Prospective evaluation of the effectiveness of a home-based program of isometric strengthening exercises: 12-month follow-up

Abstract

Background: The aim of this prospective randomized clinical trial was to investigate the efficacy of a home-based program of isometric strengthening exercises for the treatment of the lateral epicondylitis (LE) of the distal humerus. We hypothesized that 1) use of isometric strengthening exercises would result in clinical benefits similar to those provided by medication and pain relief and 2) functional improvements after exercise would be time-dependent.

Methods: Patients were assigned to one of two groups: 1) an immediate physical therapy group (group I), or 2) a delayed physical therapy group (group D). Group I patients (n = 16) were instructed how to do the exercises at their first clinic visit and immediately carried out the exercise program. Group D patients (n = 15) learned and did the exercises after being on medications for 4 weeks.

Results: Outcomes at the 1-month clinic visit indicated that pain (measured using a visual analogue scale [VAS]) had been significantly reduced in group I compared to group D (p < 0.01). However, significant differences between groups were not found at 3-, 6-, and 12-month follow-up for either VAS scores or Mayo elbow performance scores. For modified Nirschl/Pettrone scores, a significant difference between groups was found only at the 1-month follow-up visit. By then, the number of participants who returned to all activities with no pain or occasional mild pain was six (37%) in Group I and two (13%) in Group D (p = 0.031). At the final follow-up visit, 88% of all participants performed physical activities without pain.

Conclusions: Isometric strengthening exercises done early in the course of LE (within 4 weeks) provides a clinically significant improvement.

Keywords: Home based; Isometric; Lateral humeral epicondylitis; Muscle strengthening exercises.

Fig. 1

Picture showing the location of the lateral epicondyle (asterisk) and the direction of the extensor carpi radialis brevis (ECRB; arrowhead). Before providing instruction regarding the isometric strengthening exercise program, the anatomical location of the ECRB and the efficacy of isometric contraction of the ECRB were explained. By doing so, patients could understand the goal of the exercise treatment more easily.

Fig. 2

The isometric strengthening exercise program was composed of four sets of 50 repetitions daily. Each static motion is performed for 10 seconds.