Eccentric training vs muscle energy technique in adjunct to low-level laser therapy for lateral epicondylitis
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Department of Orthopedic Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, India
Submission date: 2022-08-04
Acceptance date: 2023-03-31
Publication date: 2024-06-21
Physiother Quart. 2024;32(2):84-91
Low-level laser therapy (LLLT) is considered a mainstay intervention for lateral epicondylitis (LE) with clear evidence. Eccentric Exercises (EE) and Muscle Energy Technique [MET] have been shown to be beneficial individually. However, trials are lacking where the above two approaches are compared. Further, no comprehensive EE protocol exists for LE. Hence, this study aimed to develop an EE protocol and evaluate the effectiveness of the EE protocol versus MET as adjuncts to LLLT for the management of LE.

A total of 34 (n = 17 in each group) participants with LE were randomly allocated to two study groups (EE and MET). The participants received either EE or MET along with LLLT as a common intervention over 3 weeks. The outcomes measured were pinch strength, grip strength, and pain pressure threshold, assessed at pre-intervention and post-intervention (3rd week). The patient-rated tennis elbow evaluation (PRTEE) questionnaire was assessed at 4 points in time: pre- and post-3 weeks with follow-up in the 6th week and 12th week.

When compared between the groups, a statistically significant difference was noted with the EE group being more effective than the MET group for pain pressure threshold (p = 0.001), key pinch strength (p = 0.003), tripod pinch strength (p = 0.107), grip strength (p = 0.046), pain and functional disability (p = 0.001).

Although both EE and MET were effective in treating lateral epicondylitis, eccentric exercises were superior to the MET group even at the 6th and 12th week follow-up, suggesting a longer-lasting effect of EE without recurrences.

Assendelft W, Green S, Buchbinder R, Struiis P, Smidt N. Tennis elbow BRIT MED J 2003; 327(7410):329; doi: 10.1136/bmj.327.7410.329.
Buchanan BK, Varacallo M. Tennis elbow. StatPearls. 2020. Available 04.08.2023 from: https://www.ncbi.nlm.nih.gov/p....
Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am. 1999;81(2):259–278.
Coombes BK, Bisset L, Vicenzino B. Management of lateral elbow tendinopathy: one size does not fit all. J Orthop Sports Phys Ther. 2015;45(11):938–49; doi: 10.2519/jospt.2015.5841.
Martimbianco AL, Ferreira RE, Latorraca CD, Bussado­ri SK, Pacheco RL, Riera R. Photobiomodulation with low-level laser therapy for treating Achilles tendinopathy: a systematic review and meta-analysis. Clin Rehabil. 2020;34(6):713–22; doi: 10.1177%2F0269215520912820.
Kumar V, Kothawala B. A comparative study of muscle energy technique versus cyriax technique in lateral epicondylitis among professional Indian cooks. Int J Sci Basic Appl Res. 2019;9(6):363–73.
Kuçukşen S, Yilmaz H, Salli A, Ugurlu H. Muscle energy technique versus corticosteroid injection for management of chronic lateral epicondylitis: randomized controlled trial with 1-year follow-up. Arch Phys Med Rehabil. 2013;94(11):2068–74; doi: 10.1016/j.apmr.2013.05.022.
Chaitow L, Crenshaw K. Muscle energy techniques. Elsevier Health Sciences; 2006:19. Available 11.04.2024 from: http://www.chaitowmuscleenergy....
Murtaugh B, Ihm JM. Eccentric training for the treatment of tendinopathies. Curr Sports Med Rep. 2013;12(3):175–82; doi: 10.1249/jsr.0b013e3182933761.
Parmar BA, Shukla YU. Effect of eccentric versus concentric exercise on pain, grip strength and function in lateral epicondylitis: a comparative study. Int J Health Sci Res. 2020;5(2):98–109.
Jeon JY, Lee MH, Jeon IH, Chung HW, Lee SH, Shin MJ. Lateral epicondylitis: associations of MR imaging and clinical assessments with treatment options in patients receiving conservative and arthroscopic management. Eur Radiol. 2018;28(3):972–81; doi: 10.1007/s00330-017-5084-5.
Tyler TF, Thomas GC, Nicholas SJ, McHugh MP. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial. J Shoulder Elbow Surg. 2010;19(6):917–22; doi: 10.1016/j.jse.2010.04.041.
Kenas A, Masi M, Kuntz C. Eccentric interventions for lateral epicondylalgia. Strength Cond J. 2015;37(5):47–52; doi: 10.1519/SSC.0000000000000175.
Stergioulas A. Effects of low-level laser and plyometric exercises in the treatment of lateral epicondylitis. Photomed Laser Surg. 2007;25(3):205–13; doi: 10.1089/pho.2007.2041.
Park G, Kim CW, Park SB, Kim MJ, Jang SH. Reliability and usefulness of the pressure pain threshold measurement in patients with myofascial pain. J Rehabil Med. 2011;35(3):412; doi: 10.5535/arm.2011.35.3.412.
MacDermid JC, Evenhuis W, Louzon M. Inter-instrument reliability of pinch strength scores. J Hand Ther. 2001;14(1):36–42; doi: 10.1016/S0894-1130(01)80023-5.
Bellace JV, Healy D, Besser MP, Byron T, Hohman L. Validity of the Dexter Evaluation System’s Jamar dynamometer attachment for assessment of hand grip strength in a normal population. J Hand Ther. 2000;13(1):46–51; doi: 10.1016/S0894-1130(00)80052-6.
Rompe JD, Overend TJ, MacDermid JC. Validation of the patient-rated tennis elbow evaluation questionnaire. J Hand Ther. 2007;20(1):3–11; doi: 10.1197/j.jht.2006.10.003.
Page P. A new exercise for tennis elbow that works! N Am J Sports Phys Ther. 2010;5(3):189.
Öhberg L, Alfredson H. Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc. 2004;12(5):465–70; doi: 10.1007/s00167-004-0494-8.
Hariharasudhan R, Balamurugan J. Effectiveness of muscle energy technique and Mulligan’s movement with mobilization in the management of lateral epicondylalgia. Arch Med Health Sci. 2015;3(2):198; doi: 10.4103/2321-4848.171904.
Rees JD, Lichtwark GA, Wolman RL, Wilson AM. The mechanism for the efficacy of eccentric loading in Achilles tendon injury, an in vivo study in humans. Rheumatology. 2008;47(10);1493–97; doi: 10.1093/rheumatology/ken262.
Bhabra G, Wang A, Ebert JR, Edwards P, Zheng M, Zheng MH. Lateral elbow tendinopathy: development of a pathophysiology-based treatment algorithm. Orthop J Sports Med. 2016;4(11):2325967116670635; doi: 10.1177%2F2325967116670635.
Alfredson H, Pietilä T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26(3):360–6; doi: 10.1177/03635465980260030301.
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