None listed
Conditions
Brief summary
The objective of the study is to analyze the effect of dry needling combined with an isometric exercise program in patients with lateral epicondylalgia. The hypothesis proposed for this study is that dry needling combined with an isometric exercise program is more effective than placebo dry needling combined with the same exercise program for treating patients with lateral epicondylalgia regarding pain, functionality and pain free grip strength. The study design is a randomized clinical trial with blind evaluator. The population of the study are patients with lateral epicondylalgia that met the inclusion and exclusion criteria proposed and accept enrollment in the study. The study will have two groups, which will receive the same isometric exercise program combined with dry needling (group A) or placebo dry needling (group B). The isometric exercise program has a duration of 4 weeks with 2 weekly sessions, and needling will be performed in the forearm muscles once a week. The main variable of the study is pain, measured by a 100 mm visual analogue scale (VAS). Secondary variables of the study are Patient Rated Tennis Elbow Evaluation (PRTEE), pain free grip strength, pressure pain threshold, 1st stretch sensation during wrist flexion and surface electromyography (sEMG). There will be 5 assessments during the study (baseline, post-intervention, and at 1 month, 3 months and 6 months of post-intervention). All variables will be collected in every assessment except sEMG that will be recorded at baseline, post-intervention and 3 months post-intervention. For data collection a clinic history of each patient will be complete. Statistical analysis will be done with intention to treat, using the statistic software SPSS 22.0.
Interventions
Dry needling combined with an isometric exercise program.
The intervention will be 4-week intervention program with 2 weekly treatment sessions.
-Dry needling will be performed once a week on the 1st weekly session using sterilized surgical steel disposable needles (0.3x40mm; APS (Registered Trademark), AGU-PUNT, S.L., Barcelona, Spain). The technique described by Hong will be used, which consist on fast in and out movements with the needle. The technique will be performed on the muscles of the
Dry needling combined with an isometric exercise program. The intervention will be 4-week intervention program with 2 weekly treatment sessions. -Dry needling will be performed once a week on the 1st weekly session using sterilized surgical steel disposable needles (0.3x40mm; APS (Registered Trademark), AGU-PUNT, S.L., Barcelona, Spain). The technique described by Hong will be used, which consist on fast in and out movements with the needle. The technique will be performed on the muscles of the lateral epicondyle. It will be performed by a physiotherapist with more than 10 years of clinical experience and knowledge on the technique. The duration of this part of the treatment is 10 minutes approximately. -The isometric exercise program will be done twice a week. It consists of 3 series of 10 hand-grip isometric contractions mantained 10 seconds each, and 10 rest seconds between contractions. The force of the hand-grip will be performed 20% under the forced obtained on the pain free grip strenght test. For the treatment a Riester Minimus (Registered Trademark) II sphygmomanometer will be used. It will be supervised by a physiotherapist. The exercises will take approximately 20 minutes to be performed. -During the first weekly session dry needling will be performed first, followed by a 5 minutes rest, and then the exercise program will be performed. For monitoring the adherence of patients to the study an attendance sheet in which they will have to sign each session will be done. -Intervention will be performed at Universidad de Alcala.
Sponsors
Universidad de Alcala (physiotherapy and pain group)
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
-Lateral epicondylalgia symptoms confirmed with at least 2 of the 4 following test: a) pain during palpation of lateral epicondyle, b) pain on resisted wrist extension, c) pain on resisted middle finger extension, d) pain during hand-grip. -Lateral epicondylalgia symptoms for more than 3 months
Exclusion criteria
-History of fractures, luxations, surgery and/or musculoskeletal disorders in upper limb. -Neurological disorders, inflammatory and/or degenerative diseases. -Having received as treatment techniques that involve needles on the previous 6 months to study enrollment, or having received dry needling as a treatment before. -Cervical pathology, fibromyalgia, unstable cardiovascular diseases, pregnant women or under suspect of pregnancy. -Contraindications of dry needling: anticoagulant therapy, needle phobia, diabetes, hypothyroidism, lymphoedema, muscular diseases).
Outcome results
None listed