Role of Strengthening During Non-Operative Treatment of Lateral Epicondyle Tendinopathy

Abstract Background Lateral Epicondyle Tendinopathy (LET) is the most common cause of lateral elbow pain. The literature on rehabilitation of the condition encompasses a plethora of interventions with most current evidence indicating that stretches and some form of strengthening are vital components. However, patient outcomes are infrequently reported further than twelve weeks from start of therapy and it is unclear which components of a home exercise program are necessary to alleviate symptoms up to one year from initiation of a therapy program. Purpose To determine if a therapy program with 4-6 visits spaced out over twelve weeks focusing on self-management and strengthening is more effective in reducing pain and improving function long term than the same program without strengthening, for individuals with (LET). Study Design Randomized controlled trial Methods Ninety-four patients were randomly allocated into two groups: both groups received the interventions of education in pertinent pathoanatomy, stretching, pain management through rest and icing, and activity modification. Group 1 (n=38) was also provided with a strengthening component to the home exercise program (HEP) while Group 2 did not (n=21). Our primary outcome measure was pain at rest and pain with activity; our secondary measure was level of functional impairment as measured by the QuickDASH. Outcome measurements were assessed at baseline, 6, 12, 24 and 52 weeks post initiation of therapy. Results Both groups demonstrated statistically significant improvement with a moderate to large effect size in pain and function scores when compared to previous time point at 6, 12, and 24 weeks. Pain continued to decrease for both groups from 24 weeks to 52 weeks, but interestingly, there was a significant increase with moderate effect size in QuickDASH score at 52 weeks when compared to week 24. No statistically significant difference was found between the two groups at any time point up to 52 weeks from start of therapy. Conclusion This study demonstrates that a therapy program consisting of a low number of visits spaced out over twelve weeks, based on education, stretches, activity modification and pain management techniques is effective at reducing pain and increasing function in patients with LET. The addition of strengthening to this program did not improve outcomes. The therapy approach used in this study is consistent with International Classification of Function guidelines and focuses on engaging patients in self-management of the condition through patient education and self-empowerment.