Abstract
BackgroundIn painful epicondylitis, previous studies reported deficiencies in elbow proprioception. In line, proprioceptive training of the lower limb has been reported substantial beneficial in a number of indications. Therefore, we have asked if a specified proprioceptive training using training devices that are capable of activating the deep musculature in the upper limb is able to reduce the symptoms of epicondylitis.Materials and methodsWe included 71 patients with painful lateral epicondylitis > 3 months. Interventions: Group A: Proprioceptive training intervention with a Flexibar® (9 min daily for 12 weeks). Group B: at least 40 min running or walking/week with the XCO® in addition to the proprioceptive training with the Flexibar® (9 min daily for 12 weeks), follow-up for 12 weeks. Primary end point: Pain on visual analogue scale (VAS, 0-10); secondary end points: DASH-Score (0 = very good, 100 = very poor), grip strength according to Jamar dynamometer (kg), vibration sensation measured with a 128 Hz tuning fork.ResultsThe pain on VAS in group A was reduced significantly. 3.6 ± 2.0 to 2.4 ± 2.1 (−33%, p = 0.013), and from 3.7 ± 2.4 to 2.2 ± 1.9 (−41%, p = 0.004) in group B after 12 weeks. There was no significant difference between A and B (p = 0.899). In both groups, there was a significant improvement of the DASH-Score (A: 32 ± 15 to 14 ± 12, −56%, p < 0.001; B: 27 ± 12 to 12 ± 11, −55%, p = 0.001) without any difference between groups A and B (p = 0.339). Grip strength improvement in group A from 24 ± 12 to 33 ± 11 kg (+38%, p < 0.001), and from 29 ± 14 to 34 ± 11 kg (+15%, p < 0.001) in group B. In line, vibration sensation improved in both groups (A: 6.3 ± 0.6 to 6.5 ± 0.5, p = 0.0001; B: 6.3 ± 0.7 to 6.6 ± 0.5, p = 0.003).ConclusionA 12-week proprioceptive training with the Flexibar® improves pain, quality of life, grip strength and vibration sensation in patients with painful lateral epicondylitis.Level of evidenceIb, randomised clinical trialTrial registrationGerman Clinical Trials Register, DRKS00024857, registered on 25 March 2021—retrospectively registered, http://apps.who.int/trialsearch/
Highlights
In painful epicondylitis, previous studies reported deficiencies in elbow proprioception
This includes an evaluation of 108 patients to verify clinically the existence of a lateral epicondylitis by medical history as well as performing significant clinical tests
Primary goal parameter Course of pain on the visual analogue scale (VAS 0-10) In ‘Group A’ (Flexibar®), there was a reduction of pain from 3.6 ± 2.0 to 2.4 ± 2.1, which is corresponding with a decrease of 1.2 ± 2.5 points on the pain scale and a p value of p = 0.013
Summary
Previous studies reported deficiencies in elbow proprioception. Even though the aetiology of the disease has still not been fully identified and it seems to be determined multifactorially, a number of studies have shown that there are various risk factors, for example, repetitive movements, forceful work or activities which require an unnatural posture of hands and arms [3, 4]. Such stresses cannot only be found amongst active tennis players and within a lot of professional activities, so that only a small part of the patients with lateral epicondylitis exercises the name-giving sport at all [1]. Further studies were able to demonstrate reduced deficiencies in proprioception in patients with symptomatic lateral epicondylitis [5]
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