Effects of Eccentric Exercises Along With Muscle Energy Technique in Lateral Epicondylitis

Overview

This study is intended to find the effects of Eccentric exercises along with muscle energy technique (MET) on pain, functional disability, range of motion and grip strength in Lateral Epicondylitis. For this trial, participants will be enrolled with their consent after assessing on basis of inclusion \& exclusion criteria from orthopedic workshop, Jinnah post graduate medical center Karachi. Total of 66 participants will be recruited and will be equally randomized into three groups consisting of 22 participants in each group. They would recruit into either Eccentric exercise (EE) along with MET group (group A) or MET group (group B) or EE group (group C). Participants will be allocated to intervention by sealed envelope method and will undergo a total of 8 treatment sessions within 2 weeks. Baseline assessment will carry out before treatment on 1st session and follow-up assessment on 8th session after treatment through tool named as Numeric Pain-Rating Scale (NPRS), Patient Rated Tennis Elbow Evaluation (PRTEE), Goniometer and Handheld dynamometer.

Lateral epicondylitis is one of the commonest reason of lateral elbow pain that affects 1-3% of the general population of middle-aged adults. A large population-based study of United States estimated its incidence as 3.4 cases per 1000 person annually with peak rates for 40-60 years old age group ranging between 7% and 10%. Lateral epicondylitis (LE) or tennis elbow is simply a myotendinosis of the forearm extensor muscles that frequently associate with overuse injury due to repetitive strain by activities which impose excessive loads on common extensor tendinous origin at lateral epicondyle. Commonly this has been reported in those who engaged in activities which consist of repetitive wrist extension, radial deviation, gripping and/or forearm supination. It leads to localized pain and tenderness at lateral epicondyle and along with the common extensor mass of the elbow making seemingly simple daily activities more difficult. This exaggerated with activities involving resisted wrist extension, middle finger extension, and forearm supination with extended elbow. The most common functional concern in LE is weak grip and restricted supination. A vast number of physical therapy treatments such as different manual therapy techniques, exercise programs and modalities have been used. However eccentric training and manual therapy are the two most commonly used and beneficial physiotherapeutic treatment strategies. Eccentric exercises have been suggested as first line treatment approach in conservative treatment as it improves overall function by lengthening the musculotendinous unit with low intensity load. It promotes healing and remodeling to increase collagen production and reduce pain by inhibiting pain neural pathways. Muscle energy technique (MET), a gentle manual therapy, is effective in addressing both myofascial issues and articular restrictions. It involves a patient's muscle contractions in a controlled position and direction against therapist's counterforce. Recently, international evidence supported its use in LE as a suitable intervention in this pathology and highlight its potential in reducing pain and improving grip and finger strength, and functionality in addition to home stretching and strengthening exercise. Available literature in targeted population mainly evaluated effects of MET with other treatment techniques like corticosteroids, dry needling, movement with mobilization (MWM), friction massage etc. However, there is very limited literature available on using MET with eccentric exercise as a multimodal treatment for lateral epicondylitis which can point out whether using these two as a combination has better efficacy than alone. This manual therapy technique in combination of eccentric exercises, which has not been extensively studied in the context of lateral epicondylitis, can potentially enhance the therapeutic effects and provide new insights into the treatment and give more effective and tolerable strategy. So, the goal of this trial is to find effects of eccentric exercise along with MET as combined therapy in treating Lateral epicondylitis.