None listed
Conditions
Brief summary
In this project, we will study the clinical efficacy of an 8 week graded isometric home exercise program in patients with tennis elbow, by comparing it to a wait and see approach. Exercise is commonly prescribed to reduce pain and disability from tendinopathy, however the optimal type and dose of exercise is not clear. A recent systematic review identified only two clinical trials investigating the effects of isometric exercise in people with tennis elbow, with inconsistent findings. Neither of these studies quantified the exercise load, limiting conclusions regarding dose response. We will compare the effects of an 8 week home program of isometric exercise with a wait and see approach on global recovery, pain, disability and pain free grip strength. Many patients with tennis elbow exhibit signs of central sensitisation, including widespread sensitivity to mechanical and thermal stimuli. It is not known whether exercise can improve the processes involved in central sensitisation. We will test the effects of 8 weeks of exercise on quantitative sensory tests and conditioned pain modulation. Exercise induced analgesia will be also evaluated at baseline using a submaximal (20% MVC) isometric endurance task.
Interventions
Participants randomised to the exercise group will complete a daily home program of isometric exercise for 8 weeks. Following baseline examination, participants allocated to exercise will receive a 30 minute individualised session with the trial Physiotherapist who will provide written and verbal education about the exercise program as well as general advice regarding activity modification. Participants will be provided equipment (flask with handle) to begin their home program the following day.
Participants randomised to the exercise group will complete a daily home program of isometric exercise for 8 weeks. Following baseline examination, participants allocated to exercise will receive a 30 minute individualised session with the trial Physiotherapist who will provide written and verbal education about the exercise program as well as general advice regarding activity modification. Participants will be provided equipment (flask with handle) to begin their home program the following day. Isometric exercise will be performed by holding the water filled container in the affected arm, with the forearm resting on the edge of a table (elbow approximately 90 degrees flexion, forearm pronated, wrist 30 degrees extension). The water level will be initially filled to achieve a load equivalent to 20% of the maximal voluntary wrist extension capacity of the unaffected arm. Participants will be instructed to increase the load by 5% each fortnight (by adding a set volume of water). The following progressions will be adopted to enable a progressive increase in weekly exercise volume (load x hold time x sets). Week 1: 20% load, 4x30s isometric holds, 30s intervals Week 2: 20% load, 3x45s isometric holds, 30s intervals Week 3: 25% load, 4x30s isometric holds, 30s intervals Week 4: 25% load, 3x45s isometric holds, 30s intervals Week 5: 30% load, 4x30s isometric holds, 30s intervals Week 6: 30% load, 3x45s isometric holds, 30s intervals Week 7: 35% load, 4x30s isometric holds, 30s intervals Week 8: 35% load, 3x45s isometric holds, 30s intervals Participants will complete a daily exercise diary to evaluate compliance (load, duration and sets achieved) and symptoms (rating of perceived exertion (RPE-CR10 and pain intensity (numercial rating scale, 0=no pain, 10=worst imaginable pain) during exercise. Exercise diaries will be sent to the trial Physiotherapist at the end of each week.
Sponsors
University of Queensland
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Aged 18 years or older; Elbow pain for 6 weeks or more, which is greater than 2/10 on NRS for average pain intensity; Clinical diagnosis of tennis elbow (lateral epicondylalgia): positive response to at least 2 of the following physical tests (resisted wrist, index or middle finger extension, stretch of wrist extensor muscles) and reduced pain free grip force.
Exclusion criteria
Bilateral elbow pain; Corticosteroid or other injection into elbow within preceding 6 months; Surgery, fracture or major trauma to the neck or upper limb within preceding 1 year; Clinical suspicion of other primary sources of lateral elbow pain (elbow pain exacerbated with neck movements or manual palpation, pain localised over the radiohumeral joint, sensory disturbance in the affected hand); Concomitant neck or upper limb pain (other than tennis elbow) that they consider to be their most bothersome complaint; Neurological, inflammatory or systemic conditions including daibetes, epilepsy, fibromyalgia or malignancy; Pregnant or breastfeeding.
Outcome results
None listed