For Practitioners, Papers

Does effectiveness of exercise therapy and mobilization techniques offer guidance for treatment of L & M epicondylitis?

(Hoogvliet, Randsdorp, Dingemanse, Koes, & Huisstede, 2013)

Aims: To assess the evidence for effectiveness of exercise therapy and mobilisation techniques for both medial and lateral epicondylitis.

Methods: SR on 4 DB, 2 reviewers independently extracted data and assessed the methodological quality. English, German, French, Dutch language. Quality assessed according to a scale (Furlan). Heterogeneity made synthesis impossible, hence best evidence synthesis.

Results: Moderate evidence for a short-term effect of stretching plus strengthening exercises compared to ultrasound plus friction massage. Short-term and mid-term effect of manipulation of the cervical and thoracic spine as add-on therapy to concentric and eccentric stretching plus mobilisation of the wrist and forearm in patients with LE. For all other interventions, only limited, conflicting or no evidence was found

Limitations: No meta-analysis, poor level of evidence (1 paper high, other moderate low).

In practice: We do not have strong evidence for treatment of epicondylitis. To our current knowledge the best available option is exercise therapy + stretching +/- manual therapy as adjunct.

Hoogvliet, P., Randsdorp, M. S., Dingemanse, R., Koes, B. W., & Huisstede, B. M. A. (2013). Does effectiveness of exercise therapy and mobilization techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review. British Journal of Sports Medicine, 47(17), 1112–1119. https://doi.org/10.1136/bjsports-2012-091990

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