Proprioceptive elbow training reduces pain and improves function in tennis elbow: Study

A 12-week proprioceptive training with the Flexibar® improves pain, quality of life, grip strength and vibration sensation in patients with painful lateral epicondylitis, reports a recent study published in the Journal of Orthopedic Surgery and Research.

B. Schiffke-Juhász and colleagues from the Herzogin Elisabeth Hospital, Braunschweig, Germany were curious to find out if a specified proprioceptive training using training devices are capable of activating the deep musculature in the upper limb is able to reduce the symptoms of epicondylitis.

The researchers included a total of 71 patients with painful lateral epicondylitis > 3 months and divided them into groups. Group A was where the Proprioceptive training intervention was done with a Flexibar® (9 min daily for 12 weeks) and in Group B, at least 40 min running or walking/week with the XCO® in addition to the proprioceptive training with the Flexibar® (9 min daily for 12 weeks) was recommended. Subsequently, follow-up for 12 weeks was advised.

Primary end point was classified as presence of pain on visual analogue scale (VAS, 0-10) while secondary end points highlighted the DASH-Score (0 = very good, 100 = very poor), grip strength according to Jamar dynamometer (kg), vibration sensation measured with a 128 Hz tuning fork.

The following findings were obsevred-

a. The pain on VAS in group A was reduced significantly. 3.6 ± 2.0 to 2.4 ± 2.1 (−33%, p = 0.013), and from 3.7 ± 2.4 to 2.2 ± 1.9 (−41%, p = 0.004) in group B after 12 weeks.

b. There was no significant difference between A and B (p = 0.899).

c. In both groups, there was a significant improvement of the DASH-Score (A: 32 ± 15 to 14 ± 12, −56%, p < 0.001; B: 27 ± 12 to 12 ± 11, −55%, p = 0.001) without any difference between groups A and B (p = 0.339).

d. Grip strength improvement in group A from 24 ± 12 to 33 ± 11 kg (+38%, p < 0.001), and from 29 ± 14 to 34 ± 11 kg (+15%, p < 0.001) in group B.

e. In line, vibration sensation improved in both groups (A: 6.3 ± 0.6 to 6.5 ± 0.5, p = 0.0001; B: 6.3 ± 0.7 to 6.6 ± 0.5, p = 0.003).

As a result, it was concluded that patients with lateral epicondylitis, which are more likely to have proprioceptive deficits as shown in other trials, active vibration training could cause an improvement of the proprioception itself as well as an improvement of grip strength, functionality and in particular pain reduction.

Schiffke-Juhász, B., Knobloch, K., Vogt, P.M. et al. Proprioceptive elbow training reduces pain and improves function in painful lateral epicondylitis—a prospective trial. J Orthop Surg Res 16, 468 (2021). https://doi.org/10.1186/s13018-021-02602-3