patients suffering from chronic lateral epicondylitis were randomised into two treatment groups. The first group (n = 20) was treated with progressive slow, repetitive wrist and forearm stretching, muscle conditioning and occupational exercises, which were intensified in four steps. The second group (n = 19) was treated with pulsed ultrasound. The effect of six to eight weeks' treatment was measured by a pain questionnaire (visual analogue scale), isokinetic muscle performance testing of wrist and forearm, and isometric grip strength measurements. In the follow-up visit after eight weeks' treatment, pain at rest and under strain had decreased and subjective ability to work increased in the exercise group significantly more than in the ultrasound group (p = 0.004,0.04 and 0.004). Correspondingly, sleep disturbance was alleviated significantly more in the exercise group (p = 0.01). The isokinetic torque of wrist flexion increased by 45% in the exercise group and declined by 4% in the ultrasound group (p = 0.0002). Maximum isometric grip strength increased 12 % in the exercise group and remained unchanged in the ultrasound group (p = 0.05). During treatment six of eight patients in the exercise group and three of nine patients in the ultrasound group became able to work. All clinical manual provocation tests for tennis elbow improved within the exercise group. The results indicate that progressive exercise therapy is more effective than ultrasound in treating chronic lateral epicondylitis, reducing pain and improving patients' ability to work.