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- Title
Effects of Heavy Slow Resistance Training Combined With Corticosteroid Injections or Tendon Needling in Patients With Lateral Elbow Tendinopathy: A 3-Arm Randomized Double-Blinded Placebo-Controlled Study.
- Authors
Couppé, Christian; Døssing, Simon; Bülow, Per Martin; Siersma, Volkert Dirk; Zilmer, Camilla Kampp; Bang, Christine Winther; Høffner, Rikke; Kracht, Mathilde; Hogg, Paul; Edström, Gabriella; Kjaer, Michael; Magnusson, Stig Peter
- Abstract
Background: Lateral elbow tendinopathy is a disabling tendon overuse injury. It remains unknown if a corticosteroid injection (CSI) or tendon needling (TN) combined with heavy slow resistance (HSR) training is superior to HSR alone in treating lateral elbow tendinopathy. Purpose/Hypothesis: The purpose was to investigate the effects of HSR combined with either (1) a CSI, (2) TN, or (3) placebo needling (PN) as treatment for lateral elbow tendinopathy. We hypothesized that 12 weeks of HSR in combination with a CSI or TN would have superior effects compared with PN at 12, 26, and 52 (primary endpoint) weeks' follow-up on primary (Disabilities of the Arm, Shoulder and Hand [DASH] score) and secondary outcomes in patients with chronic unilateral lateral elbow tendinopathy. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 60 patients with chronic unilateral lateral elbow tendinopathy were randomized to perform 12 weeks of home-based HSR with elastic band exercises combined with either (1) a CSI, (2) TN, or (3) PN, and at 12, 26, and 52 weeks, we assessed the primary outcome, the DASH score, and secondary outcomes: shortened version of the DASH (QuickDASH) score, pain (numerical rating scale [NRS] score), pain-free grip strength, and hypervascularization (power Doppler area). Results: A CSI, TN, and PN improved patient outcomes equally based on the DASH (Δ20 points), QuickDASH (Δ21 points), and NRS (Δ2.5 points) scores after 12 weeks. Further, after 12 weeks, a CSI also resulted in decreased hypervascularization (power Doppler area) compared with PN (Δ–2251 pixels, P =.0418). Except for the QuickDASH score (CSI increased score by Δ15 points compared with PN; P =.0427), there were no differences between the groups after 52 weeks. Conclusion: These results suggest that 12 weeks of HSR improved symptoms in both the short and the long term and that a CSI or TN did not amplify this effect. In addition, a CSI seemed to impair patient-reported outcomes compared with HSR alone at long-term follow-up. Registration: NCT02521298 (ClinicalTrials.gov identifier).
- Subjects
TENDINOPATHY; RESISTANCE training; GRIP strength; KRUSKAL-Wallis Test; ADRENOCORTICAL hormones; INJECTIONS; PAIN measurement; CONFIDENCE intervals; HEALTH outcome assessment; REGRESSION analysis; TREATMENT effectiveness; RANDOMIZED controlled trials; BLIND experiment; DESCRIPTIVE statistics; DOPPLER ultrasonography; QUESTIONNAIRES; COMBINED modality therapy; STATISTICAL sampling; DATA analysis software; MYOFASCIAL pain syndrome treatment; LONGITUDINAL method
- Publication
American Journal of Sports Medicine, 2022, Vol 50, Issue 10, p2787
- ISSN
0363-5465
- Publication type
Article
- DOI
10.1177/03635465221110214