Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: Randomised trial

Leanne Bisset, Elaine Beller, Gwendolen Jull, Peter Brooks, Ross Darnell, Bill Vicenzino

Research output: Contribution to journalArticleResearchpeer-review

266 Citations (Scopus)

Abstract

Objective To investigate the efficacy of physiotherapy compared with a wait and see approach or corticosteroid injections over 52 weeks in tennis elbow.

Design Single blind randomised controlled trial.

Setting Community setting, Brisbane, Australia.

Participants 198 participants aged 18 to 65 years with a clinical diagnosis of tennis elbow of a minimum six weeks' duration, who had not received any other active treatment by a health practitioner in the previous six months.

Interventions Eight sessions of physiotherapy; corticosteroid injections; or wait and see.

Main outcome measures Global improvement, grip force, and assessor's rating of severity measured at baseline, six weeks, and 52 weeks.

Results Corticosteroid injection showed significantly better effects at six weeks but with high recurrence rates thereafter (47/65 of successes subsequently regressed) and significantly poorer outcomes in the long term compared with physiotherapy. Physiotherapy was Superior to wait and see in the short term: no difference was seen at 52 weeks, when most participants in both groups reported a successful outcome. Participants who had physiotherapy Sought less additional treatment, such as non-steroidal anti-inflammatory drugs, than did participants who had wait and see or injections.

Conclusion Physiotherapy combining elbow manipulation and exercise has a Superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term. The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in die management of tennis elbow.

Original languageEnglish
Pages (from-to)939-941
Number of pages5
JournalBritish Medical Journal
Volume333
Issue number7575
DOIs
Publication statusPublished - 4 Nov 2006
Externally publishedYes

Cite this

Bisset, Leanne ; Beller, Elaine ; Jull, Gwendolen ; Brooks, Peter ; Darnell, Ross ; Vicenzino, Bill. / Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow : Randomised trial. In: British Medical Journal. 2006 ; Vol. 333, No. 7575. pp. 939-941.
@article{d12cb2ba72704b55bf3d821fe07bacd1,
title = "Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: Randomised trial",
abstract = "Objective To investigate the efficacy of physiotherapy compared with a wait and see approach or corticosteroid injections over 52 weeks in tennis elbow.Design Single blind randomised controlled trial.Setting Community setting, Brisbane, Australia.Participants 198 participants aged 18 to 65 years with a clinical diagnosis of tennis elbow of a minimum six weeks' duration, who had not received any other active treatment by a health practitioner in the previous six months.Interventions Eight sessions of physiotherapy; corticosteroid injections; or wait and see.Main outcome measures Global improvement, grip force, and assessor's rating of severity measured at baseline, six weeks, and 52 weeks.Results Corticosteroid injection showed significantly better effects at six weeks but with high recurrence rates thereafter (47/65 of successes subsequently regressed) and significantly poorer outcomes in the long term compared with physiotherapy. Physiotherapy was Superior to wait and see in the short term: no difference was seen at 52 weeks, when most participants in both groups reported a successful outcome. Participants who had physiotherapy Sought less additional treatment, such as non-steroidal anti-inflammatory drugs, than did participants who had wait and see or injections.Conclusion Physiotherapy combining elbow manipulation and exercise has a Superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term. The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in die management of tennis elbow.",
author = "Leanne Bisset and Elaine Beller and Gwendolen Jull and Peter Brooks and Ross Darnell and Bill Vicenzino",
year = "2006",
month = "11",
day = "4",
doi = "10.1136/bmj.38961.584653.AE",
language = "English",
volume = "333",
pages = "939--941",
journal = "BMJ (Clinical research ed.)",
issn = "0959-535X",
publisher = "BMJ Publishing Group",
number = "7575",

}

Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow : Randomised trial. / Bisset, Leanne; Beller, Elaine; Jull, Gwendolen; Brooks, Peter; Darnell, Ross; Vicenzino, Bill.

In: British Medical Journal, Vol. 333, No. 7575, 04.11.2006, p. 939-941.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow

T2 - Randomised trial

AU - Bisset, Leanne

AU - Beller, Elaine

AU - Jull, Gwendolen

AU - Brooks, Peter

AU - Darnell, Ross

AU - Vicenzino, Bill

PY - 2006/11/4

Y1 - 2006/11/4

N2 - Objective To investigate the efficacy of physiotherapy compared with a wait and see approach or corticosteroid injections over 52 weeks in tennis elbow.Design Single blind randomised controlled trial.Setting Community setting, Brisbane, Australia.Participants 198 participants aged 18 to 65 years with a clinical diagnosis of tennis elbow of a minimum six weeks' duration, who had not received any other active treatment by a health practitioner in the previous six months.Interventions Eight sessions of physiotherapy; corticosteroid injections; or wait and see.Main outcome measures Global improvement, grip force, and assessor's rating of severity measured at baseline, six weeks, and 52 weeks.Results Corticosteroid injection showed significantly better effects at six weeks but with high recurrence rates thereafter (47/65 of successes subsequently regressed) and significantly poorer outcomes in the long term compared with physiotherapy. Physiotherapy was Superior to wait and see in the short term: no difference was seen at 52 weeks, when most participants in both groups reported a successful outcome. Participants who had physiotherapy Sought less additional treatment, such as non-steroidal anti-inflammatory drugs, than did participants who had wait and see or injections.Conclusion Physiotherapy combining elbow manipulation and exercise has a Superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term. The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in die management of tennis elbow.

AB - Objective To investigate the efficacy of physiotherapy compared with a wait and see approach or corticosteroid injections over 52 weeks in tennis elbow.Design Single blind randomised controlled trial.Setting Community setting, Brisbane, Australia.Participants 198 participants aged 18 to 65 years with a clinical diagnosis of tennis elbow of a minimum six weeks' duration, who had not received any other active treatment by a health practitioner in the previous six months.Interventions Eight sessions of physiotherapy; corticosteroid injections; or wait and see.Main outcome measures Global improvement, grip force, and assessor's rating of severity measured at baseline, six weeks, and 52 weeks.Results Corticosteroid injection showed significantly better effects at six weeks but with high recurrence rates thereafter (47/65 of successes subsequently regressed) and significantly poorer outcomes in the long term compared with physiotherapy. Physiotherapy was Superior to wait and see in the short term: no difference was seen at 52 weeks, when most participants in both groups reported a successful outcome. Participants who had physiotherapy Sought less additional treatment, such as non-steroidal anti-inflammatory drugs, than did participants who had wait and see or injections.Conclusion Physiotherapy combining elbow manipulation and exercise has a Superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term. The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in die management of tennis elbow.

U2 - 10.1136/bmj.38961.584653.AE

DO - 10.1136/bmj.38961.584653.AE

M3 - Article

VL - 333

SP - 939

EP - 941

JO - BMJ (Clinical research ed.)

JF - BMJ (Clinical research ed.)

SN - 0959-535X

IS - 7575

ER -