Physiotherapy Applications in Lateral Epicondylitis

A Comparison of Extracorporeal Shockwave Therapy (ESWT) and High-intensity Laser Therapy (HILT) in Terms of Pain, Function and Grip Strength in Lateral Epicondilitis: a Randomized Controlled Study

This study aims to compare the effectiveness of extracorporeal shock wave therapy (ESWT) and high-intensity laser therapy (HILT) in improving pain, grip strength, and function in patients with lateral epicondylitis. A total of 42 volunteer patients aged 18-65 were enrolled at Balıkesir Private Sevgi Hospital physical medicine polyclinic. Participants were randomly assigned into three groups: group 1 received conventional physiotherapy, group 2 received physiotherapy plus ESWT, and group 3 received physiotherapy plus HILT. Physiotherapy was applied for 2 weeks, totaling 10 sessions. ESWT and HILT were each administered twice weekly for 2 weeks, totaling 4 sessions. Pain was measured using the visual analog scale (VAS), grip strength with a hand dynamometer, and function using the Duruöz Hand Index and PRTEE-T questionnaire. Evaluations were performed before treatment, after 2 weeks, and one month post-treatment.

Study Overview

• Status: Completed
• Conditions: Lateral Epicondylitis
• Intervention / Treatment: Other: Physiotherapy; Device: Extracorporeal Shock Wave Therapy (ESWT); Device: High-Intensity Laser Therapy (HILT)

Detailed Description

This randomized controlled clinical trial investigates the effects of extracorporeal shock wave therapy (ESWT) and high-intensity laser therapy (HILT) on pain, grip strength, and function in patients diagnosed with lateral epicondylitis. The study was conducted at the physical medicine polyclinic of Balıkesir Private Sevgi Hospital and included 42 patients aged 18 to 65 who were referred for therapeutic physical therapy after being diagnosed for the first time with lateral epicondylitis.

Participants were randomly divided into three groups:

Group 1: received conventional physiotherapy including hot pack application, transcutaneous electric nerve stimulation (TENS), and stretching/strengthening exercises. Physiotherapy was administered 5 times per week for 2 weeks (total of 10 sessions).

Group 2: received the same physiotherapy as group 1, plus extracorporeal shock wave therapy (ESWT) administered twice per week for 2 weeks (total of 4 sessions).

Group 3: received the same physiotherapy as group 1, plus high-intensity laser therapy (HILT) administered twice per week for 2 weeks (total of 4 sessions).

Pain severity was evaluated using the visual analog scale (VAS), grip strength using a hand dynamometer, and functional status using the Duruöz Hand Index and patient-rated tennis elbow evaluation (PRTEE-T). All outcome measures were assessed at three time points: baseline (before treatment), post-treatment (after 2 weeks), and at 1-month follow-up. The primary objective was to assess whether either ESWT or HILT offers additional benefit over standard physiotherapy and whether one modality is superior to the other in treating lateral epicondylitis.

• Study Type: Interventional
• Enrollment (Actual): 42
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Denizli, Turkey
    • Pamukkale University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Being over the age of 18,
• Being diagnosed with lateral epicondylitis,
• Not having received lateral epicondylitis treatment in the last 3 months

Exclusion Criteria:

• Stopping the treatment,
• Those who have been traumatized in the last 3 months,
• Those who use drugs that can affect muscle strength or pain level (muscle relaxants, analgesics, gabapentinoids, etc.)
• Those with open wounds in the elbow area, Those with elbow fractures, Those with drug allergies, Pregnant and breastfeeding women.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Physiotherapy; This group received conventional physiotherapy only	Other: Physiotherapy; 10 sessions over 2 weeks, including TENS, cold therapy, ultrasound, and exercise therapy, 5 sessions per week.
Active Comparator: Physiotherapy + ESWT; This group received conventional physiotherapy and additional extracorporeal shock wave therapy (ESWT)	Other: Physiotherapy; 10 sessions over 2 weeks, including TENS, cold therapy, ultrasound, and exercise therapy, 5 sessions per week.; Device: Extracorporeal Shock Wave Therapy (ESWT); 4 sessions total, applied 2 times per week for 2 weeks.
Active Comparator: Physiotherapy + HILT; This group received conventional physiotherapy and additional high-intensity laser therapy (HILT).	Other: Physiotherapy; 10 sessions over 2 weeks, including TENS, cold therapy, ultrasound, and exercise therapy, 5 sessions per week.; Device: High-Intensity Laser Therapy (HILT); 4 sessions total, applied 2 times per week for 2 weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Severity - Visual Analog Scale (VAS)	Pain intensity will be evaluated using the visual analog scale (VAS), a 10 cm line ranging from 0 (no pain) to 10 (worst imaginable pain). Continuous scale (0-10), higher scores indicate worse outcome.	Baseline (Day 1), at the end of 2-week treatment, 4 weeks after treatment completion
Grip Strength - Hand Dynamometer	Grip strength will be measured in kilograms using a hand dynamometer. Continuous scale, higher scores indicate better outcome	Baseline (Day 1), at the end of 2-week treatment, 4 weeks after treatment completion
Upper Extremity Function - Duruöz Hand Index	The Duruöz Hand Index is a functional scale that assesses hand-related disability. Scores range from 0 to 90, with higher scores indicating worse functional impairment.	Baseline (Day 1), at the end of 2-week treatment, 4 weeks after treatment completion
Functional Evaluation - PRTEE-T (Patient-Rated Tennis Elbow Evaluation)	The PRTEE-T is a 15-item patient-rated questionnaire for lateral epicondylitis. Total scores range from 0 (no disability) to 100 (maximum disability). Continuous scale (0-100), higher scores indicate worse outcome.	Baseline (Day 1), at the end of 2-week treatment, 4 weeks after treatment completion

Collaborators and Investigators

• Sponsor: Pamukkale University
• Investigators: Study Director: SUAT EREL, PROF.DR., Pamukkale University

Study record dates

Study Major Dates

• Study Start (Actual): June 10, 2020
• Primary Completion (Actual): September 5, 2020
• Study Completion (Actual): December 30, 2020

Study Registration Dates

• First Submitted: October 7, 2021
• First Submitted That Met QC Criteria: June 11, 2025
• First Posted (Actual): June 19, 2025

Study Record Updates

• Last Update Posted (Estimated): June 25, 2025
• Last Update Submitted That Met QC Criteria: June 20, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Elbow Tendinopathy; Elbow Injuries; Musculoskeletal Diseases; Muscular Diseases; Wounds and Injuries; Tendon Injuries; Arm Injuries; Tendinopathy; Tennis Elbow
• Other Study ID Numbers: 674325

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: all collected IPD, all IPD that underlie results in a publication
• IPD Sharing Time Frame: FOR 6 MONTH
• IPD Sharing Access Criteria: FOR RESEARCH
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No