TY - JOUR

T1 - 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

AU - Couppe, Christian

AU - Døssing, Simon

AU - Bulow, Per Martin

AU - Siersma, Volkert Dirk

AU - Zilmer, Camilla K.

AU - Bang, Christine Winther

AU - Hoffner, Rikke

AU - Kracht, Mathilde

AU - Hogg, Paul

AU - Edstrom, Gabriella

AU - Kjaer, Michael

AU - Magnusson, Stig Peter

PY - 2022

Y1 - 2022

N2 - 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 (Delta 20 points), QuickDASH (Delta 21 points), and NRS (Delta 2.5 points) scores after 12 weeks. Further, after 12 weeks, a CSI also resulted in decreased hypervascularization (power Doppler area) compared with PN (Delta-2251 pixels, P = .0418). Except for the QuickDASH score (CSI increased score by Delta 15 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.

AB - 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 (Delta 20 points), QuickDASH (Delta 21 points), and NRS (Delta 2.5 points) scores after 12 weeks. Further, after 12 weeks, a CSI also resulted in decreased hypervascularization (power Doppler area) compared with PN (Delta-2251 pixels, P = .0418). Except for the QuickDASH score (CSI increased score by Delta 15 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.

KW - tendinopathy

KW - heavy slow resistance training

KW - cortisone injection

KW - needling

KW - TENNIS ELBOW

KW - PATELLAR TENDINOPATHY

KW - CLINICAL-OUTCOMES

KW - ACHILLES TENDINOPATHY

KW - MECHANICAL-PROPERTIES

KW - CONTROLLED-TRIAL

KW - PAIN INTENSITY

KW - GRIP STRENGTH

KW - PRIMARY-CARE

KW - SEE POLICY

U2 - 10.1177/03635465221110214

DO - 10.1177/03635465221110214

M3 - Journal article

C2 - 35867777

VL - 50

SP - 2787

EP - 2796

JO - American Journal of Sports Medicine

JF - American Journal of Sports Medicine

SN - 0363-5465

IS - 10

ER -