title: Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review.
abstract: BACKGROUND
  Owing to the change in paradigm of the histological nature of epicondylitis, therapeutic modalities as exercises such as stretching and eccentric loading and mobilisation are considered for its treatment.
  
  
  OBJECTIVE
  To assess the evidence for effectiveness of exercise therapy and mobilisation techniques for both medial and lateral epicondylitis.
  
  
  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.
  
  
  RESULTS
  One review and 12 RCTs, all studying lateral epicondylitis, were included. Different therapeutic regimes were evaluated: stretching, strengthening, concentric/eccentric exercises and manipulation of the cervical or thoracic spine, elbow or wrist. No statistical pooling of the results could be performed owing to heterogeneity of the included studies. Therefore, a best-evidence synthesis was used to summarise the results. Moderate evidence for the short-term effectiveness was found in favour of stretching plus strengthening exercises versus ultrasound plus friction massage. Moderate evidence for short-term and mid-term effectiveness was found for the manipulation of the cervical and thoracic spine as add-on therapy to concentric and eccentric stretching plus mobilisation of wrist and forearm. For all other interventions only limited, conflicting or no evidence was found.
  
  
  CONCLUSIONS
  Although not yet conclusive, these results support the belief that strength training decreases symptoms in tendinosis. The short-term analgesic effect of manipulation techniques may allow more vigorous stretching and strengthening exercises resulting in a better and faster recovery process of the affected tendon in lateral epicondylitis.
authors.affiliation: Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC-University Medical Center Rotterdam, , Rotterdam, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Hoogvliet
authors.forename: Manon S
authors.initials: MS
authors.lastname: Randsdorp
authors.forename: Rudi
authors.initials: R
authors.lastname: Dingemanse
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Bionka M A
authors.initials: BM
authors.lastname: Huisstede
mesh_terms: D026241:Exercise Movement Techniques; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D026882:Manipulation, Chiropractic / Q000379:methods; D008405:Massage / Q000379:methods*; D026201:Musculoskeletal Manipulations / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013716:Tennis Elbow / Q000628:therapy*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods
keywords: Eccentric exercise; Elbow injuries; Evidence based reviews; Exercise rehabilitation; Intervention effectiveness