Effects of extracorporeal shockwave therapy versus ultrasonic therapy and deep friction massage in the management of lateral epicondylitis: a randomized clinical trial

Abstract

The study's goal was to compare and evaluate the benefits of deep friction massage and ultrasonic therapy (US) vs extracorporeal shockwave therapy (ESWT) for people with lateral epicondylitis. This double-blind, parallel-arm randomized clinical trial was conducted after ethical approval on a sample of 80 subjects with lateral epicondylitis. Participants were enrolled based on predefined eligibility criteria. They were randomly allocated to groups A and B. Group A received ESWT, while Group B received the US combined with deep friction massage. Data was collected using the Numeric Pain Rating Score (NPRS) and Patient-rated tennis elbow evaluation questionnaire (PRTEE) at baseline, at 3rd, and at 7th week of treatment. On the basis of the normality of the data, a non-parametric test was applied to evaluate between-group and within-group differences. P value ≤ 0.05 was considered significant. There was a significant difference between groups (p < 0.001). Comparisons of PRTEE scores at 3rd week and 7th week of intervention were found significant for both groups (p < 0.001). While considering between-group comparisons based on percentile scores of PRTEE at baseline, 3rd and 7th week of intervention, in group A Median (IQR) at the baseline was 24.00 (5.00), at 3rd week, 10.00 (5.00) and 7th week was 1.50 (2.50) and in group B Median (IQR) at the baseline was 25.00 (4.00), at 3rd week 19.50 (4.50) and at 7th week was 11.50 (2.50). The results were significant in both groups (p = 0.000), but between-group analysis revealed that ESWT is more effective in patients with lateral epicondylitis.

Keywords: Pain; Patient-rated tennis elbow evaluation questionnaire; Physiotherapy; Tennis elbow.

Figure 1

(a) Application of extracorporeal shockwave therapy on the right elbow of a patient with lateral epicondylitis. (b) Output settings of the extracorporeal shockwave therapy device for a patient with lateral epicondylitis.

Figure 2

(a) Output settings of the ultrasonic therapy device for a patient with lateral epicondylitis. (b) Application of the ultrasonic therapy for a patient with lateral epicondylitis. (c) Application of the deep tissue friction massage for a patient with lateral epicondylitis.

Figure 3

The Consolidated Standards of Reporting Trials (CONSORT) flow diagram shows the recruitment, randomization, allocation, and analysis of participants.

Figure 4

Between-group comparison of mean ranks PTREE Scores at baseline, 3rd week and 7th week.