TENNIS ELBOW

For those who suffer tennis elbow, wrist-strengthening exercises with an inexpensive rubber bar may relieve pain and restore function, a small trial revealed.

Adding these exercises to home care dramatically increased the number of patients with reduced disability scores, compared with standard care alone.

Pain and tenderness likewise improved at least fourfold more with the addition of isolated eccentric wrist extensor strengthening.

His group had been searching for a way to make the therapy work in the home when they happened across a solid rubber bar -- similar to the baton passed by relay runners but flexible enough to be twisted.

To test it, they enrolled a group of 21 patients who had reported chronic symptoms of lateral epicondylitis -- a.k.a. tennis elbow -- for at least six weeks, but had no prior surgical treatment for it.

During physical therapy visits, these patients' standard treatment involved wrist extensor stretching, ultrasound, cross friction massage, heat and ice. At home, they were randomized to either isotonic wrist extensor or isolated eccentric wrist extensor strengthening exercises.

For the investigational exercise, patients were given a Thera-Band FlexBar to twist with the wrist of their uninjured arm and then slowly untwist with eccentric wrist extension of the injured arm over a period of about four seconds. Three sets of 15 repetitions were scheduled each day.

After seven weeks of physical therapy in both groups, pain scores improved to an average of about 5 on the 10-point Visual Analog Scale in the standard treatment group -- but dropped all the way to about 1 point in the isolated eccentric exercise group.

The mean improvement in pain was 81% in the group that used the bar compared with 22% in the control group.

The researchers cautioned that their study was limited by the small sample size, but noted that the treatment for home use was practical, inexpensive, did not require direct medical supervision, and had no significant side effects.

Among the wide array of treatments for tennis elbow -- ranging from strengthening and stretching to cortisone injections and extracorporeal shockwave therapy -- all have been shown to be, at best, equivocal in efficacy.