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

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.

Key words::

• Exercise
• pain
• RCT
• tendinitis
• tendinosis
• tennis elbow

Acknowledgements

This study was supported by grants from the Swedish Research Council (grant no. K2005-27X-15293-01A), The Amersham Fund at Uppsala University, The Research Fund at Uppsala County Council, The Family Medicine Foundation, and Uppsala University.

Declaration of interest: The funding sources had no involvement in study design, data collection, analysis, result interpretation, manuscript preparation, or decision to publish. Authors have no financial or other relationship that might lead to a conflict of interest. The trial is registered at http://clinicaltrials.gov/ as NCT00888225. The authors alone are responsible for the content and writing of the paper.