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Proprioceptive elbow training reduces pain and improves function in painful lateral epicondylitis -- a prospective trial
Schiffke-Juhasz B, Knobloch K, Vogt PM, Hoy L
Journal of Orthopaedic Surgery and Research 2021 Jul 27;16(468):Epub
clinical trial
6/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: In painful epicondylitis, previous studies reported deficiencies in elbow proprioception. In line, proprioceptive training of the lower limb has been reported substantial beneficial in a number of indications. Therefore, we have asked if a specified proprioceptive training using training devices that are capable of activating the deep musculature in the upper limb is able to reduce the symptoms of epicondylitis. MATERIALS AND METHODS: We included 71 patients with painful lateral epicondylitis > 3 months. INTERVENTIONS: Group A: Proprioceptive training intervention with a Flexibar R (9 min daily for 12 weeks). Group B: at least 40 min running or walking/week with the XCO R in addition to the proprioceptive training with the Flexibar R (9 min daily for 12 weeks), follow-up for 12 weeks. Primary end point: Pain on visual analogue scale (VAS, 0 to 10); secondary end points: DASH-Score (0 = very good, 100 = very poor), grip strength according to Jamar dynamometer (kg), vibration sensation measured with a 128 Hz tuning fork. RESULTS: The pain on VAS in group A was reduced significantly. 3.6 +/- 2.0 to 2.4 +/- 2.1 (-33%, p = 0.013), and from 3.7 +/- 2.4 to 2.2 +/- 1.9 (-41%, p = 0.004) in group B after 12 weeks. There was no significant difference between A and B (p = 0.899). In both groups, there was a significant improvement of the DASH-Score (A: 32 +/- 15 to 14 +/- 12, -56%, p < 0.001; B: 27 +/- 12 to 12 +/- 11, -55%, p = 0.001) without any difference between groups A and B (p = 0.339). Grip strength improvement in group A from 24 +/- 12 to 33 +/- 11 kg (+38%, p < 0.001), and from 29 +/- 14 to 34 +/- 11 kg (+15%, p < 0.001) in group B. In line, vibration sensation improved in both groups (A: 6.3 +/- 0.6 to 6.5 +/- 0.5, p = 0.0001; B: 6.3 +/- 0.7 to 6.6 +/- 0.5, p = 0.003). CONCLUSION: A 12-week proprioceptive training with the Flexibar R improves pain, quality of life, grip strength and vibration sensation in patients with painful lateral epicondylitis. LEVEL OF EVIDENCE: Ib, randomised clinical trial TRIAL REGISTRATION: German Clinical Trials Register, DRKS00024857, registered on 25 March 2021 retrospectively registered, http://apps.who.int/trialsearch/.

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