92Topical NSAIDs Are Effective for Tennis Elbow Without Oral Side Effects
Cochrane Database of Systematic Reviews (2013) · Pattanittum P, Turner T, Green S, Buchbinder R
This Cochrane systematic review analyzed 15 trials with 759 participants to evaluate the effectiveness of topical and oral NSAIDs for treating lateral elbow pain, commonly known as tennis elbow. The review found that topical NSAIDs were significantly more effective than placebo for short-term pain relief, with a number needed to treat of 7, meaning that for every 7 patients treated with topical NSAIDs, one additional patient experienced significant pain relief compared to placebo. Participants using topical NSAIDs also reported better overall treatment effectiveness at 28 days. Adverse effects from topical NSAIDs were minimal, with only mild skin reactions such as rash reported in 2.5% of users, compared to 1.3% with placebo. For oral NSAIDs, the evidence was conflicting. One trial found significant pain improvement compared to placebo while another found no difference, and neither showed improvement in function. Notably, oral NSAIDs were associated with an increased risk of gastrointestinal side effects, and several participants had to discontinue treatment due to GI issues. The review found no trials that directly compared topical and oral NSAIDs head to head. These findings support the use of topical NSAIDs as a first-line option for conditions like tennis elbow, where the anti-inflammatory medication can be delivered directly to the injured tendon without exposing the gastrointestinal system to the risks associated with oral NSAIDs. For patients who do use oral NSAIDs, the evidence suggests limiting duration to the short term.
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12Shortwave Diathermy Enhances Recovery in Lateral Epicondylitis
Journal of Bodywork & Movement Therapies (2020) · A. Babaei-Ghazani, B. Shahrami, E. Fallah, T. Ahadi, B. Forough, S. Ebadi
This study evaluated the effectiveness of continuous shortwave diathermy (SWD) in treating chronic lateral epicondylitis (tennis elbow). Fifty patients were assigned to either an SWD + exercise group or a sham diathermy + exercise group. The SWD group received 15 minutes of 40-60 W continuous SWD along with specific exercises. Pain, function, and grip strength were measured at baseline, after 5 and 10 treatment sessions, and at 3 months. The SWD group showed significantly greater improvements in all outcomes compared to the control group. These findings suggest that SWD enhances pain relief and functional recovery in lateral epicondylitis.
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85Corticosteroid Injections Help Short Term but Worsen Outcomes Long Term
Lancet (2010) · Coombes BK, Bisset L, Vicenzino B
This systematic review of 41 randomized controlled trials with 2,672 participants evaluated the clinical efficacy and safety of injection therapies for tendinopathy. The study found that corticosteroid injections reduced pain in the short term (within 4 weeks) compared to other interventions, showing a large effect size. However, this benefit was reversed at intermediate term (13 to 26 weeks) and long term (52 weeks and beyond). For example, in treating lateral epicondylalgia (tennis elbow), corticosteroid injections showed a large positive effect in the short term but actually performed worse than no intervention at all by the intermediate and long-term follow-up. This means that patients who received corticosteroid injections were ultimately worse off than if they had done nothing. The study also found that the short-term efficacy for rotator cuff tendinopathy was not clear. Among 991 participants who received corticosteroid injections, one case of tendon rupture was reported. These findings demonstrate that while corticosteroid injections provide temporary pain relief, they do not support long-term healing and may actually delay recovery. The reversal of benefit over time is consistent with the concern that pain masking leads to further tissue damage, as patients overuse the injured area while unable to feel the warning signs of strain.
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21Low-Level Laser Therapy Effectively Treats Tennis and Golferâs Elbow
Journal of Clinical Laser Medicine & Surgery (1998) · Z. Simunovic, T. Trobonjaca, Z. Trobonjaca
This multicenter, double-blind, placebo-controlled study evaluated the effectiveness of low-level laser therapy (LLLT) in 324 patients with medial (n=50) or lateral (n=274) epicondylitis. Patients received either trigger point laser therapy, scanner-based laser therapy, or a combination of both. The combination treatment resulted in complete pain relief and improved functional ability in 82% of acute and 66% of chronic cases. The study highlights the importance of proper dosing, technique, and therapist expertise in optimizing LLLT outcomes for epicondylitis.
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49Muscle Damage from Sustained Isometric Contractions
European Journal of Applied Physiology (2017) · Morgan DL, Proske U, Allen TJ
This study investigated how muscle damage accumulates during sustained isometric contractions of the human elbow flexors. Results showed that the majority of damage occurred during the plateau phase of the contraction, not the initiation or relaxation phases. Although mechanical strain was continuous, pain and muscle tenderness did not appear until later, during movement or physical activity. These findings reinforce the concept that tissue injury from isometric strain may not be perceived until after the event, aligning with delayed symptom onset in joint conditions like bursitis.
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4Effects of Far-Infrared Radiation Lamp Therapy on Recovery from Muscle Damage
European Journal of Sport Science (2023) · Trevor C. Chen, Yuh-Chuan Huang, Tai-Ying Chou, Sheng-Tsung Hsu, Mei-Yen Chen, Kazunori Nosaka
This study examined the effects of far-infrared radiation (FIR) lamp therapy on muscle damage and proprioception following eccentric exercise of the elbow and knee flexors. In a controlled experiment, 24 sedentary women received either FIR therapy or a sham treatment. The FIR group showed significantly faster recovery in muscle strength and proprioception, reduced muscle soreness by 55-60%, and lowered peak plasma creatine kinase activity by 45-89%. FIR therapy accelerated recovery from exercise-induced muscle damage more effectively than previously studied interventions.
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