BACKGROUND AND PURPOSE: To determine if painful loading of tendinous conditions of the lateral elbow impacts outcomes to guide effective clinical practice. METHODS: A systematic literature review examined randomized controlled trials from 1975 to October 2018 regarding conservative management of lateral elbow tendinopathy. An electronic search of PubMed, CINAHL, Ovid Medline, and SPORTDiscus were performed and assessed for bias. FINDINGS: Eighteen studies of fair to high quality evidence based on the PEDro scale were included. All articles including loading found it to be an effective intervention in reducing lateral epicondylalgia pain. CLINICAL RELEVANCE: Loading, manipulation, and mobilizations with movement are supported in the management of lateral elbow tendinopathy. CONCLUSION: The results of this review are unable to support the use of painful loading as effective management of lateral epicondylalgia. Future studies are necessary due to the limited number of pain measures, heterogeneous populations, insufficient exercise prescriptions, and lack of pain classification.

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