From the Guidelines
Lateral epicondylitis is best treated with a combination of rest, physical therapy, and pain management, as this approach has been shown to reduce morbidity, mortality, and improve quality of life. The treatment of lateral epicondylitis, commonly known as tennis elbow, should prioritize conservative measures to minimize the risk of complications and promote optimal recovery. Initially, reducing activities that aggravate the condition and applying ice to the affected area for 15-20 minutes several times daily can help alleviate symptoms 1.
Key Components of Treatment
- Over-the-counter NSAIDs like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily) can help manage pain and inflammation for short periods, typically 1-2 weeks 1.
- Physical therapy focusing on eccentric strengthening exercises and stretching is crucial for recovery, with a recommended frequency of 3-4 times weekly for 6-8 weeks 1.
- A counterforce brace worn just below the elbow can provide symptom relief during activities.
- For persistent cases, a corticosteroid injection (typically methylprednisolone 40mg with lidocaine) may provide temporary relief, though this should be limited to 1-2 injections due to potential tendon weakening 1.
Rationale for Treatment Approach
The chosen treatment approach is based on the most recent and highest quality study available, which emphasizes the importance of conservative management in reducing morbidity, mortality, and improving quality of life for patients with lateral epicondylitis 1. By prioritizing rest, physical therapy, and pain management, patients can expect to recover within 6-12 months, with most cases resolving without the need for surgical intervention. This approach is supported by the American College of Radiology, which recommends conservative measures as the initial treatment for chronic elbow pain, including lateral epicondylitis 1.
From the Research
Treatment Options for Lateral Epicondylitis
- Initial treatment for lateral epicondylitis can include rest, ice, tennis brace, and/or injections, with injections being a popular method due to their high success rate 2
- When the condition is chronic or not responding to initial treatment, physical therapy is often initiated, utilizing modalities such as ultrasound, phonophoresis, electrical stimulation, manipulation, soft tissue mobilisation, and stretching and strengthening exercises 2
- Other treatment options include laser, acupuncture, and augmented soft tissue mobilisation (ASTM), which is becoming increasingly popular due to its ability to detect changes in soft tissue texture during rehabilitation 2
- In cases where conservative treatment is not effective, surgery may be considered as a last resort 2, 3
Efficacy of Nonoperative Treatments
- A systematic review and meta-analysis found that electrophysiotherapy and physical therapy were effective in improving pain, function, and quality of life for patients with lateral epicondylitis, while injections did not improve any outcome measures 4
- Another study found that dry needling was more effective than corticosteroid injection in treating lateral epicondylitis, with significant improvements in pain and function at 3 weeks and 6 months post-treatment 5
Physiotherapy Treatment
- A systematic review found that manual therapy and eccentric strength training were the most effective physiotherapeutic treatment methods for lateral epicondylitis, with a favorable cost-benefit ratio 6
- Other physiotherapy techniques, such as shock waves, bandages, and Kinesio taping, may also be beneficial in achieving therapeutic objectives, but may entail additional cost 6