title: Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: a systematic review.
abstract: BACKGROUND
  Several treatments are available to treat epicondylitis. Among these are instrumental electrophysical modalities, ranging from ultrasound, extracorporeal shock wave therapy (ESWT), transcutaneous electrical nerve stimulation (TENS) to laser therapy, commonly used to treat epicondylitis.
  
  
  OBJECTIVE
  To present an evidence-based overview of the effectiveness of electrophysical modality treatments for both medial and lateral epicondylitis (LE).
  
  
  METHODS
  Searches in PubMed, EMBASE, CINAHL and Pedro were performed to identify relevant randomised clinical trials (RCTs) and systematic reviews. Two reviewers independently extracted data and assessed the methodological quality. A best-evidence synthesis was used to summarise the results.
  
  
  RESULTS
  A total of 2 reviews and 20 RCTs were included, all of which concerned LE. Different electrophysical regimes were evaluated: ultrasound, laser, electrotherapy, ESWT, TENS and pulsed electromagnetic field therapy. Moderate evidence was found for the effectiveness of ultrasound versus placebo on mid-term follow-up. Ultrasound plus friction massage showed moderate evidence of effectiveness versus laser therapy on short-term follow-up. On the contrary, moderate evidence was found in favour of laser therapy over plyometric exercises on short-term follow-up. For all other modalities only limited/conflicting evidence for effectiveness or evidence of no difference in effect was found.
  
  
  CONCLUSIONS
  Potential effectiveness of ultrasound and laser for the management of LE was found. To draw more definite conclusions high-quality RCTs examining different intensities are needed as well as studies focusing on long-term follow-up results.
authors: Department of Rehabilitation Medicine and Physical Therapy, Erasmus Medical Center-University Medical Centre Rotterdam, Rotterdam, The Netherlands Department of General Practice, Erasmus Medical Center-University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors: Rudi
authors: R
authors: Dingemanse
authors: Department of Rehabilitation Medicine and Physical Therapy, Erasmus Medical Center-University Medical Centre Rotterdam, Rotterdam, The Netherlands Department of General Practice, Erasmus Medical Center-University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors: Manon
authors: M
authors: Randsdorp
authors: Department of General Practice, Erasmus Medical Center-University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors: Bart W
authors: BW
authors: Koes
authors: Department of Rehabilitation Medicine and Physical Therapy, Erasmus Medical Center-University Medical Centre Rotterdam, Rotterdam, The Netherlands Department of General Practice, Erasmus Medical Center-University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors: Bionka M A
authors: BM
authors: Huisstede
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods; D004599:Electric Stimulation Therapy / Q000379:methods*; D019317:Evidence-Based Medicine; D005081:Exercise Therapy / Q000379:methods; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D008096:Lithotripsy / Q000379:methods; D055909:Magnetic Field Therapy / Q000379:methods; D026882:Manipulation, Chiropractic / Q000379:methods; D008405:Massage / Q000379:methods; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D013716:Tennis Elbow / Q000628:therapy*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods
keywords: Elbow injuries; Evidence based reviews; Muscle injury and inflammation; Tendons; Ultrasound