Comments on: What should we do about tennis elbow

By: Does vertebroplasty for osteoporosis-related fractures work

Does vertebroplasty for osteoporosis-related fractures work — Tue, 27 Jul 2010 19:03:18 +0000

[...] I went to. The best was a talk by Prof Rachelle Buchbinder, who did a BiM post not that long ago on tennis elbow. She walked us through an RCT she did on vertebroplasty for painful osteoporosis-related [...]

By: Jim

Jim — Tue, 20 Jul 2010 12:49:53 +0000

Great post…my thoughts:

Injections – works in the short term, causes tendon degeneration.
Anti-inflammatories – pain relief for 2-3 hours, pain returns, cycle starts again.
Braces/bands/straps – promotes muscle fatigue and weakness.

Oh wait…how about preventative therapy, simple tennis elbow exercises

Good health,
Jim

By: Deanne Brown

Deanne Brown — Fri, 09 Jul 2010 19:50:16 +0000

My husband had severe tennis elbow many years ago. It bothered him constantly, including aching so much it prevented him from sleeping. Then we spent 3 weeks in the algarve. Yes, the hot white sand and warm salt water and, since that trip he has never had a concern again. Must have allowed his body a chance to heal!

Deanne
Vancouver, Canada

By: Frédéric Wellens, pht

Frédéric Wellens, pht — Tue, 06 Jul 2010 12:15:48 +0000

Thanks,

no offense taken then!

It is true that many things that are done in PT lack strong evidence behinf it. It is the case in lat. epicondylagia. But, some good research is available on other topics, namely LBP.

Research wise, we are getting on the right track. I think, I hope.

By: adorablesin

adorablesin — Tue, 06 Jul 2010 09:53:36 +0000

Fair comment, and thanks (I was a little over-enthusiastic.)
A question: Did you mean no comparative trials for PT versus botulinum toxin injection for lateral epicondylitis, or for all aspects of physical therapy versus botulinum toxin for other conditions?

By: adorablesin

adorablesin — Tue, 06 Jul 2010 09:18:42 +0000

“This sounds a bit disrespectful to me”.
This was not my intention, so please forgive me. How I intended it to be taken was: there is evidence for many things in PT but little of it high level in the grand scheme of things. However, we are married (again no disrespect) to the medical model of the hierarchy of evidence with SRs and MAs of RCTs at the zenith and as such, there is little high-level evidence in relation to the modalities suggested for lateral epicondylitis (or as talked of a lateral epicondyle tendonopathy). As per the article you suggest:
“There is some evidence, albeit low-level, of positive initial
effects of several manipulative therapy techniques for pain relief
and restoration of function when compared with control (p. 255)”…that’s what I meant by not expecting it to be high-level in relation to manual therapy
interventions.
Many thanks for your suggestion, I’ll follow up the references contained therein. Adorablesin.

By: Frédéric Wellens, pht

Frédéric Wellens, pht — Mon, 05 Jul 2010 20:16:02 +0000

Adorable sin,

«And as this is PT were talking about I’m not asking for it to be high level evidence.»

This sounds a bit disrespectful to me. Maybe I understood you wrong. As for your question on the effectiveness on some PT modalities and a review on epicondylagia’s pathobiology I suggest this :

http://www.ncbi.nlm.nih.gov/pubmed/19050004

By: Rachelle Buchbinder

Rachelle Buchbinder — Mon, 05 Jul 2010 06:33:50 +0000

There are no comparative trials comparing botulinum toxin injection to physical therapy so we have no evidence one way or the other that one or other is more effective.

By: Rachelle Buchbinder

Rachelle Buchbinder — Mon, 05 Jul 2010 06:29:36 +0000

At the moment there is not enough evidence to support the use of botulinum toxin in routine clinical care as it is unclear that any benefits outweigh the risks and known high incidence of weakness of the hand. The natural history of lateral epicondylitis is self-limiting and so it is important to tell patients of the favourable prognosis irrespective of treatment. I agree that physical therapy modalities such as the ones you describe may provide limited benefits and are safe so are a reasonable first option. Steroid injection may also be useful for people with inflammatory symptoms such as night pain and stiffness but their effect may only be short lasting (2-6 weeks) and two studies have suggested a rebound worsening of symptoms. Terminology for this condition varies but lateral epicondylitis is the term most commonly used. There is mounting evidence of an inflammatory component early in the course of the condition and the aetiology is likely multifactorial.

By: adorablesin

adorablesin — Fri, 02 Jul 2010 13:36:37 +0000

>>”mobilization/cross friction massage, stretching, eccentric strengthening, activity modification”
“Aggressive” or placid, is there any clinical evidence that these are any more effective? (And as this is PT were talking about I’m not asking for it to be high level evidence.)
The use of Botulinum Toxin has been proven to be effective in neuromuscular re education – as an adjunct, rather than a ‘cure’ – and physio is still required to optimise outcomes…you also have the advantage of central plastic reorganisation that has the potential to prevent re-injury.
Check Cullen et al 2007 – http://www.ncbi.nlm.nih.gov/pubmed/18033608