Therapeutic exercise in the management of lateral elbow tendinopathy

Abstract

Lateral elbow tendinopathy is the most common cause of pain in this joint.
Although it is also widely known as ‘tennis elbow’ as it affects 50% of tennis players, especially beginners who learn the one-handed backhand, LET often develops as a work-related condition and therefore constitutes a serious public health problem: only 10% of all affected patients play tennis.
The typical clinical presentation is characterized by pain and reduction of strength and function with considerable repercussions on daily activities. Although signs and symptoms of LET are clear, as well as the definition of the diagnosis, to date no ideal treatment has yet emerged; clinicians advocate a conservative approach as the first choice of management and physiotherapy, with its wide range of treatments, is commonly recommended: therapeutic exercise has shown good clinical results and the goal of this review is to evaluate its effectiveness in the management of the aforementioned clinical picture.
For the realization of this revision was made reference to the guidelines for reporting systematic reviews PRISMA Statement (PRISMA-P checklist).
Randomized clinical trials were identified using strings, which were specifically constituted on each used database: MEDLINE, Cochrane Library and PEDro. After the elimination of repeated articles from the search in the various databases and studies that did not meet the inclusion criteria, the selection took place by reading the title, abstract and full text. Subsequently, the evaluation of the internal validity of the studies was carried out with the Rob 2.0 of the Cochrane Collaboration.
The strings produced a total of 1418 items. After reading the title, abstract and full text, only 12 works were really relevant to the research question and containing the pre-established inclusion criteria.
Therapeutic exercise has been found to be the safest, cheapest and most effective means in the management of lateral elbow tendinopathy; all the included trials have precisely outlined the dosage, type and principle of application in different populations without restrictions of the time of onset of symptoms. Unsupervised isometric exercise demonstrated a considerable reduction in pain and disability in the short term. Eccentric exercise, the most contemplated type, was effective in reducing the painful symptom and increasing the grip strength. Stretching, a valid therapeutic strategy often associated with other modes of intervention, has recorded significant benefits related to painless grip strength, function and VAS, overlapping with the results obtained in the comparison groups.
However, the heterogeneity of the trials included for the type administered, the size of the samples examined and the type of outcomes considered, makes it difficult to extract an objective and clear answer to the clinical question.
Better targeting clinical practice in LET management is the goal of future research, defining exercise programs with statistically and/or clinically significant superiority.