affects about half of athletes in racquet sports, but it can affect anyone. It usually starts with a mild pain on the outer side of the elbow, and progresses to a more severe pain over time, which can radiate to the forearm. First-line treatments for tennis elbow may include watchful waiting, pain medications, corticosteroid injections, and/or physical therapy. But there is some question as to which of these treatments is most effective.
A new study in the November 4, 2006 issue of the
British Medical Journal
evaluated the effectiveness of corticosteroid injections, physical therapy, and a wait-and-see approach in treating tennis elbow. The researchers found that while corticosteroid injections were the most effective initially, physical therapy proved to be the most beneficial over time.
About the Study
Researchers in Australia studied 198 volunteers who had tennis elbow. The participants were randomly assigned to corticosteroid injections, physical therapy, or a wait-and-see approach. The injections were given once or twice, and physical therapy was given in eight 30-minute sessions. The participants in the wait-and-see group were instructed on modifying their daily activities, and were told to use pain medications, heat, cold, or braces as needed. The researchers followed the participants for one year, tracking the severity of their symptoms, (on a six-point scale, from “completely recovered” to “much worse”), pain-free grip force, and need for additional medications.
The injections were the most effective at six weeks, with 78% of the participants in the injection group reporting success, compared with 27% in the wait-and-see group, and 65% in the physical therapy group. But at one year, the participants in the injection group were significantly worse than both other groups (72% who had reported success had subsequently regressed).
Physical therapy was superior to wait-and-see in the first six weeks, but there was no difference between the treatments at one year, when most participants in both groups reported a successful outcome. Those in the physical therapy group sought less additional treatment (eg, pain medications) than those in the other groups.
It is possible that the high recurrence rate associated with the injections occurred because the initial improvement was so great that the participants prematurely increased their activity levels and aggravated their tennis elbow, despite advice to rest.
How Does This Affect You?
These findings suggest that compared to corticosteroid injections, physical therapy may be the best treatment for tennis elbow over the long-term. It was superior to wait-and-see in the short-term, and more beneficial than injections in the long-term.
If you have tennis elbow and are weighing your treatment options, talk with your doctor about physical therapy. And if you do receive injections, realize that you will see the most improvement initially, and follow your doctor’s advice on resting and caring for your elbow despite the urge to resume your activity. Keep in mind that even without treatment, tennis elbow will usually subside on its own over time.
Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait-and-see for tennis elbow: ransomised trial.
Tennis elbow (lateral epicondylitis). American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=132&topcategory=Arm. Accessed November 27, 2006.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a