A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis)

Magnus Peterson, Stephen Butler, Margaretha Eriksson, Kurt Svärdsudd, Magnus Peterson, Stephen Butler, Margaretha Eriksson, Kurt Svärdsudd

Abstract

Background: Chronic tennis elbow (lateral epicondylosis) is a common disorder. Like other chronic soft-tissue pain conditions it is often difficult to treat successfully. The effects of exercise have been discussed, but no convincing evidence has been put forward so far, and a simple protocol for exercise is lacking.

Aims of the study: This study is a randomized, controlled, clinical trial of the effect of exercise versus expectation (wait-list) on pain, muscle strength, function, and quality of life in patients with long-standing lateral epicondylosis.

Methods: Eighty-one subjects with tennis elbow lasting for more than 3 months were randomly allocated to an exercise group (n = 40) or a reference group (n = 41). The exercise group performed daily exercise, with weekly load increase, for 3 months. The reference group was wait-listed, but otherwise followed in the same way. Outcome measures were pain during maximum voluntary muscle contraction (Cozen's test) and pain during maximum muscle elongation with a load (modified Empty-can-test); muscle strength was measured with a Chatillon MSE 100 hand-held dynamometer, and the Disability of the Arm, Shoulder and Hand (DASH) and the Gothenburg Quality of Life questionnaires.

Results: The exercise group had greater and faster regression of pain, both during muscle contraction and muscle elongation, than the reference group (p = 0.0005 and p = 0.0016, respectively). There was a non-significant muscle strength difference between the groups, but no differences regarding DASH scores or quality of life measures.

Conclusions: Exercise appears to be superior to expectation in reducing pain in chronic lateral epicondylosis.

Trial registration: ClinicalTrials.gov NCT00888225.

Figures

Figure 1.
Figure 1.
Flow chart of the study population.
Figure 2.
Figure 2.
Photograph showing exercise set-up with the patient seated in an armchair with forearm support, holding the weight (a plastic container with a specified amount of water in it) in the affected arm, and performing exercise by lifting and lowering the container.
Figure 3.
Figure 3.
Cumulative proportion of responder analysis graph showing the proportions of subjects (vertical axis) that equal or exceed a specified improvement of pain during the 3-month treatment period (horizontal axis). The exercise group had higher responder rate at all levels of change in pain score during maximum voluntary contraction (A), as well as pain score during maximum muscle elongation (B).

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