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IRCT20180728040618N7 IRCT 2023-07-01 Iran University of Medical Sciences The effect of eccentric exercises on pain and function in patients with chronic lateral epicondylitis The effect of eccentric exercises on maximum grip strength, function, pain and thickness of common extensor tendon in patients with chronic lateral epicondylitis 2023-07-21 anticipated 30 Complete https://irct.ir/trial/62591 interventional Randomization: Randomized, Blinding: Single blinded, Placebo: Not used, Assignment: Parallel, Purpose: Treatment, Randomization description: Samples are randomly assigned to one of the two groups of usual passive physiotherapy and progressive eccentric strengthening exercises equally by the restricted randomization and law of random allocation (drawing a card from the number of cards equal to the sample size and entering a group of two groups), Blinding description: After placing the patients in the desired group, they are asked not to provide their grouping information to the examiner. All evaluations will be performed by a physical therapist. This person does not know about the grouping of patients with external epicondylitis of the elbow. In other words, during the initial and final evaluation of the patients, the examiner is not able to distinguish what type of treatment each patient received. Therapeutic interventions will be applied by another physiotherapist. N/A Chronic lateral epicondylitis. Intervention 1: Control group: People receive stretching of the wrist extensor muscles, ultrasound, friction massage, and analgesic TENS during physiotherapy treatment. Stretching exercises for both groups are performed 2 times a day with 3 repetitions and 30 seconds rest between each repetition, in such a way that the person is standing and his shoulder is at a 90-degree flexion angle and his elbow is at a 0-degree flexion angle and his palm is It is towards the ground and with the healthy hand, he takes his wrist to flexion and ulnar deviation and maintains the tension for 30 seconds. In this study, ultrasound with a frequency of 1 Mhz and an intensity of 1-1.5 W/Cm2 is used. The circumference of the applicator head is four square centimeters, which is applied to the junction of the tendon of the extensor carpi radialis brevis muscle for 5 minutes. The modern pain-relieving TENS device is used with high frequency (110Hz) and intermittently in time intervals of 200 μs and with an intensity that is strong for the patient and at the same time tolerable. Ice massage for the people of both groups is performed 3 times a day using an ice pack in the painful area of the external epicondyle in a circle for 5-10 minutes until this area becomes numb. Intervention 2: Intervention group: The treatment group performed progressive eccentric strengthening exercises while sitting in a straight position, while their elbows and wrists are in maximum extension and forearms are in pronation and supported by a surface, and the palms are facing the ground so that the wrists are used for performing movements. It hangs freely. The patient is asked to slowly bend the wrist for 30 counts and use the opposite hand to return it to the original position. This exercise is performed 3 times a day with 10 repetitions and at least 1-minute rest between each time. Before and after performing these exercises, wrist extensor muscles are stretched and finally, ice massage is performed on the external epicondyle of the humerus. Eccentric exercises are started at a low speed with or with weights according to the individual's condition, and the individual is told to continue the exercise if he has mild pain (pain less than 4 on the linear scale of pain), but if it worsens and becomes unbearable If pain occurs, stop the exercise. When the person will be able to do the exercise without any pain and discomfort, the exercise is done at a medium speed and with the same load, and again when the person does not feel pain and discomfort at this level, the exercise is done quickly. When the person is able to perform high-speed training without feeling pain and discomfort, the training load will be increased by using free weights based on the ten-repetition maximum of the patients. And during treatment, progress continues in this way. Eccentric exercises are taught to the patient in the first session of treatment, and corrections and improvements are made during weekly appointments for people to receive TENS and ultrasound treatment. Yes - There is a plan to make this available What will be shared: Deidentified individual participant data collected for the primary and secondary outcome measures will be shared if necessary When: Starting 6 months after publication To whom: The data will be available for physical therapists working in academic institutions and also clinicians working in the field of musculoskeletal disorders Conditions: The raw data and results of this study can be used in future relevant systematic reviews. Thus, the raw data and results of this study will be available for researchers working in the field of lateral epicondylitis treatment and effects of eccentric exercises. Where to obtain: Applicants can contact the researcher of this study Sahar Torkaman by email. Email address: shr_torkaman@yahoo.com How to obtain: Applicants should explain in detail about their project and how the data/documents of this study will be used in their project. Then, the data/documents files will be sent by email to applicants on request. This process may takes 10-12 working days. Comments:
public Holakoo Mohsenifar
School of Rehabilitation Sciences of Iran University of Medical Sciences, Madadkaran St, Shah Nazari St, Madar Sq, Mirdamad Blvd, Tehran
Tehran Iran (Islamic Republic of) 1545913487 +98 21 2222 7124 mohsenifarpt@gmail.com Iran University of Medical Sciences scientific Holakoo Mohsenifar
School of Rehabilitation Sciences of Iran University of Medical Sciences, Madadkaran St, Shah Nazari St, Madar Sq, Mirdamad Blvd,
Tehran, Iran (Islamic Republic of) 1545913487 +98 912 380 7685 mohsenifarpt@gmail.com Iran University of Medical Sciences Iran (Islamic Republic of) Patients with chronic lateral epicondylitis(more than 3 months) Moderate pain based on the VAS scale (between 3-7) in the external epicondyle of the humerus, which increases with active wrist extension and decreases with rest Positive Mills test Positive Cozen test Positive Maudslesy Existence of tenderness at the tenoperiosteal site or at the junction of the common extensor tendon to the external epicondyle of the humerus The average age is 55-35 years referred by a doctor 35 years 55 years Both Pain in the lateral epicondyle of the humerus due to involvement of the neck, shoulders and thorax Acute lateral epicondylitis Pain in the lateral epicondyle of the humerus following a trauma to the elbow Radial tunnel syndrome and pain in the posterior interosseous nerve pathway Inflammation of the elbow joint Damage to the internal and external ligaments of the elbow joint Sensory disturbance in the involved limb Patients with bilateral symptoms or other specific problems in the upper extremities Neck problems Any surgical treatment, medication, topical injection and physiotherapy during the last 3 months Pregnancy Infection in the elbow joint Malignancy Hemophilia Dissatisfaction of participants in the study Patients with mental disorders or inability to communicate Patients who refuse to exercise M77.1 Lateral epicondylitis Rehabilitation Rehabilitation Control group: People receive stretching of the wrist extensor muscles, ultrasound, friction massage, and analgesic TENS during physiotherapy treatment. Stretching exercises for both groups are performed 2 times a day with 3 repetitions and 30 seconds rest between each repetition, in such a way that the person is standing and his shoulder is at a 90-degree flexion angle and his elbow is at a 0-degree flexion angle and his palm is It is towards the ground and with the healthy hand, he takes his wrist to flexion and ulnar deviation and maintains the tension for 30 seconds. In this study, ultrasound with a frequency of 1 Mhz and an intensity of 1-1.5 W/Cm2 is used. The circumference of the applicator head is four square centimeters, which is applied to the junction of the tendon of the extensor carpi radialis brevis muscle for 5 minutes. The modern pain-relieving TENS device is used with high frequency (110Hz) and intermittently in time intervals of 200 μs and with an intensity that is strong for the patient and at the same time tolerable. Ice massage for the people of both groups is performed 3 times a day using an ice pack in the painful area of the external epicondyle in a circle for 5-10 minutes until this area becomes numb. Intervention group: The treatment group performed progressive eccentric strengthening exercises while sitting in a straight position, while their elbows and wrists are in maximum extension and forearms are in pronation and supported by a surface, and the palms are facing the ground so that the wrists are used for performing movements. It hangs freely. The patient is asked to slowly bend the wrist for 30 counts and use the opposite hand to return it to the original position. This exercise is performed 3 times a day with 10 repetitions and at least 1-minute rest between each time. Before and after performing these exercises, wrist extensor muscles are stretched and finally, ice massage is performed on the external epicondyle of the humerus. Eccentric exercises are started at a low speed with or with weights according to the individual's condition, and the individual is told to continue the exercise if he has mild pain (pain less than 4 on the linear scale of pain), but if it worsens and becomes unbearable If pain occurs, stop the exercise. When the person will be able to do the exercise without any pain and discomfort, the exercise is done at a medium speed and with the same load, and again when the person does not feel pain and discomfort at this level, the exercise is done quickly. When the person is able to perform high-speed training without feeling pain and discomfort, the training load will be increased by using free weights based on the ten-repetition maximum of the patients. And during treatment, progress continues in this way. Eccentric exercises are taught to the patient in the first session of treatment, and corrections and improvements are made during weekly appointments for people to receive TENS and ultrasound treatment. Tendon thickness. Timepoint: Before the intervention and after the last treatment session. Method of measurement: Ultrasonographic imaging. Pain. Timepoint: Before the intervention and after the last treatment session. Method of measurement: Visual analog scale. Maximum hand- grip strength. Timepoint: Before the intervention and after the last treatment session. Method of measurement: Digital hand held dynamometer. Function. Timepoint: Before the intervention and after the last treatment session. Method of measurement: The PREE questionnaire is used to measure performance. This questionnaire has 20 questions that examine two areas of pain and disability. The first field examines the degree of elbow pain in 5 questions. The maximum total score of this field is 50 (for each question, 0 pain-free state, and 10 maximum imaginable pain). The second field is related to disability, which measures a person's functional capacity during special activities (11 items) and usual activities (4 items). The maximum score of this domain is 50 (for each question, 0 is no limit, and 10 is the maximum difficulty to perform the activity). The final score of this questionnaire ranges from zero (the best score) to 100 (the worst score). Iran University of Medical Sciences Approved 2022-01-26 Ethics committee of Iran University of Medical Sciences Iran University of Medical Sciences, Shahid Hemmat Highway, Tehran Tehran Tehran Iran (Islamic Republic of)