Studies have shown that osteopathic manual treatment have greater progressive benefits in the long term for treating Lateral Epicondylitis compared to corticosteroid injection.
What is Lateral Epicondylitis (Tennis Elbow)?
Lateral epicondylitis (LE) is a painful trauma condition where the extensor tendon muscles in the elbow is overused by repetitive motion of the wrist and arm, which causes inflammation and muscle strain. Another characterization of LE is “…tenderness or pain at the lateral epicondyle of the humerus and by pain and weakness with gripping activities.” (Küçükşen et al., 2013, pg. 2068). The lateral epicondylitis is also known as tennis elbow, but it does not only apply to tennis players or athletes. People with an occupation related to any activities that involved using strong grip and repetitive wrist movements are most likely to develop tennis elbow.
Occupations that commonly causes LE:
1. Carpentry
2. Plumbing
3. Painting
4. Landscaping
5. Occupation that requires repetitive arm and wrist movement
Effective Treatments For Lateral Epicondylitis:
Corticosteroid Injection vs. Muscle Energy Technique Based on the research study "Muscle Energy Technique Versus Corticosteroid Injection for Management of Chronic Lateral Epicondylitis: Randomized Controlled Trial With 1-Year Follow-up" by Küçükşen, S., Yilmaz, H., Sallı, A., & Uğurlu, H. (2013). There were 2 groups in the study corticosteroid injection group (CSI) and muscle energy technique group (MET).
The participants were assessed and tested in 3 factors:
Pain-free grip strength (PFGS),
Visual analog scale (VAS),
And disability of the arm, shoulder, and hand (DASH).
Among the two groups, the CSI group was reported to have greater result in PFGS in the first six weeks compared to the MET group. However, for the long-term treatment up to 52 weeks, the MET group was reported to have a progressive significant improvement, while the CSI group began to have a decline at 26 weeks and remained stagnant until 52 weeks.
The next test is VAS, a method used by practitioners to understand the level of pain that the participants are experiencing during PFGS test, and it “…consists of a 10-cm line marked at one end with “no pain” and at the other end with ‘worst imaginable pain”” (Küçükşen et al., 2013, pg. 2070). This is an essential method because pain is subjective, meaning every individual has different degree of pain tolerance and how they interpret pain, so by this test they can comprehend better what the patient is going through. VAS test is a great measurement for progress of improvement because it is coming from the patient’s perception of pain. From the baseline up to six weeks CSI group have lower scores compared to MET, but the VAS score started to go up beginning at 26 weeks and then a short reduction from 26 weeks to 52 weeks. While the MET group have a high score from the baseline up to 6 weeks compared to the CSI group, although in the long term up to 52 weeks the MET group continues to reduce the VSA score significantly, which is better results than CIS group.
In conclusion of Küçükşen’s (2013) study, muscle energy technique has been recognized as an efficacious alternative medicine for individuals that are suffering from lateral epicondylitis also known as tennis elbow, because it does not have any adverse events like the corticosteroid injections, and it has progressive significant improvement in the long run, unlike CSI group that was only beneficial during the first 6 weeks, then the improvements started to subside until the last period of treatment. The CSI group was reported that the participants experienced unfortunate events, “1 participant reported pain lasting 5 days after the injection, 2 participants reported a loss of pigment, and 1 patient had subcutaneous atrophy” (Küçükşen et al., 2013, pg. 2071-2072).
These are adverse events that can be a major reason for a patient to seek alternative medicine, but these are just the mild ones other study have shown that the sequela for long-term corticosteroid use may result in osteoporosis, aseptic joint necrosis, adrenal insufficiency, gastrointestinal, hepatic, and ophthalmologic effects, hyperlipidemia, growth suppression, and possible congenital malformations (Buchman, 20001). Corticosteroid injection therapy is superior to muscle energy technique only in the initial stage of treatment, that’s why patients should rely more on muscle energy technique because the improvement lasts longer, and the MET treatment choice is non-invasive, painless, effective, and convenient. More significantly, MET is a repeatable treatment choice without harmful occurrence (unlike CSI). Especially in resistant or chronic cases, the repeated intervention can be beneficial. In addition, as with other therapies, MET is cost-effective (Küçükşen et al., 2013).
MET is one of osteopathic manual treatment techniques that gives satisfactions to patients suffering from lateral epicondylitis because it is safe and improvements in pain free grip strength and visual analog scale is remarkable, compared to CSI that have adverse effects and do not progress with significant results.
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