An isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy.
BACKGROUND
Lateral epicondylitis represents a frequent overuse injury. In spite of many conservative treatment procedures, prolonged symptoms and relapse are frequently observed.


OBJECTIVE
To compare the outcome of patients performing an isokinetic eccentric training with that of age-, gender-, activity-matched patients receiving a non-strengthening classical rehabilitation.


METHODS
Ninety-two patients with unilateral chronic lateral epicondylar tendinopathy (mean duration of symptoms 8+/-3 months) were assigned either to a control group (n = 46) or to an eccentrically trained group (n = 46). The control group underwent a passive standardised rehabilitation programme that excluded strengthening exercises. In addition to this programme, the trained group also performed eccentric exercises based on the repetitive lengthening of the active musculo-tendinous unit. The latter exercises started with submaximal contraction intensity and slow speed movement. Modalities were progressively intensified (increase in intensity contraction and speed movement) over a long period of treatment. Programme effectiveness was assessed through pain score evaluation, a disability questionnaire, muscle strength measurement and ultrasonographic examination.


RESULTS
Compared to the non-strengthening control group, the following observations were made in the eccentrically trained group: (1) a significantly more marked reduction of pain intensity, mainly after one month of treatment; (2) an absence of strength deficit on the involved side through bilateral comparison for the forearm supinator and wrist extensor muscles; (3) an improvement of the tendon image as demonstrated by decreasing thickness and a recovered homogenous tendon structure; and (4) a more marked improvement in disability status during occupational, spare time and sports activities.


CONCLUSIONS
These results highlight the relevance of implementing isokinetic adapted eccentric training in the management of chronic lateral epicondylar tendinopathy.
Croisier
Jean-Louis
JL
Department of Physical Medicine and Rehabilitation, University of Liege, CHU Sart Tilman, Liege, Belgium. jlcroisier@ulg.ac.be
Foidart-Dessalle
Marguerite
M
Tinant
France
F
Crielaard
Jean-Michel
JM
Forthomme
Bénédicte
B
D000328:Adult; D016022:Case-Control Studies; D002908:Chronic Disease; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement; D013716:Tennis Elbow / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D014463:Ultrasonography