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Cited by 16Tendon Structure and TreatmentElbow and Forearm Trauma TreatmentShoulder Injury and Treatment

Role of strengthening during nonoperative treatment of lateral epicondyle tendinopathy

McQueen, Kathryn S., Powell, Rhonda K., Keener, Tracy, Whalley, Richard, Calfee, Ryan P.·2021·Journal of Hand Therapy
DOI 10.1016/j.jht.2020.10.009
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Abstract

Introduction Lateral epicondyle tendinopathy (LET) is the most common cause of lateral elbow pain. The literature on rehabilitation of the condition encompasses a plethora of interventions with most current evidence indicating that stretches and some form of strengthening are vital components. However, patient outcomes are infrequently reported further than 12 weeks from the start of therapy and it is unclear which components of a home exercise program are necessary to alleviate symptoms up to one year from the initiation of a therapy program.Purpose of the study The purpose of the study is to determine if a therapy program with 4 to 6 visits spaced out over 12 weeks focusing on self-management and strengthening is more effective in reducing pain and improving function long term than the same program without strengthening, for individuals with LET.Study design This is a randomized controlled trial.Methods Ninety-four patients were randomly allocated into two groups: both groups received the interventions of education in pertinent pathoanatomy, stretching, pain management through rest and icing, and activity modification. Group 1 (n = 38) was also provided with a strengthening component to the home exercise program, whereas group 2 did not (n = 21). Our primary outcome measure was pain at rest and pain with activity; our secondary measure was the level of functional impairment as measured by the quick disabilities of arm shoulder and hand. Outcome measurements were assessed at baseline, 6, 12, 24, and 52 weeks after initiation of therapy.Results Both groups demonstrated statistically significant improvement with a moderate to large effect size in pain and function scores when compared with previous time point at 6, 12, and 24 weeks. Pain continued to decrease for both groups from 24 weeks to 52 weeks, but interestingly, there was a significant increase with moderate effect size in the quick disabilities of arm shoulder and hand score at 52 weeks when compared with week 24. No statistically significant difference was found between the two groups at any time point up to 52 weeks from the start of therapy.Conclusions This study demonstrates that a therapy program consisting of a low number of visits spaced out over 12 weeks based on education, stretches, activity modification, and pain management techniques is effective at reducing pain and increasing function in patients with LET. The addition of strengthening to this program did not improve outcomes. The therapy approach used in this study is consistent with the International Classification of Function guidelines and focuses on engaging patients in self-management of the condition through patient education and self-empowerment.

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  • Disability levels at the end of the program (12.56, 95% CI 10.25; 14.87) were within the ranges reported in previous studies (9-23 points).

    “Disability levels at the end of this program (12.56, 95% CI 10.25; 14.87) were within the ranges reported in previous studies (9–23 points), using either QuickDASH, DASH or the Patient-Rated Tennis Elbow Evaluation questionnaire (PRTEE) [74,75,78,79].”

    From Digital Rehabilitation for Elbow Pain Musculoskeletal Conditions: A Prospective Longitudinal Cohort Study (2022) · cites this paper as [75]

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Authors
McQueen, K. S., Powell, R. K., Keener, T., Whalley, R., & Calfee, R. P.
Affiliations
Washington University in St. Louis (US)
Corresponding author
McQueen, Kathryn S.
ORCID
Calfee, Ryan P.
Venue
Journal of Hand Therapy
Publisher
Elsevier BV
Published
2021-10
Volume
34
Issue
4
Pages
619-626
ISSN
0894-1130 (ISSN-L)
DOI
10.1016/j.jht.2020.10.009
OpenAlex
W3092757631
Cited by
15
References
39
Citations by year
2026: 2 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 4
FWCI
2.50
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Journal of Hand Therapy (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Tendon Structure and Treatment
  • Health Sciences › Medicine › Rehabilitation › Elbow and Forearm Trauma Treatment
  • Health Sciences › Medicine › Surgery › Shoulder Injury and Treatment
Keywords
lateral elbow pain, resistance training, home exercise program, conservative treatment, patient education, stretching, activity modification, pain management, self-management, long-term outcomes, functional disability
MeSH terms
Exercise Therapy, Humans, Pain, Treatment Outcome, Tendinopathy, Pain Management

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