ASTYM treatment better than home exercise for lateral epicondylitis

ASTYM combined with a home exercise program yielded better improvements in pain and function than home exercise alone.

Patients who had lateral epicondylitis, commonly known as “tennis elbow,” responded better to ASTYM treatment than exercise alone, particularly during the early stages of intervention, a new study showed.

Sue A. Stover, MHS, PT, CSCS, of Muncie, Ind., and her co-authors set out to learn about the ASTYM treatment’s effectiveness in conjunction with a home exercise program. They did a single blinded, randomized trial, assigning patients to undergo either ASTYM treatment combined with home exercise or to home exercise alone.

ASTYM treatment, based on Augmented Soft Tissue Mobilization, or ASTM, is based on the belief that most cases of lateral epicondylitis are degenerative, not inflamed, and are likely to benefit from healing stimuli, Stover said at the Joint Annual American Society for Surgery of the Hand/American Society for Hand Therapists Meeting. Stover is a physical therapist for Performance Dynamics, developers of the ASTYM treatment system.

“Our hypothesis was that ASTYM patients would recover better and faster than home exercise patients after four weeks of treatment,” Stover said. “In the home exercise patients who did not recover with a home exercise program, we thought further intervention would be prudent with ASTYM being applied.”

Inclusion criteria included patients being 18 to 65 years old and having pain with two of the following: palpation of the lateral epicondyle, resisted wrist extension or passive wrist flexion with the elbow extended. A total of 127 patients participated in the study, with 93 completing at least the first treatment phase.

Exclusion criteria included conditions that may have mimicked lateral epicondylitis symptoms or affected the elbow area directly.

Patients in the two groups received treatment for four weeks followed by a four-week washout period of home stretching. Patients who rated themselves as being in the same or worse condition at the end of the initial treatment period had the option of receiving the other treatment, surgical consultation or injection. The researchers took measurements at baseline, at four, eight and 12 weeks, and at six months and one year, Stover said.

Researchers measured maximum voluntary and pain-free grip strength, Visual Analog Scale (VAS) for pain and function, Disability of Arm, Shoulder and Hand (DASH) and a patient global rating form. The rating researcher was blinded during treatment assignment and the first four weeks of treatment. Researchers also did ANOVA analysis and independent t-tests of gain scores. They used chi-square analysis to test differences in the number of patients requesting alternative treatment, Stover said.

‘Significantly better’

“The results show that after the first four weeks of treatment, 56.5% of the ASTYM group and 23.4% of the [home exercise] group resolved,” Stover said. After four more weeks of observation and home stretching, 78.3% of the ASTYM group and 38.3% of the home exercise group had resolved, she said.

The ASTYM group improved “significantly better” than the home exercise group in VAS at rest, maximum grip strength and DASH in the first four weeks. More home exercise patients than ASTYM patients asked for alternative treatment. Those who had the ASTYM treatment as an initial or alternative treatment also had less pain at rest than those who had home exercise exlusively, Stover said.

“Our conclusion was that in this study, ASTYM treatment was more effective than [home exercise] in the treatment of patients with lateral epicondylitis, both as an initial intervention and as a crossover intervention,” Stover said. “Further analysis is underway and studies need to confirm these findings with other study samples.”

For more information:
Stover S, Sevier T, Helfst R, Jansen CWS. The effectiveness of the ASTYM system in improving treatment outcomes in patients with lateral epicondylitis: a single-blinded randomized trial. Joint #1. Presented at the Joint Annual ASSH/ASHT Meeting. Sept. 22-24, 2005. San Antonio.