Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: A prospective randomized trial

• Published in: Journal of shoulder and elbow surgery 2010-09, Vol.19 (6), p.917-922
• Main Authors: Tyler, Timothy F., MSPT, ATC, Thomas, Gregory C., DPT, CSCS, Nicholas, Stephen J., MD, McHugh, Malachy P., PhD
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Chronic Disease; Diseases of the osteoarticular system; eccentric; Exercise Therapy - methods; Female; Follow-Up Studies; Humans; Lateral epicondylosis; Male; Medical sciences; Middle Aged; Muscle Contraction - physiology; Muscle, Skeletal - physiopathology; Orthopedics; physical therapy; Prospective Studies; Range of Motion, Articular; Tennis Elbow - physiopathology; Tennis Elbow - therapy; Treatment Outcome; Wrist - physiology
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2010.04.041

Backround Isokinetic eccentric training of the wrist extensors has recently been shown to be effective in treating chronic lateral epicondylosis. However, isokinetic dynamometry is not widely available or practical for daily exercise prescription. Therefore, the objective of this study was to assess the efficacy of a novel eccentric wrist extensor exercise added to standard treatment for chronic lateral epicondylosis. Materials and methods Twenty-one patients with chronic unilateral lateral epicondylosis were randomized into an eccentric training group (n = 11, 6 men, 5 women; age 47 ± 2 yr) and a Standard Treatment Group (n = 10, 4 men, 6 women; age 51 ± 4 yr). DASH questionnaire, VAS, tenderness measurement, and wrist and middle finger extension were recorded at baseline and after the treatment period. Results Groups did not differ in terms of duration of symptoms (Eccentric 6 ± 2 mo vs Standard 8 ± 3 mos., P = .7), number of physical therapy visits (9 ± 2 vs 10 ± 2, P = .81) or duration of treatment (7.2 ± 0.8 wk vs 7.0 ± 0.6 wk, P = .69). Improvements in all dependent variables were greater for the Eccentric Group versus the Standard Treatment Group (percent improvement reported): DASH 76% vs 13%, P = .01; VAS 81% vs 22%, P = .002, tenderness 71% vs 5%, P = .003; strength (wrist and middle finger extension combined) 79% vs 15%, P = .011. Discussion All outcome measures for chronic lateral epicondylosis were markedly improved with the addition of an eccentric wrist extensor exercise to standard physical therapy. This novel exercise, using an inexpensive rubber bar, provides a practical means of adding isolated eccentric training to the treatment of chronic lateral epicondylosis.