Lateral Epicondyle Tendinopathy Toolkit: Section D - Summary of the Evidence

PURPOSE, SCOPE & DISCLAIMER: The purpose of this document is to provide physical therapists with a summary of the evidence for interventions commonly used to manage tendinopathy of the lateral epicondyle. This decision-making tool is evidence-informed and where there is insufficient evidence, expert-informed. It is not intended to replace the clinician’s clinical reasoning skills and inter-professional collaboration. ‘Acute’ refers primarily to symptoms of less than 3 months duration and ‘chronic’ to greater than 3 months. For studies which (1) included participants with symptoms that encompassed both acute and chronic stages or (2) did not clarify the duration of symptoms, the results have been reported within the ‘chronic’ stage.

Lateral Epicondyle Tendinopathy:
Summary of the Evidence for Physical Therapy Interventions

• Click to go back to the contents page
• Click to continue to Treatment Algorithm
• Click to continue to Appendix A: Exercise Programs
• Click to continue to Appendix B: Low Level Laser Therapy Dosage Calculation
• Click to continue to: Appendix C: Details of Articles on Interventions
• Click to continue to: Appendix D: Medical and Surgical Interventions

Manual Therapy

Elbow Joint Mobilizations
Stage of pathology	Acute	Chronic
Clinical research evidence*	No	• 4 RCT • 5 SR (21) • 1 CAT (5) • 1 wrist RCT
Published expert opinion	No	2 expert opinion narrative reviews
Take home message	There is no clinical evidence to support or refute the use of elbow mobilization in the acute stage.	There is a large amount of clinical evidence to support the use of elbow mobilizations for short term effects. There is a small amount of evidence that supports long-term effects. There is a small amount of clinical evidence to support the use of radial head mobilization and neural tension techniques. There is weak support for the use of wrist MWM.
Clinical implication	There is no direction provided by the literature on the use of elbow mobilization in the management of acute LET.	Strongly consider using MWM of the elbow as part of a multimodal treatment regime (manual therapy and exercise) in the treatment of chronic LET. The effects should be apparent within the first few treatments. (See Appendix B for details) Consider using radial head mobilization and neural tension techniques. Consider using MWM of the wrist as part of multimodal treatment regime.
Spinal Mobilization Techniques
Stage of pathology	Acute	Chronic
Clinical research evidence*	No
Published expert opinion	No
Take home message	There is no clinical evidence or expert opinion on the use of spinal mobilization for patients with acute LET.	There is a small amount of clinical evidence to support the use of soft tissue techniques, such as frictions, in the chronic stage.
Clinical implication	There is no direction provided by the literature on the use of spinal mobilization in the management of acute LET.	May consider a trial of soft tissue techniques, such as frictions, in the chronic stage.
Soft Tissue Techniques
Stage of pathology	Acute	Chronic
Clinical research evidence*	No	Yes 1CS
Published expert opinion	Yes	Yes
Take home message	There is no clinical evidence but there is expert level consensus to support the use of joint mobilizations in the acute stage if assessment reveals joint restriction.	There is a small amount of clinical evidence and more substantial expert level consensus to support the use of joint mobilizations in the chronic stage if assessment reveals joint restriction.
Clinical implication	May consider using manual therapy in the acute stage after undertaking a comprehensive biomechanical evaluation of the ‐ Joint mobs hip, knee, foot and ankle.	May consider using manual therapy in the chronic stage after undertaking a comprehensive biomechanical evaluation of the hip, knee, foot and ankle.

LET = Lateral Epidocndyle Tendinopathy; RCT = Randomized Control Trial; SR ‐ Systematic Review; CAT = Critically Appraised Topic; MWM = Mobilization With Movement

*Numbers in parentheses in the "Clinical Research Evidence" column represent the number of individual studies included in each review article.

Author/s

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Abstract

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Background

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Objectives

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Data sources

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Study selection or eligibility criteria

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Study appraisal and synthesis methods

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Results

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Limitations

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Conclusion

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Funding and Declerations

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Systematic review registration number

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Author Biography

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References

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