Efficacy of physical therapy interventions for chronic lateral elbow tendinopathy: a systematic review

Abstract

Study Design: Systematic review.

Background: Existing systematic reviews and meta-analyses do not support a specific physical therapy treatment for lateral elbow tendinopathy (LET). The results of these studies, however, may not accurately represent the current state of evidence. This may be due, in part, to methodological limitations in these studies, specifically the lack of utilization of standardized and disease-specific outcome measures.

Objectives: To determine the effectiveness of physical therapy interventions in treating chronic lateral elbow tendinopathy as assessed in randomized controlled trials (RCTs) using pain-free grip strength and/or patient-rated tennis elbow evaluation questionnaire as outcome measures.

Methods: A search of PubMed, Physiotherapy Evidence Database (PEDro), Scopus database, Google Scholar and bibliography was conducted from inception to November 2018. The methodological quality of the identified RCTs were assessed using the PEDro scale and the modified Sackett scale was used to appraise findings based on the level of evidence.

Results: A total of two thousand nine hundred and six citations were identified, however, only twenty-two RCTs matched the eligibility criteria and were included in the review. The identified studies varied in design, investigated diverse physical therapy modalities that were applied for dissimilar periods, assessed outcome measures at unalike periods, and showed inconsistent results.

Conclusion: A rigorous review of literature showed insufficient evidence to support or refute the effectiveness of many of the current physical therapy interventions for chronic LET. Nevertheless, the results might suggest immediate efficacy of mobilization with movement of the elbow joint and short-term efficacy of myofascial release technique.

Level of evidence: Therapy, level 1a-

Keywords:

• Chronic tendinopathy
• chronic tendon disease
• conservative management
• lateral epicondylitis
• tennis elbow

Disclosure statement

No potential conflict of interest was reported by the authors

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Additional information

Notes on contributors

Beshoy Girgis

Beshoy Girgis is a physical therapist. Currently he is a third-year PhD student in the Doctoral Program in Physiotherapy at the Faculty of Sport, University of Porto.

José Alberto Duarte

José Alberto Duarte is a full professor of physiology and the Head of the Laboratory of Biochemistry and Experimental Morphology at the Faculty of Sport, University of Porto; in this school, he also directs the PhD Course in Physiotherapy. He has published about two hundred scientific manuscripts in peer-reviewed journals and registered three international patents.