Rest as Good as Therapy in Aching Tennis Elbow

Study finds those taking steroids recover more slowly

FRIDAY, Feb. 22, 2002 (HealthDayNews) -- Simply resting your racket arm gives you an equally sporting chance of recovering from tennis elbow as does physical therapy.

A new study by Dutch researchers says that while corticosteroid injections work best in the short run, by the end of a year fewer players have tennis elbow symptoms if they've undergone physical therapy or merely waited out the pain. A report on the findings appears in tomorrow's issue of The Lancet.

Tennis elbow, or lateral epicondylitis, is a misnomer. Although half of all tennis players will develop the condition, they make up only about 5 percent of people with the joint disorder, according to the American College of Sports Medicine. The vast bulk of cases are overuse injuries associated with arm tools like hammers and screwdrivers.

Also inaccurate is the notion that tennis elbow is always a bout of acute tendon swelling. In fact, the pain is usually not accompanied by inflammation, suggesting that tiny tears in the muscle surrounding the joint may be to blame for the discomfort, the sports medicine group says.

A team led by Nynke Smidt, a physical therapist and epidemiologist at Vrije University in Amsterdam, followed 185 men and women, aged 41 to 54, with tennis elbow. The volunteers, who'd had at least six weeks of pain before entering the study, were divided into three groups: some were given up to three shots of corticosteroids, some received six weeks of intense physical therapy, and the rest were told to ride out the discomfort, taking painkillers if necessary.

To assess the effectiveness of the interventions, the volunteers were asked to rate their symptoms, including elbow pain, grip strength, disability and general inconvenience from their injury.

After six weeks, the injections were clearly more effective, with 92 percent of the people reporting full or nearly complete recovery. At the same time, only about half of those receiving physical therapy, and a third of those in the wait-and-see group, had improved so well.

However, as the study wore on the results shifted sharply. By 12 weeks, 40 percent of the people who got shots had suffered relapses, Smidt says. After a year, 69 percent of those in the injection group had recovered, compared with 91 percent of those who got physical therapy and 83 percent of those who did nothing. However, the difference between the last two groups was statistically marginal, Smidt says.

Those who didn't get treatment in the early weeks of the study were also far less likely than the other volunteers to require additional therapy as it progressed. They had reported far fewer adverse reactions, such as increased or radiating pain.

One reason for the worsening outcomes with shots is their effectiveness, meaning players may take to the court before their injuries have truly healed.

"We don't know if the injection is harmful or if patients are maybe overtaxing their elbows," Smidt says. Finding out may be the focus of her next study.

In the meantime, Smidt recommends the conservative approach: "We only recommend a wait-and-see policy, and not to go directly to the physical therapy. But no injections. I'm absolutely sure that I don't want to have an injection."

Dr. Jon Schriner, an assistant professor of medicine at Michigan State University and medical director of the Michigan Center for Athletic Medicine, says he also tends to be conservative when it comes to treating tennis elbow and its near cousin, golf elbow.

Schriner says he typically recommends a regimen of icing, stretching and strengthening exercises. Only in the most severe cases does he suggest surgery. "There's a whole program that [patients] virtually have to buy into or they'll be back," he says.

Schriner says he offers corticosteroids, but usually not as a first-line treatment. "If I inject [a patient], it's a magic trick and within four to six days they feel golden. Then they go out and tear something worse."

What To Do

To learn more about tennis elbow, check out the Nicholas Institute of Sports Medicine and Athletic Trauma or the American College of Sports Medicine.

SOURCES: Interviews with Nynke Smidt, Ph.D., Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam; Jon Schriner, D.O., assistant professor, medicine, Michigan State University, East Lansing, and medical director, Michigan Center for Athletic Medicine, Flint; American College of Sports Medicine; Feb. 23, 2002, The Lancet
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