Comparison of effectiveness of supervised exercise program and Cyriax physiotherapy in patients with tennis elbow (lateral epicondylitis): a randomized clinical trial

Rajadurai Viswas, Rejeeshkumar Ramachandran, Payal Korde Anantkumar, Rajadurai Viswas, Rejeeshkumar Ramachandran, Payal Korde Anantkumar

Abstract

Objective: To compare the effectiveness of supervised exercise program and Cyriax physiotherapy in the treatment of tennis elbow (lateral epicondylitis).

Design: Randomized clinical trial.

Setting: Physiotherapy and rehabilitation centre.

Subjects: This study was carried out with 20 patients, who had tennis elbow (lateral epicondylitis).

Intervention: Group A (n = 10) had received supervised exercise program. Group B (n = 10) was treated with Cyriax physiotherapy. All patients received three treatment sessions per week for four weeks (12 treatment sessions).

Outcome measures: Pain was evaluated using a visual analogue scale (VAS), and functional status was evaluated by completion of the Tennis Elbow Function Scale (TEFS) which were recorded at base line and at the end of fourth week.

Results: Both the supervised exercise program and Cyriax physiotherapy were found to be significantly effective in reduction of pain and in the improvement of functional status. The supervised exercise programme resulted in greater improvement in comparison to those who received Cyriax physiotherapy.

Conclusion: The results of this clinical trial demonstrate that the supervised exercise program may be the first treatment choice for therapist in managing tennis elbow.

Figures

Figure 1
Figure 1
Deep transverse friction massage.
Figure 2
Figure 2
Mill's Manipulation.
Figure 3
Figure 3
Participants flow chart.
Figure 4
Figure 4
Comparison of the ages of the two groups.
Figure 5
Figure 5
Distribution of gender in both groups.
Figure 6
Figure 6
Duration of symptoms (in weeks) in both groups.
Figure 7
Figure 7
Comparison of VAS scores of two groups.
Figure 8
Figure 8
Comparison of TEFS scores of two groups.

References

    1. Bosworth DM. The role of the orbicular ligament in tennis elbow. The Journal of Bone and Joint Surgery. 1955;37(3):527–533.
    1. Cyriax JH. The pathology and treatment of tennis elbow. The Journal of Bone and Joint Surgery. 1936;18:921–940.
    1. Kaplan EB. Treatment of tennis elbow (epicondylitis) by denervation. The Journal of Bone and Joint Surgery. 1959;41(1):147–151.
    1. Mills GP. The treatment of tennis elbow. The Journal of Bone and Joint Surgery. 1928;1:12–13.
    1. Smith CH, Kunz HG. Butazolidin in rheumatoid disorders. The Journal of the Medical Society of New Jersey. 1952;49(7):306–309.
    1. Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. British Journal of Sports Medicine. 2005;39(7):411–422.
    1. Turek SL. Orthopaedics Principle and Their Applications. 4th edition. Vol. 2. Philadelphia, Pa, USA: J. B. Lippincott; 2006.
    1. Vasseljen O. Low-level laser versus traditional physiotherapy in the treatment of tennis elbow. Physiotherapy. 1992;78(5):329–334.
    1. Allander E. Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes. Scandinavian Journal of Rheumatology. 1974;3(3):145–153.
    1. Vicenzino B, Wright A. Lateral epicondylalgia. I. A review of epidemiology, pathophysioogy, aetiology and natural history. Physical Therapy Reviews. 1996;1:23–34.
    1. Murtagh JE. Tennis elbow. Australian Family Physician. 1988;17(2):90–95.
    1. Pienimäki TT, Tarvainen TK, Siira PT, Vanharanta H. Progressive strengthening and stretching exercises and ultrasound for chronic lateral epicondylitis. Physiotherapy. 1996;82(9):522–530.
    1. Haker E. Lateral epicondylalgia: diagnosis, treatment and evaluation. Critical Reviews in Physical and Rehabilitation Medicine. 1993;5:129–154.
    1. Nagrale AV, Herd CR, Ganvir S, Ramteke G. Cyriax physiotherapy versus phonophoresis with supervised exercise in subjects with lateral epicondylalgia: a randomized clinical trial. The Journal of Manual and Manipulative Therapy. 2009;17(3):171–178.
    1. Kamien M. A rational management of tennis elbow. Sports Medicine. 1990;9(3):173–191.
    1. Mathew DP. Painful conditions around the elbow. Orthopedic Clinics of North America. 1999;30(1):109–118.
    1. Carol C, Garrett WE. Tendon problems in athletic individuals. The Journal of Bone and Joint Surgery A. 1997;79:138–150.
    1. Boyer MI, Hastings H. Lateral tennis elbow: ‘is there any science out there?’. Journal of Shoulder and Elbow Surgery. 1999;8(5):481–491.
    1. Basford JR, Sheffield CG, Cieslak KR. Laser therapy: a randomized, controlled trial of the effects of low intensity Nd:YAG laser irradiation on lateral epicondylitis. Archives of Physical Medicine and Rehabilitation. 2000;81(11):1504–1510.
    1. Maher S. Is low-level laser therapy effective in the management of lateral epicondylitis? Physical Therapy. 2006;86(8):1161–1167.
    1. Vasseljen O, Hoeg N, Kjeldstad B, Johnsson A, Larsen S. Low level laser versus placebo in the treatment of tennis elbow. Scandinavian Journal of Rehabilitation Medicine. 1992;24(1):37–42.
    1. Lundeberg T, Haker E, Thomas M. Effect of laser versus placebo in tennis elbow. Scandinavian Journal of Rehabilitation Medicine. 1987;19(3):135–138.
    1. Caldwell GL, Safran MR. Elbow problems in the athlete. Orthopedic Clinics of North America. 1995;26(3):465–485.
    1. Wright A, Vicenzino B. Lateral epicondylagia: therapeutic management. Physical Therapy. 1997;2:39–48.
    1. Norris C. Sports Injuries: Diagnosis and Management. 3rd edition. Butterworth Heinemann; 2005.
    1. Roetert EP, Brody H, Dillman CJ, Groppel JL, Schultheis JM. The biomechanics of tennis elbow: an integrated approach. Clinics in Sports Medicine. 1995;14(1):47–57.
    1. Chen SC. A tennis elbow support. British Medical Journal. 1977;2(6091):p. 894.
    1. Brattberg G. Acupuncture therapy for tennis elbow. Pain. 1983;16(3):285–288.
    1. Molsberger A, Hille E. The analgesic effect of acupuncture in chronic tennis elbow pain. British Journal of Rheumatology. 1994;33(12):1162–1165.
    1. Goguin JP, Rush F. Lateral epicondylitis. What is it really? Current Orthopaedics. 2003;17(5):386–389.
    1. Labelle H, Guibert R, Joncas J, Newman N, Fallaha M, Rivard CH. Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow: an attempted meta-analysis. The Journal of Bone and Joint Surgery B. 1992;74(5):646–651.
    1. Trudel D, Duley J, Zastrow I, Kerr EW, Davidson R, MacDermid JC. Rehabilitation for patients with lateral epicondylitis: a systematic review. Journal of Hand Therapy. 2004;17(2):243–266.
    1. Cyriax HJ, Cyriax JP. Cyriax's Illustrated Manual of Orthopaedic Medicine. Oxford, UK: Butterworth-Heinemann; 1983.
    1. Stasinopoulos D, Johnson MI. Cyriax physiotherapy for tennis elbow/lateral epicondylitis. British Journal of Sports Medicine. 2004;38(6):675–677.
    1. Baltaci G, Ergun N, Tunay VB. Effectiveness of Cyriax manipulative therapy and elbow band in the treatment of lateral epicondylitis. European Journal of Sports Traumatology and Related Research. 2001;23(3):113–118.
    1. Stasinopoulus DI, Stasinopoulos I. Comparison of effects of Cyriax physiotherapy, a supervised exercise programme and polarized polychromatic non-coherent light (Bioptron light) for the treatment of lateral epicondylitis. Clinical Rehabilitation. 2006;20(1):12–23.
    1. Verhaar JAN, Walenkamp GHIM, van Mameren H, Kester ADM, van der Linden AJ. Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. The Journal of Bone and Joint Surgery B. 1996;78(1):128–132.
    1. Stasinopoulos D, Stasinopoulou K, Johnson MI. An exercise programme for the management of lateral elbow tendinopathy. British Journal of Sports Medicine. 2005;39(12):944–947.
    1. Kesson M, Atkins E. Orthopedic Medicine: A Practical Approach. Oxford, UK: Butterworth-Heinemann; 1998.
    1. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45–56.
    1. Price DD, Bush FM, Long S, Harkins SW. A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain. 1994;56(2):217–226.
    1. Lowe KA. Test/retest reliability, construct validity, and responsiveness of the tennis elbow function scale. Alberta, Canada: Department of Physical Therapy, Faculty of Graduate Studies and Research, University of Alberta; 1999. M.S. thesis.
    1. de Bruijn R. Deep transverse friction; its analgesic effect. International Journal of Sports Medicine. 1984;5:35–36.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren