Training may be the best treatment for tennis elbow

Training and ergonomic advice are more effective than anti-inflammatory drugs and cortisone injections in treating tennis elbow, according to a thesis presented at the University of Gothenburg.

The thesis also pointed out that training and ergonomic advice give fewer side effects than anti-inflammatories and cortisone injections.

“It became clear that treatment with medication has side effects in many cases,” stated thesis author and physiotherapist Pia Nilsson in a press release. “Most side effects were reported from just those treatments that are often the treatment of choice for tennis elbow by GPs [general practitioners], which are cortisone injections and anti-inflammatory drugs.”

A structured training program

Nilsson studied the results from a new, structured training program for tennis elbow wherein 78 patients participated in a 4-month pilot study and 297 patients participated in a follow-up study that took place 2 years later.

The pilot study utilized a prospective non-randomized design to compare the effect of a home exercise program against more traditional primary care management. Seventy-eight patients presenting with tennis elbow were recruited and divided into groups of 51 who underwent intervention and 27 controls.

The intervention group was reportedly treated with the home training program, ergonomic advice and, when necessary, wrist and/or night bandages. The control group was treated conventionally with corticosteroid injections, stretching, or no intervention. Pain and function were evaluated by questionnaire, an electronic hand-power gauge measured strength and stamina, and sick-leave absence was collected via the regional Social Insurance Office.

Nilsson reported in the thesis that after 4 weeks, the intervention group experienced fewer sick leaves, less pain, better function and an earlier return-to-work than the control group. After 16 weeks, the intervention group was reported to still have “significantly better function” than the control group, with less sick leave taken. Nilsson also noted that pain decreased more in the intervention group, but this difference was not significant. Grip strength was the same across the two groups.

The use of ergonomic advice

The thesis also described the selection of treatment by healthcare personnel, their experiences when treating tennis elbow patients, and results from the use of the new training program. Results were collected via a questionnaire distributed to GPs, orthopedic surgeons and physiotherapists.

Nilsson explained that ergonomic advice can enable the patient to adapt to any difficulties at work – meaning many can continue to work without the aid of wrist support.

“It may be painful at night since many people sleep with a bent elbow, leading to difficulty straightening it in the morning,” she stated in the release. “The bending of the elbow can be prevented with a simple night bandage, and this facilitates the healing of the muscles.”

Nilsson concluded that a treatment program designed by a physiotherapist and occupational therapist in conjunction can reduce the patient’s pain, increase function of the elbow and hand, and reduce the duration of sick leave.

Reference:

Nilsson P, Thom E, Baigi A, et al. A prospective pilot study of a multidisciplinary home training programme for lateral epicondylitis. Musculoskeletal Care. 2007 Mar;5(1):36-50.

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