As an orthopedic physical therapist, I’m always excited to see new research on treating common conditions like tennis elbow. A recent feasibility study published in BMJ Open compared three treatments for tennis elbow: heavy slow resistance training, radial extracorporeal shock wave therapy, and information/advice. Let’s break down the key findings and what they mean for clinical practice.

Key Findings

• Shock wave therapy had the highest adherence and acceptability among patients
• Heavy slow resistance training had low compliance (32%), mainly due to pain aggravation
• All groups showed improvements in pain and function at 3 and 6 months
• The information/advice group had high acceptability, but 50% wanted to cross over to another treatment after 3 months

Clinical Applications

As physical therapists, these findings give us some important insights:

1. Shock wave therapy appears to be a feasible and well-tolerated treatment option for tennis elbow. Consider offering this to patients who haven’t responded to other approaches.
2. Heavy slow resistance training, while effective for some tendinopathies, may not be suitable for all tennis elbow patients. We need to carefully monitor pain levels and modify exercises as needed.
3. Education and advice remain crucial components of treatment. However, patients may desire more active interventions, so be prepared to progress treatment if symptoms persist.
4. A combination approach may be optimal – starting with education/advice and progressing to shock wave therapy or modified exercises based on individual response.

Limitations of the Study

It’s important to note some limitations:

• This was a feasibility study, not designed to compare effectiveness between treatments
• The sample size was relatively small (60 participants total)
• Participants and therapists were not blinded to treatment allocation
• The study was conducted in a secondary care setting, so results may not fully generalize to primary care

Conclusion

This study provides valuable insights into the feasibility of different tennis elbow treatments. Shock wave therapy emerged as a promising option, while heavy slow resistance training may need modification for this patient population. As physical therapists, we should consider these findings when developing treatment plans, while remembering that individualized care is key. Future research comparing shock wave therapy to sham treatment in a larger randomized controlled trial will help further guide our clinical decision-making for patients with tennis elbow.

The original article is available at https://bmjopen.bmj.com/content/14/12/e085916.