Combined Physiotherapy in the Approach to Work-Related Epicondylalgia

We will compare two highly popular electrotherapy treatments in physiotherapy: electrolysis and peripheral magnetic stimulation. The duration of the intervention will be 6 weeks. For this purpose, three groups will be established: Control Group: Gold standard treatment. Exercise plus diathermy. Exercise Protocol: -Isometric exercises: On alternate days, 4-5 repetitions of 30 seconds with 1-2 minutes of rest between repetitions, progressively increasing the time up to 45 seconds, at 70% of their calculated maximum voluntary contraction using a dynamometer. -Eccentric exercises: 3 sets of 10 repetitions on alternate days, gradually increasing the load (2.5-5%), aiming for slight discomfort not exceeding 4-5/10 on the pain visual analog scale (EVA). Starting position will be wrist extension, finishing in wrist palmar flexion. -Shoulder muscle strengthening: 3 sets of 15 repetitions, 2-3 days per week, depending on the worker's capacity (sedentary or active individual). This exercise targets the rotator cuff muscles. Patients will work on external and internal rotation, followed by shoulder flexion, shoulder abduction, and shoulder extension exercises with the same parameters (3 sets of 15 repetitions). -Scapula and neck motor control: 3 basic exercises for each area, performing 3 sets of 10 repetitions with a focus on proper execution rather than load. Voluntary contraction of rhomboids, inferior trapezius, and serratus for shoulder stability, and deep flexors and extensors for the neck. They will perform a 10-second contraction with 25% of strength intensity during each 10-second contraction. -Forearm and shoulder muscle stretches: Hold each stretch for 10 seconds and repeat 3 times daily during the treatment period. Diathermy: 60 watts for 10 minutes. Static application with a variation of 250 EP, aiming for a comfortable warm sensation. Applied daily. Intervention Group 1: One session per week (on a day without programmed exercises or after completing exercises). Percutaneous ecoguided electrolysis on the injured tendon: 4-6 sessions maximum, applying one session per week. It involves 350 microseconds of galvanic current for 1 minute and 30 seconds, and 6-7 minutes of microcurrents (150Hz, intensity subthreshold less than 1mA) using the EPTE2 device. - Exercise protocol. -Diathermy: 60 watts for 10 minutes. Static application with a variation of 250 EP, aiming for a comfortable warm sensation. Applied daily. Intervention Group 2: They will receive the same treatment as intervention group 1 plus Radial nerve neuromodulation using peripheral electromagnetic stimulation (Magrex) at 80 Hz, sensory threshold, for 15 minutes daily until the end of the intervention. The application will be located over the shoulder 4 fingers above the epicondyle. The treatments will be conducted in the physiotherapy facility of the work accident insurance company. The various treatments will be administered by the physiotherapists at the center, who have undergone prior training in different techniques and are supervised by a physiotherapist with over 10 years of experience in this type of treatment. All participants must complete more than 80% of the sessions, and attendance will be controlled with a checklist.