Lateral Epicondylitis
Conditions
Keywords
scapular PNF, scapular proprioceptive neuromuscular facilitation exercise, shoulder strengthening exercises
Brief summary
The purpose of this study is to compare between the effect of scapular proprioceptive neuromuscular facilitation versus shoulder and scapular strengthening exercise on pain, functional outcome and grip strength in patients with lateral epicondylitis.
Detailed description
There is no standard treatment for lateral epicondylitis, it is always a combination of physical therapy modalities aimed to reduce pain and increase the ability to return functional activities participation. Accordingly, many researchers have added shoulder strengthening exercise to the rehabilitation plan for treating lateral epicondylitis. Consequently, development of new concept of scapula motor control exercise using proprioceptive neuromuscular facilitation to add proximal stability to patients with lateral epicondylitis may be beneficial. We believe that this study can serve as a step toward documenting the evidence of scapular proprioceptive neuromuscular facilitation exercise in the treatment of patients with lateral epicondylitis which was not available before. Patients with lateral epicondylitis will be recruited after approval of ethical committee of the faculty of physical therapy, Cairo University. All participants will sign a written informed consent form. After group assignment, patients' demographics will be collected, and then assessment of pain, function and grip strength will be performed. The same assessment procedure will be conducted by the end of the treatment (by the end of the 12th visit). The study will be two comparative groups, pre-post experimental design, the subjects will be randomly assigned into one of two groups: * Group (I) : will receive scapular proprioceptive neuromuscular facilitation exercises. * Group (II) : will receive shoulder strengthening exercises.
Interventions
OTHERScapular PNF
Scapular proprioceptive neuromuscular facilitation exercise: will be applied in two diagonals: 1. anterior elevation and posterior depression 2. posterior elevation and anterior depression for 3 sets of 10 repetitions, The rest interval between sets will be 20 seconds. Patients will lay on the unaffected side while the therapist stands in the line of desired motion. Firstly, the therapist will give preparatory instructions. In the beginning of the pattern, the therapist pulls the scapula to the elongated position and then gives instructions for the desired movement.
Shoulder strengthening exercises: The following four exercises will focus on shoulder and scapular strengthening. Before starting the program, the patients will be thoroughly instructed in the four exercises, and illustrations with specific exercise instructions will be provided. All subjects will perform the exercises with the affected side for three sets of 10 repetitions for each exercise, with a 1-minute rest between sets. 1. Standing shoulder external rotation with elastic resistance. 2. Bilateral external rotation with scapular retraction exercise. 3. Resisted scapular retraction with shoulder external rotation (Middle trapezius muscle). 4. Weighted scapular retraction and downward rotation Y-shape (lower trapezius muscle).
Sponsors
Cairo University
Mahmoud Essam Abu Elfetouh Ghallab
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* Patients will be included if they have the following criteria: * Fifty-two male and female subjects. * Patients complaining of chronic lateral epicondylitis (more than three months). * Age between 20-50.
Exclusion criteria
* Patients will be excluded if they had any of the following conditions: * Received physiotherapy in last 3 months. * Received corticosteroids injection in lateral epicondyle in last 3 months. * Receiving anti-inflammatories medications on regular basis. * Had neurologic problems in shoulder, neck and thoracic regions. * Had history of rheumatic disease. * Had cooperation difficulties due to cognitive disorders. All Patients will be instructed to keep away from activities that aggravate the symptoms such as grasping, lifting, knitting and using a screwdriver during the treatment period.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain intensity by The Numeric Pain Rating Scale (NPRS) | one month | (NPRS) is a unidimensional measure of pain intensity in adults. Consists of 11-item NPRS. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g., no pain) to '10' representing the other pain extreme (e.g., pain as bad as you can imagine or worst pain imaginable. |
| Pain and functional disability by patient-rated tennis elbow evaluation (PRTEE) | one month | The PRTEE is a valid and reliable tool that may be used in both research and clinical settings to assess the subjective outcome in patient with lateral epicondylitis. Subjects will be asked to rate the level of discomfort and difficulty they had encountered in the previous week. High total scores imply more pain and impairment; the scale spans from 0 to 100. The PRTEE is a 15-item questionnaire designed to measure forearm pain and disability in patients with LE. The PRTEE allows patients to rate their levels of pain and disability from 0 to 10, and consists of 2 subscales: 1. PAIN subscale (0 = no pain, 10 = worst imaginable) • Pain - 5 items 2. FUNCTION subscale (0 = no difficulty, 10 = unable to do) * Specific activities - 6 items * Usual activities - 4 items |
| Grip strength by Jammar handheld dynamometer. | one month | The Jammar hand grip dynamometer is valid and reliable, will be used to assess the subject's pain-free grip strength while they are lying on their side with their elbow extended and pronated. Subjects will be instructed to squeeze the dynamometer handles until they experienced pain. It will be performed three times with 20 s rest period between repetitions. Average of three trials will be recorded in kilograms. |
Countries
Egypt
Contacts
Primary ContactMahmoud Ghallab, Master
Backup ContactMohamed Ahmed, Lecturer
Outcome results
None listed