The Effectiveness of the Conservative Versus Myofascial Pain Physiotherapy in Tennis Elbow Patients: Double-Blind Randomized Trial of 80 Patients

Objective: The aim was to check usefulness of a conservative [C] or myofascial pain [MFP] approach in low-level laser therapy [LLLT] or ultrasound [US] therapy for patients with tennis elbow [TE], independent of the presence of trigger points [TrPs]. Methods: Eighty patients [38 males, 42 females] with TE, in acute or subacute states, were randomly divided into four groups: LLLT-C, LLLT-MFP, US-C, or US-MFP. Doses of LLLT were 1 J/cm(2) in the conservative group and 5 J/cm(2) for each TrP related to TE in the MFP group. US: 0.5 W/cm(2) 3 MHz for conservative and 0.7 W/cm(2) 1 MHz on each TrP and each taut band. Evaluations of each patient at baseline and at the end of therapy [10 interventions] included: the presence and sensitivity of TrPs [algometer], level of pain [VAS], Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire, and hand grip strength [dynamometer]. After one year of therapy, the patients were rechecked. Results: Improvement of the VAS was 36.7 percent with LLLT-C, 36.9 percent with US-C, 48.4 percent with LLLT-MFP, and 55.4 percent with US-MFP [P < 0.005]. The Outcome of Disabilities of the Arm, Shoulder and Hand correlated with the VAS [r = 0.464]. Improvement of the grip strength was, respectively, 5.1 percent, 16.0 percent, 9.5 percent, and 109.0 percent for US-MFP [only US-MFP P < 0.01]. The only worsening of grip strength was after classic LLLT [-2.8 percent] among TrP-positive patients. TrPs were confirmed in 35 percent of patients. In that group, MFP methods were more effective than were conservative measures. After one year symptoms reappeared in 37.5 percent of patients. Conclusion: We suggest that though both agents and both approaches for therapy of TE patients are equally effective, but the authors still favor US-MFP.