Eccentric exercises have been successfully used in the treatment of Achilles and patellar tendinopathies, as well as lateral epicondylalgia. No studies have explored the same treatment for medial epicondylalgia (golfer's elbow).
Methods
Twenty consecutive adults with a clinical diagnosis of medial epicondylalgia were treated with eccentric exercise over 3 months in this prospective case series. The programme was based on home training. There were 11 women and nine men, with a mean age of 47 years, and a mean duration of symptoms of 19 months. At baseline, at 3 months and after a mean of 11 years, pain was assessed by three independent visual analogue scales (VAS) and grip strength using a Jamar dynamometer (Sammons Preston Inc., Jackson, MI, USA). At the 11-year follow-up, patients also reported their satisfaction on a 100-mm VAS and completed the Disabilities of Arm, Shoulder and Hand questionnaire.
Results
Pain decreased significantly in all measured variables at both assessment occasions (allp < 0.0001). Grip strength in the affected arm/hand increased significantly after 3 months (p = 0.009).
Discussion
Twelve weeks of eccentric training reduced pain and increased grip strength in patients with medial epicondylalgia. It is a safe, uncomplicated and cost-effective method, with only a minimum contribution from a physiotherapist.
NirschlRP, RodinDM, OchiaiDH, Maartmann-MoeC. Iontophoretic administration of dexamethasone sodium phosphate for acute epicondylitis. A randomized, double-blinded, placebo-controlled study. Am J Sports Med2003; 31: 189–95.
2.
RosenbergN, SoudryM, StahlS. Comparison of two methods for the evaluation of treatment in medial epicondylitis: pain estimation vs grip strength measurements. Arch Orthop Trauma Surg2004; 124: 363–5.
LjungBO, AlfredsonH, ForsgrenS. Neurokinin 1-receptors and sensory neuropeptides in tendon insertions at the medial and lateral epicondyles of the humerus. Studies on tennis elbow and medial epicondylalgia. J Orthop Res2004; 22: 321–7.
5.
CiccottiMC, SchwartzMA, CiccottiMG. Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med2004; 23: 693–705, xi.
CiccottiMG, RamaniMN. Medial epicondylitis. Tech Hand Up Extrem Surg2003; 7: 190–6.
8.
GongHS, ChungMS, KangES,. Musculofascial lengthening for the treatment of patients with medial epicondylitis and coexistent ulnar neuropathy. J Bone Joint Surg Br2010; 92: 823–7.
9.
LeachRE, MillerJK. Lateral and medial epicondylitis of the elbow. Clin Sports Med1987; 6: 259–72.
10.
O'DwyerK, HowieC. Medial epicondylitis of the elbow. Int Orthop1995; 19: 69–71.
11.
WilsonJJ, BestTM. Common overuse tendon problems: a review and recommendations for treatment. Am Fam Physician2005; 72: 811–18.
12.
PienimakiTT, SiiraPT, VanharantaH. Chronic medial and lateral epicondylitis: a comparison of pain, disability, and function. Arch Phys Med Rehabil2002; 83: 317–21.
13.
PiligianG, HerbertR, HearnsM,. Evaluation and management of chronic work-related musculoskeletal disorders of the distal upper extremity. Am J Ind Med2000; 37: 75–93.
14.
GabelGT, MorreyBF. Operative treatment of medical epicondylitis. Influence of concomitant ulnar neuropathy at the elbow. J Bone Joint Surg Am1995; 77: 1065–9.
15.
StahlS, KaufmanT. The efficacy of an injection of steroids for medial epicondylitis. A prospective study of sixty elbows. J Bone Joint Surg Am1997; 79: 1648–52.
16.
AlfredsonH, PietilaT, JonssonP, LorentzonR. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med1998; 26: 360–6.
17.
CroisierJL, Foidart-DessalleM, TinantF, CrielaardJM, ForthommeB. An isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy. Br J Sports Med2007; 41: 269–75.
18.
JonssonP, AlfredsonH. Superior results with eccentric compared to concentric quadriceps training in patients with jumper's knee: a prospective randomised study. Br J Sports Med2005; 39: 847–50.
19.
ManiasP, StasinopoulosD. A controlled clinical pilot trial to study the effectiveness of ice as a supplement to the exercise programme for the management of lateral elbow tendinopathy. Br J Sports Med2006; 40: 81–5.
20.
OhbergL, LorentzonR, AlfredsonH. Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up. Br J Sports Med2004; 38: 8–11; discussion.
21.
StanishW, CurwinK. Tendinitis. Its etiology and treatment.Toronto: Collamore Press, 1984.
22.
StanishWD, CurwinS, RubinovichM. Tendinitis: the analysis and treatment for running. Clin Sports Med1985; 4: 593–609.
23.
StasinopoulosD, StasinopoulouK, JohnsonMI. An exercise programme for the management of lateral elbow tendinopathy. Br J Sports Med2005; 39: 944–7.
24.
SvernlovB, AdolfssonL. Non-operative treatment regime including eccentric training for lateral humeral epicondylalgia. Scand J Med Sci Sports2001; 11: 328–34.
25.
CarlssonAM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain1983; 16: 87–101.
26.
MylesPS, TroedelS, BoquestM, ReevesM. The pain visual analog scale: is it linear or nonlinear?Anesth Analg1999; 89: 1517–20.
27.
ScottJ, HuskissonEC. Graphic representation of pain. Pain1976; 2: 175–84.
28.
MathiowetzV, KashmanN, VollandG,. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil1985; 66: 69–74.
29.
MathiowetzV, WeberK, VollandG, KashmanN. Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am1984; 9: 222–6.
30.
RadpasandM, OwensE. Combined multimodal therapies for chronic tennis elbow: pilot study to test protocols for a randomized clinical trial. J Manipulative Physiol Ther2009; 32: 571–85.
31.
SvernlovB, AdolfssonL. Outcome of release of the lateral extensor muscle origin for epicondylitis. Scand J Plast Reconstr Surg Hand Surg2006; 40: 161–5.
32.
AtroshiI, GummessonC, AnderssonB, DahlgrenE, JohanssonA. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: reliability and validity of the Swedish version evaluated in 176 patients. Acta Orthop Scand2000; 71: 613–18.
33.
LangbergH, EllingsgaardH, MadsenT,. Eccentric rehabilitation exercise increases peritendinous type I collagen synthesis in humans with Achilles tendinosis. Scand J Med Sci Sports2007; 17: 61–6.
34.
KnoblochK. Eccentric rehabilitation exercise increases peritendinous type I collagen synthesis in humans with Achilles tendinosis. Scand J Med Sci Sports2007; 17: 298–9.
35.
KnoblochK. Eccentric training in Achilles tendinopathy: is it harmful to tendon microcirculation?Br J Sports Med2007; 41: e1–5.
36.
KnoblochK. Eccentric training and the science behind. Med Sci Sports Exerc2009; 41: 251.
37.
KurversH, VerhaarJ. The results of operative treatment of medial epicondylitis. J Bone Joint Surg Am1995; 77: 1374–9.
38.
PeolssonA, HedlundR, ObergB. Intra- and inter-tester reliability and reference values for hand strength. J Rehabil Med2001; 33: 36–41.
39.
StratfordPW, LevyD, GowlandC. Evaluative properties of measures used to assess patients with lateral epicondylitis at the elbow. Phys Ther Can1993; 45: 160–4.
40.
CorkR, IsaacI, ElsharydahA,. A comparison of the verbal rating scale and the visual analog scale for pain assessment. The Internet Journal of Anesthesiology [serial on the Internet]2004; 8.
41.
ShiriR, VaronenH, HeliovaaraM, Viikari-JunturaE. Hand dominance in upper extremity musculoskeletal disorders. J Rheumatol2007; 34: 1076–82.
42.
ShiriR, Viikari-JunturaE, VaronenH, HeliovaaraM. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol2006; 164: 1065–74.
43.
BissetL, BellerE, JullG,. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. Br Med J2006; 333: 939.
44.
RineerCA, RuchDS. Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures. J Hand Surg Am2009; 34: 566–76.
