ArticlePDF AvailableLiterature Review

Abstract

Tennis elbow or lateral epicondylitis is one of the most common lesions of the arm with a well defined clinical presentation, which significantly impacts on the community. Many treatment approaches have been proposed to manage this condition. One is Cyriax physiotherapy. The effectiveness and reported effects of this intervention are reviewed.
REVIEW
Cyriax physiotherapy for tennis elbow/lateral epicondylitis
D Stasinopoulos, M I Johnson
...............................................................................................................................
Br J Sports Med 2004;38:675–677. doi: 10.1136/bjsm.2004.013573
Tennis elbow or lateral epicondylitis is one of the most
common lesions of the arm with a well defined clinical
presentation, which significantly impacts on the
community. Many treatment approaches have been
proposed to manage this condition. One is Cyriax
physiotherapy. The effectiveness and reported effects of this
intervention are reviewed.
...........................................................................
See end of article for
authors’ affiliations
.......................
Correspondence to:
D Stasinopoulos, 16
Orfanidou Street, Athens
11141, Greece;
d_Stasinopoulos@
yahoo.gr
Accepted 11 May 2004
.......................
T
ennis elbow (lateral epicondylitis) is one of
the most common lesions of the arm. This
disorder challenges the clinician daily, as it is
an injury that is difficult to treat, is prone to
recurrent bouts, and may last for several weeks
or months. The average duration of a typical
episode of tennis elbow is between six months
and two years.
1
It is a degenerative or failed healing tendon
response characterised by the increased presence
of fibroblasts, vascular hyperplasia, and disorga-
nised collagen in the origin of the extensor carpi
radialis brevis, the most commonly affected
structure.
2
It is generally a work related or sport related
pain disorder with macroscopic and microscopic
tears in the extensor carpi radialis brevis, usually
caused by excessive quick, monotonous, repeti-
tive eccentric contractions and gripping activities
of the wrist.
34
The dominant arm is commonly
affected, with a prevalence of 1–3% in the
general population, but this increases to 19% at
30–60 years of age and appears to be more long
standing and severe in women.
56
It has a well defined clinical presentation, the
main complaints being pain and decreased grip
strength, both of which may affect activities of
daily living. Diagnosis is simple and can be
confirmed by tests that reproduce the pain, such
as palpation over the facet of the lateral
epicondyle, resisted wrist extension, resisted
middle finger extension, and passive wrist
flexion.
7
‘‘Such a variety of treatment options suggests
that the optimal treatment strategy is not
known’’
Although the signs and symptoms of tennis
elbow are clear and its diagnosis is easy, to date
no ideal treatment has emerged. A myriad of
conservative treatments have been used. Over 40
different methods have been reported in the
literature.
8
These treatments have different theor-
etical mechanisms of action, but all have the
same aim, to reduce pain and improve function.
Such a variety of treatment options suggests that
the optimal treatment strategy is not known, and
more research is needed to discover the most
effective treatment in patients with tennis elbow.
A common intervention is Cyriax physiother-
apy. The purpose of this article is to describe its
use in the treatment of tennis elbow and its
effects.
CYRIAX PHYSIOTHERAPY
Cyriax and Cyriax
9
claimed substantial success in
treating tennis elbow using deep transverse
friction (DTF) in combination with Mill’s manip-
ulation, which is performed immediately after
DTF. For it to be considered a Cyriax interven-
tion, the two components must be used together
in the order mentioned. Patients must follow the
protocol three times a week for four weeks.
910
Deep transverse friction
Although the word friction is technically incor-
rect and would be better replaced by ‘‘massage’’,
this name will be used in this article. DTF is a
specific type of connective tissue massage applied
precisely to the soft tissue structures such as
tendons. It was developed in an empirical way by
Cyriax and Cyriax and is currently used exten-
sively in rehabilitation practice.
11–15
It is vital that DTF be performed only at the
exact site of the lesion, with the depth of friction
tolerable to the patient.
910121416
The effect is so
localised that, unless the finger is applied to the
exact site and friction given in the right direc-
tion, relief cannot be expected.
9101415
DTF must
be applied transversely to the specific tissue
involved, unlike superficial massage given in the
longitudinal direction parallel to the vessels,
which enhances circulation and return of fluids.
9
The therapist’s fingers and patient’s skin must
move as a single unit, otherwise subcutaneous
fascia could lead to blister formation or sub-
cutaneous bruising.
14
As a general guideline, DTF is applied for
10 minutes after the numbing effect has been
achieved, every other day or at a minimum
interval of 48 hours, because of the traumatic
hyperaemia induced, to prepare the tendon for
the manipulation.
910121416
There is only empiri-
cal evidence to support the times suggested
above. Unfortunately, the technique has devel-
oped a reputation for being very painful.
15 17 18
However, pain during friction massage is usually
the result of a wrong indication, a wrong
technique, or an unaccustomed amount of
pressure. If this form of massage is applied
correctly, it will quickly result in an analgesic
effect over the treated area and is not at all
painful for the patient.
9101416
On the other hand,
treating clinicians claim this technique places
considerable strain on their hands.
34121319
675
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There is very little scientific evidence on mode of action
and effectiveness of DTF. Only a few studies exist, and more
research is urgently needed. However, although the exact
mode of action is not known, some theoretical explanations
have been put forward. It has been hypothesised, with no
scientific proof, that DTF has a local pain diminishing effect
and results in better alignment of connective tissue fibrils.
It is a common clinical observation that application of DTF
leads to immediate pain relief: the patient experiences a
numbing effect during the session, and reassessment
immediately after shows reduction in pain and increase in
strength and mobility.
15
A number of hypotheses to explain
the pain relieving effect of DTF have been put forward.
Pain relief during and after DTF may be due to modulation
of the nociceptive impulses at the level of the spinal cord: the
‘‘gate control theory’’. The centripetal projection into the
dorsal horn of the spinal cord from the nociceptive receptor
system is inhibited by the concurrent activity of the
mechanoreceptors located in the same tissues.
16 20
According
to Cyriax and Cyriax,
9
DTF also leads to increased destruction
of pain provoking metabolites, such as Lewis’s substances.
This metabolite, if present in too high a concentration, causes
ischaemia and pain. It has also been suggested that a
10 minute DTF treatment of a localised area may give rise to
lasting peripheral disturbance of nerve tissue, with local
anaesthetic effect.
15
Another mechanism by which reduction
in pain may be achieved is through diffuse noxious inhibitory
controls, a pain suppression mechanism that releases
endogenous opiates. The latter are inhibitory neurotransmit-
ters which diminish the intensity of the pain transmitted to
higher centres.
20 21
In addition, the application of DTF can produce therapeutic
movement by breaking down the strong cross links or
adhesions that have been formed, softening the scar tissue
and mobilising the cross links between the mutual collagen
fibres and the adhesions between repairing connective tissue
and surrounding tissues.
14 16 20 22
Moreover clinicians claim,
without support from clinical studies, that the rhythmical
transverse stress of DTF stimulates fibre orientation with the
result of enhancing tensile strength.
14 15
Finally, DTF produces vasodilatation and increased blood
flow to the area. This may facilitate the removal of chemical
irritants and increase the transportation of endogenous
opiates, resulting in a decrease in pain.
14 16 20 22
Absolute contraindications to DTF are few. It is never
applied to active infections, bursitis and disorders of nerve
structures, ossification and calcification of the soft tissues, or
active rheumatoid arthritis, and care is required if there
is fragile skin or the patient is having anticoagulant
treatment.
9101415
DTF for tennis elbow is applied as follows.
910
Position the
patient comfortably with the elbow fully supinated and in 90
˚
of flexion. Locate the anterolateral aspect of the lateral
epicondyle (facet of the lateral epicondyle, where the
extensor carpi radialis brevis inserts, the most common site
of pain in patients with tennis elbow, as mentioned in the
introduction), and identify the area of tenderness. Apply DTF
with the side of the thumb tip, applying the pressure in a
posterior direction on the teno-osseous junction. Maintain
this pressure while imparting DTF in a direction towards your
fingers, which should be positioned on the other side of the
elbow for counter pressure. DTF is applied for 10 minutes
after the numbing effect has been achieved, to prepare the
tendon for Mill’s manipulation.
Mill’s manipulation
Mill’s manipulation is the most common manipulative
technique used by physiotherapists.
12 13 23
Cyriax and Cyriax
9
state that it should be performed immediately after the DTF
provided that the patient has a full range of passive elbow
extension. If passive elbow extension is limited, the
manipulative thrust will affect the elbow joint, rather than
the common extensor tendon, possibly causing traumatic
arthritis.
910
It is defined as a passive movement performed at
the end of range—that is, once all the slack has been taken
up—and is a minimal amplitude, high velocity thrust.
910
The
aim of this technique, again without properly designed
controlled studies to prove this, is to elongate the scar tissue
by rupturing adhesions within the teno-oseous junction,
making the area mobile and pain free.
9121323
Mill’s manipulation for tennis elbow should be conducted
as follows.
91023
Position the patient on a chair with a backrest
and stand behind the patient. Support the patient’s arm
under the crook of the elbow with the shoulder joint
abducted to 90
˚
and medially rotated. The forearm will
automatically fall into pronation. Place the thumb of your
other hand in the web space between the patient’s thumb
and index finger and fully flex the patient’s wrist and pronate
the forearm. Move the hand supporting the crook of the
elbow on to the posterior surface of the elbow joint and,
while maintaining full wrist flexion and pronation, extend
the patient’s elbow until you feel that all the slack has been
taken up in the tendon. Step sideways to stand behind the
patient’s head, taking care to prevent the patient from
leaning away either forwards or sideways, which would
reduce the tension on the tendon. Apply a minimal
amplitude, high velocity thrust by simultaneously side
flexing your body away from your arms and pushing smartly
downwards with the hand over the patient’s elbow.
Cyriax and Cyriax
9
cautioned that, if poor manipulation is
performed by failing to maintain full wrist flexion, the thrust
is absorbed mainly by the elbow joint, potentially causing
traumatic arthritis. Depending on the magnitude of the
thrust, full wrist flexion probably does little to protect the
joint from such a manipulation if this is a really serious
consideration.
This manoeuvre is conducted once only at each treatment
session because it is not a comfortable procedure for the
patient, and the effects of treatment often become fully
apparent over the following few days.
91023
Studies in which Cyriax physiotherapy for tennis
elbow has been used
Computerised searches were performed using Medline (from
1966 to March 2004), Embase (from 1988 to March 2004),
Cinahl (from 1982 to March 2004), Index to Chiropractic
literature (from 1992 to March 2004), and Chirolars (from
1994 to March 2004) databases. Only English language
publications were considered. The search terms ‘‘tennis
elbow’’, ‘‘lateral epicondylitis’’, ‘‘Cyriax physiotherapy’’,
‘‘treatment’’, ‘‘management’’, ‘‘physiotherapy’’, ‘‘randomised
control trials’’ were used individually or in various combina-
tions. Other references identified from existing reviews and
other papers cited in the publications were searched.
Moreover, we tried to identify further citations from the
reference sections of papers retrieved, by contacting experts
in the field, and from the Cochrane Collaboration, an
international network of experts who search journals for
relevant citations, but we did not find any more studies.
Unpublished reports and abstracts were not considered.
Only one study was found in which Cyriax physiotherapy
had been used in the management of tennis elbow. Verhaar
et al
24
compared the effects of corticosteroid injections with
Cyriax physiotherapy in treating patients with tennis elbow.
The results showed that the corticosteroid injection was
significantly more effective on the outcome measures (pain,
function, grip strength, and global assessment) than Cyriax
physiotherapy at the end of the treatment, but at the follow
676 Stasinopoulos, Johnso n
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up one year after the end of treatment, there were no
significant differences between the two treatment groups.
This study is not helpful for practicing physiotherapists,
because most do not use injections to manage this condition.
It is better to compare Cyriax physiotherapy with other
physiotherapy treatments in order to assess its effects. In two
studies,
419
only DTF was used to treat patients rather than all
the components of Cyriax physiotherapy. Therefore we do not
know if Cyriax physiotherapy, which is mainly based on
clinicians’ claims, is effective as the sole treatment for tennis
elbow or if it is better than other methods. Randomised
controlled trials are needed to confirm the clinicians’ claims.
CONCLUSIONS
Although Cyriax physiotherapy is commonly used in the
treatment of tennis elbow, more research is needed to assess
firstly its effectiveness and secondly the effects of both its
components.
Authors’ affiliations
.....................
D Stasinopoulos, Centre of Rheumatology and Rehabilitation, Leeds
Metropolitan University, Leeds, UK
M I Johnson, Leeds Metropolitan University
Conflict of interest: none declared
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Cyriax physiotherapy for tennis elbow 677
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... A conservative approach is advocated by many clinicians as the treatment of choice for LET [2,3,7,8]. Physiotherapy is usually recommended for LET patients [2][3][4][5][6][7][8][9]. A wide array of physiotherapy treatments has been recommended for the management of LET [10][11][12][13][14]. ...
... Such a variety of treatment techniques suggests that the optimal treatment management is not known, and more research is needed to find out the most effective treatment approach in patients with LET [10][11][12][13][14]. An exercise programme is the most common physiotherapy treatment for LET [2][3][4][5][6][7][8][9][10][11][12][13][14]. There are two types of exercise programs: home exercise programs and exercise programs carried out in a clinical setting. ...
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Background: One of the two most common tendinopathies of the upper limb is Lateral elbow Tendinopathy (LET). An exercise programme consisting of static stretching exercises of wrist extensors, isometric of wrist extensors, concentric – eccentric training of wrist extensors, Tendon Neuroplastic Training (TNT) of wrist extensors, and strengthening of rotator cuff, scapula muscles exercises and supinator has been recommended for the management of LET. Radial Extracorporeal shockwave therapy (RESWT) is usually used as a supplement to exercise programme. The purpose of the present article will be to make a comparison of the effects of an exercise programme consisting of TNT of wrist extensors, static stretching exercises of wrist extensors, isometric of wrist extensors, concentric – eccentric training of wrist extensors and strengthening of supinator, rotator cuff and scapula muscles exercises and RESWT in the painful point and an exercise programme consisting of TNT of wrist extensors, static stretching exercises of wrist extensors, isometric of wrist extensors, concentric – eccentric training of wrist extensors and strengthening of supinator, rotator cuff and scapula muscles exercises and RESWT, scanning and painful (sensitive) point for the treatment of LET. Methods/Design: LET patients will participate in this randomized clinical trial (RCT). Patients will be allocated to two groups randomly. Group A will be treated with TNT of wrist extensors, static stretching exercises of wrist extensors, isometric of wrist extensors, concentric – eccentric training of wrist extensors and strengthening of supinator, rotator cuff and scapula muscles exercises and RESWT in the painful point and group B will be treated with TNT of wrist extensors, static stretching exercises of wrist extensors, isometric of wrist extensors, concentric – eccentric training of wrist extensors and strengthening of supinator, rotator cuff and scapula muscles exercises and RESWT, scanning the relative area and painful (sensitive) point. All patients will receive 20 treatments totally of exercise programme (5 treatments / week for 4 weeks). RESWT will be administered without anaesthesia in 3 treatment sessions held at weekly intervals (2000 shocks for painful site and 4000 shocks for scanning the relative area and painful (sensitive) point; 8 Hz; 2,5 bars). Pain (visual analogue scale; Patient-Rated Tennis Elbow Evaluation), function (visual analogue scale; Patient-Rated Tennis ElbowEvaluation) and pain-free grip strength will be evaluated at the end of treatment, at 3 months follow-up and at 6 months follow up. The independent t test will be used to determine the differences between groups. A paired t test will be used to determine the difference within groups. The level for statistical significance will be 5% level of probability. SPSS 21.00 will be used for the statistical analysis. Discussion: The present RCT will be evaluate the effectiveness of two different applications of RESWT as a supplement to exercise programme in patients with LET. Trial Registration: The Ethics Committee of the University of West Attica will approve the study.
... However, the effect of exercise in pain reduction and disability is small and a significant proportion of patients seem to respond adequately even to a wait-and-see policy at one-year follow-up (Bisset, 2006;Karanasios, 2020;Smidt, 2002a). At the same time, despite limited or inconclusive evidence for the effectiveness of specific interventions in LET such as corticosteroid injections, orthoses, deep transverse friction massage combined with Mill's manipulation (Stasinopoulos and Johnson, 2004), acupuncture, high and low-intensity laser (Lian et al., 2019a;Long et al., 2015;Karanasios et al., 2021b;Stasinopoulos, 2021) they remain very popular in clinical practice (Harland and Livadas, 2020;BatemanTitch-enerClarkTambe, 2017). A survey report (BatemanTitch-enerClarkTambe, 2017) among UK practitioners including physiotherapists, surgeons and occupational therapists has identified a significant evidence-to-practice gap in the management of the condition, reporting that up to 27% of responders select second-line treatment options (corticosteroid injections, extracorporeal shockwave therapy and acupuncture). ...
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... Although it affects equally females and males, it lasts longer and more severely in females than in males. Usually, the onset of TE is gradual due to repeated movements and strain injuries with increasing symptoms over time as the pain is described as severe and profound with a decrease in grip strength and functional ability of the upper limb [5][6]. In some cases, the severity of symptoms in lateral epicondylitis improves without any interventions within 6 to 24 months. ...
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Background: Tennis elbow (TE) is a common disorder of the upper extremities that occurs due to powerful grip and repetitive motions in the wrist joint during various activities. Although several management strategies have discussed some of the methods used to reduce pain and improve elbow and wrist movements, the use of new approaches remains a vigorous option to reach the maximum degree of improvement and complete recovery. Aim: The current study aimed to investigate the effect of Transcutaneous electrical nerve stimulation (TENS) and cupping therapy in treating TE. Methods: One hundred and twenty patients between the ages of 20 and 50 years of both sexes complained of tennis elbow. They were divided randomly into four groups. Group A (n=30) received conventional treatment, group B (n=30) received TENS in addition to conventional treatment, group C (n=30) received cupping therapy with conventional treatment, and group D (n=30) received TENS and cupping therapy plus conventional treatment. Visual analog scale (VAS) was used to assess pain intensity, a hand dynamometer was used to measure pain-free grip strength (PFGS), and a patient-rated tennis elbow evaluation (PRTEE) questionnaire was used to measure pain and disability of the forearm before and after four weeks. Results: There was a significant decrease in VAS, PRTEE score, and an increase in PFGS favoring group D compared to the other groups post-treatment (p < 0.001). Conclusion: The combination of TENS and cupping therapy results in better improvement in TE treatment than conventional therapy, TENS, and cupping therapy alone.
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Aims: To see the effectiveness of supervised exercises and cyriax physiotherapy both including therapeutic ultrasound for improving pain and function in adults with lateral epicondylitis. Study Design: Comparative study- to find out the efficacy of effectiveness of two different interventions for reducing pain and improving function in patients with lateral epicondylitis Place and Duration of Study: Department of Musculoskeletal Physiotherapy Sciences, Ravi Nair Physiotherapy College, Sawangi (Meghe), Wardha, for 12 months. Methodology: A total of 30 people with lateral epicondylitis (tennis elbow) were selected to take part in a comparative research. Subjects were randomized 1:1 to either (1) supervised exercise programme group, or (2) cyriax physiotherapy group. Over just a 4-week period, three times each week for a sum of 12 sessions, promptly after baseline evaluation and randomization, subjects received static stretching of Extensor Carpi Radialis Brevis followed by eccentric strengthening of the wrist extensors and Therapeutic Ultrasound in supervised exercise programme group. While those in cyriax physiotherapy group received deep transverse friction massage for 10 min immediately followed by Mill’s manipulation and Ultrasound. The study concluded at the 4 weeks. Results: Out of 30 patients half were placed in each group, where p=.0001. Significant increase in mean in the group I and II in pre ad post-test VAS score (4.20±0.77 and 5.20±0.67) and TEFS score pre and post-test (17.33±1.44 and 19.80±1.42). analysis showed significant improvement in both the groups. Conclusion: From the observations and results, the conclusion drawn that there is significant improvement in both the groups but effect of cyriax physiotherapy in the form of deep friction massage and mills manipulation combined with therapeutic ultrasound for improving pain on VAS and function on TEF scale.
... Another mechanism by which reduction in pain may be achieved is through diffuse noxious inhibitory controls, a pain suppression mechanism that releases endogenous opiates. The latter are inhibitory neurotransmitters which diminish the intensity of the pain transmitted to higher center (Stasinopoulos, 2004). The present study showed that both Gong's mobilization and Cyriax manipulation are statistically and clinically significant in improving shoulder abduction mobility and reducing SPADI score following 2 weeks of intervention. ...
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... The aim of this section is to present evidence of the mechanisms of these interventions to directly address the pathology in the context of Cook's model of continuum of tendinopathy. 37 Proof of principle studies of interventions directly interacting with the involved tissues aim to enhance healing of the degenerative LE tissues by various cellular mechanisms, such as promoting protein synthesis within the fibroblast cells [76][77][78] , managing vascularity, 78 , 79 , 80 transforming collagen structure, 81 changing gamma motor tone of muscle, 82 better aligning connective tissue fibrils, 77 83,84 modulating nociceptive impulses, 85 enhancing extracellular matrix modification, 87 and neuromodulation. 78 Other treatments aim to unload involved tissues, such as altering the line of force production applied to the tendinous structure, or reducing force production or resting involved tissues by partial or full immobilization. ...
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Background Common treatments for lateral epicondylosis focus on tissue healing. Ergonomic advice is suggested broadly, but recommendations based on biomechanical motion parameters associated with functional activities are rarely made. This review analyzes the role of body functions and activities in lateral epicondylosis and integrates the findings to suggest motion parameters applicable to education and interventions relevant to activities and life roles for patients. Purpose This study examines lateral epicondylosis pathology, tendon and muscle biomechanics, and population exposure outlining potentially hazardous activities and integrates those to provide motion parameters for ergonomic interventions to treat or prevent lateral epicondylosis. A disease model is discussed to align treatment approaches to the stage of LE tendinopathy. Study Design Integrative review Methods We conducted in-depth searches using PubMed, Medline, and government websites. All levels of evidence were included, and the framework for behavioral research from the National Institutes of Health was used to synthesize ergonomic research. Results The review broadened the diagnosis of lateral epicondylosis from a tendon ailment to one affecting the enthesis of the capitellum. It reinforced the continuum of severity to encompass degeneration as well as regeneration. Systematic reviews confirmed the availability of evidence for tissue-based treatments, but evidence of well-defined harm reducing occupational interventions was scattered amongst evidence levels. Integration of biomechanical studies and population information gave insight into types of potentially hazardous activities and provided a theoretical basis for limiting hazardous exposures to wrist extensor tendons by reducing force, compression, and shearing during functional activities. Conclusions These findings may broaden the first treatment approach from a passive, watchful waiting into an active exploration and reduction of at-risk activities and motions. Including the findings into education modules may provide patients with the knowledge to lastingly reduce potentially hazardous motions during their daily activities, and researchers to define parameters of ergonomic interventions.
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Background: Lateral epicondylitis is a tendinopathy with a prevalence of between 1-3% of the population aged 35-54 years. It is a pathology with a favorable evolution, but with frequent recurrences (which imply an economic extra cost). Objective: The objective of this review was to determine the efficacy of physiotherapy treatment for the treatment of epicondylitis and, if any, to identify the most appropriate techniques. Methods: A systematic search was carried out in October 2020 in the databases of PubMed, Cinahl, Scopus, Medline and Web of Science using the search terms: Physical therapy modalities, Physical and rehabilitation medicine, Rehabilitation, Tennis elbow and Elbow tendinopathy. Results: Nineteen articles were found, of which seven applied shock waves, three applied orthoses, three applied different manual therapy techniques, two applied some kind of bandage, one applied therapeutic exercise, one applied diacutaneous fibrolysis, one applied high intensity laser, and one applied vibration. Conclusions: Manual therapy and eccentric strength training are the two physiotherapeutic treatment methods that have the greatest beneficial effects, and, furthermore, their cost-benefit ratio is very favorable. Its complementation with other techniques, such as shock waves, bandages or Kinesio® taping, among others, facilitates the achievement of therapeutic objectives, but entails an added cost.
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Lateral epicondylitis is a common condition treated by many physical therapists. Although multiple treatment methods exist, scientific research has found that few have been consistently effective in treating lateral epicondylitis. Initially, lateral epicondylitis is often treated with rest, ice, braces and/or injections. When the condition is chronic or not responding to initial treatment, physical therapy is introduced. Common therapeutic modalities often utilized are ultrasound, phonophoresis, electric stimulation, manipulation, soft tissue mobilization, neural tension, friction massage, ASTM AdvantEDGE™, in addition to stretching and strengthening exercises. ASTM AdvantEDGE™ is becoming a more standard treatment process owing to its ability to help with the detection in changes in the soft tissue texture as the patient progresses through the therapeutic process. Laser and acupuncture are also becoming more popular. Finally, in resistant cases of lateral epicondylitis, patients can receive surgery. In all, there are over 40 different treatment methods reported in the literature. Further research efforts are needed to determine which methods are most effective.
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The purposes of this study were to determine whether ultrasound and a 10% hydrocortisone ointment (phonophoresis) was superior to ultrasound and a placebo ointment, and to determine whether friction massage was superior to no friction, in patients with the clinical diagnosis of extensor carpi radialis tendinitis (proximal tendon). Forty consecutive lateral epicondylitis patients fulfilling the eligibility criteria were entered into the study. Using a 2 by 2 factorial design, the patients were stratified on the basis of pain-free grip strength. They were then randomly assigned to 1 of the 4 treatment groups. The patients' outcomes were assessed following 9 treatments within 5 weeks of the initial visit. No one therapy was demonstrated to be superior to another; however, site of lesion and history of a prior occurrence were found to be predictors of outcome, independent of therapy. The results suggest that the most cost-effective method of treating the lateral epicondylitis patient is by ultrasound alone.
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Lateral epicondylitis is a common condition treated by many physical therapists. Although multiple treatment methods exist, scientific research has found that few have been consistently effective in treating lateral epicondylitis. Initially, lateral epicondylitis is often treated with rest, ice, braces and/or injections. When the condition is chronic or not responding to initial treatment, physical therapy is introduced. Common therapeutic modalities often utilized are ultrasound, phonophoresis, electric stimulation, manipulation, soft tissue mobilization, neural tension, friction massage, ASTM AdvantEDGE™, in addition to stretching and strengthening exercises. ASTM AdvantEDGE™ is becoming a more standard treatment process owing to its ability to help with the detection in changes in the soft tissue texture as the patient progresses through the therapeutic process. Laser and acupuncture are also becoming more popular. Finally, in resistant cases of lateral epicondylitis, patients can receive surgery. In all, there are over 40 different treatment methods reported in the literature. Further research efforts are needed to determine which methods are most effective.
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