For Practitioners, Papers

Unsupervised isometric exercise versus wait-and-see for LET

(Vuvan, Vicenzino, Mellor, Heales, & Coombes, 2019)

Aims: To investigate the effect of an 8-week unsupervised program of isometric exercise compared to a wait-and-see approach on pain, disability, global improvement, and pain-free grip strength in participants with unilateral LET.

Methods: RCT in Australia. Inclusion: 18-70 years old, unilateral LET >6 weeks, pain >2 on average, provoked by 2 of grip, palpation, stretch, resisted contraction, reduced pain free grip strength. Exclusion: other diagnosis, other MSK complaint > to LET, major neurologic inflammatory, systemic condition, treatment in preceding 3 months, major trauma, fracture, or surgery in the last year. All participants were provided written and verbal general advice regarding self-management and ergonomics. Ex group: additional information about 8 week daily progressive isometric exercise program standardized and tailored to max voluntary contraction of each subject. Recording of exercises on a diary with adherence and symptoms. Adherence measured by % of 56 sessions done. Blinding of assessor, computer randomization (stratified <5 or >6 pain at baseline). PRTEE, GROC, and pain-free grip strength (3 measures 30 sec rest, mean). 20 / group = enough power to detect change. Stat analysis. 533 responders, 40 included n=21 exercise n=19 wait-and-see. Follow-up 98%.

Results: The exercise group had better PRTEE scores at 8 weeks compared to the wait–and-see group (SMD -0.92, 95% CI -1.58 to -0.26, P = 0.006). No ≠ in GROC nor in pain-free grip strength. 90% completed greater than 71% of prescribed sessions. No participants reported a serious adverse event. Use of co-interventions was similar between groups

Limitations: Power enough for PRTEE unknown for GROC & PFGS. Only non-severe patients. Program <10min / day.

In practice: This protocol of self-management isometrics for LET has moderate effect on PRTEE when compared to wait and see, but not on GROC nor pain-free grip strength at 8 weeks.

Vuvan, V., Vicenzino, B., Mellor, R., Heales, L. J., & Coombes, B. K. (2019). Unsupervised Isometric Exercise versus Wait-and-See for Lateral Elbow Tendinopathy. Medicine and Science in Sports and Exercise, 52(2), 287–295. https://doi.org/10.1249/MSS.0000000000002128

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