Abstract
BACKGROUND: The aim of this prospective randomized clinical trial was to investigate the efficacy of a home-based program of isometric strengthening exercises for the treatment of the lateral epicondylitis (LE) of the distal humerus. We hypothesized that 1) use of isometric strengthening exercises would result in clinical benefits similar to those provided by medication and pain relief and 2) functional improvements after exercise would be time-dependent.
METHODS: Patients were assigned to one of two groups: 1) an immediate physical therapy group (group I), or 2) a delayed physical therapy group (group D). Group I patients (n = 16) were instructed how to do the exercises at their first clinic visit and immediately carried out the exercise program. Group D patients (n = 15) learned and did the exercises after being on medications for 4 weeks.
RESULTS: Outcomes at the 1-month clinic visit indicated that pain (measured using a visual analogue scale [VAS]) had been significantly reduced in group I compared to group D (p < 0.01). However, significant differences between groups were not found at 3-, 6-, and 12-month follow-up for either VAS scores or Mayo elbow performance scores. For modified Nirschl/Pettrone scores, a significant difference between groups was found only at the 1-month follow-up visit. By then, the number of participants who returned to all activities with no pain or occasional mild pain was six (37%) in Group I and two (13%) in Group D (p = 0.031). At the final follow-up visit, 88% of all participants performed physical activities without pain.
CONCLUSIONS: Isometric strengthening exercises done early in the course of LE (within 4 weeks) provides a clinically significant improvement.
Diagnosis: Lateral Epicondylitis
Outcome: VAS dropped from 53.1 at start to 29.7 at 1 month, 10.6 at 3 months, 8.5 at 6 months, 7.8 at 12 months for the immediate group, the delayed group was similar but with delayed results ~4 weeks, catching up with immediate group by 6 months. By 12 months 88% of participants were performing all daily activities without pain.
When Assessed: 1, 3, 6 and 12 months
Subjects: 31 subjects, 15 in the immediate therapy group, 16 delayed exercise 4 week. No control group. Average age 50 years. 13 men and 19 women.
Protocol: Isometric holds, 4 sets of 50 repetitions performed daily, with each rep held 10 seconds. Participants were instructed to perform the exercises gently, without pain. Elbow held in full extension in demo photo. Does not say if the 4 sets were done all at once or divided throughout the day. Not told to stop the exercises but compliance ~80% after 1 month, and dropped steadily to ~40% as 12 months.
Other Activity: No mention of other activities.
Chad’s Comments: This one is interesting because it showed isometric exercise to be effective, rather than the more frequent use of eccentric exercise. Also no equipment was required and they trained without pain. I would expect, over time the isometric contractions without pain would become stronger, but there was no mention of this. No control group, the the 4 week delay in treatment group served as a kind of control, with no meaningful improvement in that group until after they started the exercises, while the immediate group was well ahead by this time. The authors theorized isometric exercise might be better for epicondylitis because forearm contractions during ADLs were more isometric in nature than calf or quadriceps contractions, but it would be interesting to see if results are generalizable. While the exercise program did not require any equipment (4 sets of 50 reps, with each rep being 10 seconds long) the program does sounds a bit arduous. 10 seconds each, times 50 reps means each set is 8.33 minutes, not counting any rests. It 10 minutes per set if you rest 2 seconds between reps.
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Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed his Yoga Teacher Training at Sampoorna Yoga in Goa, India.
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