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The Somatic Connection  |   January 2016
Muscle Energy Technique Improves Chronic Lateral Epicondylitis
Author Affiliations
  • Christine Koh, OMS III
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California
  • Michael A. Seffinger, DO
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California
Article Information
The Somatic Connection   |   January 2016
Muscle Energy Technique Improves Chronic Lateral Epicondylitis
The Journal of the American Osteopathic Association, January 2016, Vol. 116, 58. doi:10.7556/jaoa.2016.012
The Journal of the American Osteopathic Association, January 2016, Vol. 116, 58. doi:10.7556/jaoa.2016.012
Kűçűkşen S, Yilmaz H, Sallı A, Uğurlu H. Muscle energy technique versus corticosteroid injection for management of chronic lateral epicondylitis: randomized controlled trial with 1-year follow-up. Arch Phys Med Rehabil. 2013;94(11):2068-2074. 
Lateral epicondylitis (LE) is the most commonly diagnosed elbow condition, affecting an estimated 1% to 3% of the population.1 Proposed treatments are numerous; however, multiple reviews have revealed insufficient evidence to determine which modalities are most effective.2-6 Researchers from Turkey investigated the efficacy of muscle energy techniques (MET) compared with corticosteroid injections (CSI) for the management of chronic LE. 
Eighty-two participants with chronic LE, as determined by an allopathic physiatrist, were randomly allocated to the MET group (n=41; 23 women; mean [SD] age, 46.17 [7.56] years) or CSI group (n=41; 22 women; mean [SD] age, 43.78 [9.16] years). Inclusion criteria included tenderness over or near the lateral epicondyle, pain elicited with at least 2 of 3 pain provocation tests, unilateral pain lasting more than 3 months, and pain greater than or equal to 50 mm on a 100-mm visual analog scale. Patients were excluded if they were surgically treated for elbow complaints, received physical therapy or CSI in the past 6 months, had bilateral elbow symptoms, or had elbow pain for less than 3 months. 
Participants in the MET group received MET twice per week for 4 consecutive weeks from another physiatrist. Participants in the CSI group were injected with 1 mL of triamcinolone acetonide (4 mg/mL) plus 1 mL of 1% lidocaine (10 mg/mL), 1 cm distally from the lateral epicondyle. 
Patients were assessed with 3 standard outcome measures at baseline, 6, 26, and 52 weeks. Compared with baseline scores, mean pain-free grip strength scores in the MET group were significantly lower than the CSI group at 6 weeks (P=.005) but higher at 52 weeks (P=.007). Mean pain scale scores were significantly higher in the MET group than the CSI group at 6 weeks (P=.004) but were significantly lower at 26 and 52 weeks (P=.016 and P=.01, respectively). There were no statistically significant differences between the groups in their Disabilities of the Arm, Shoulder, and Hand (DASH) self-reported questionnaire scores. 
Overall, both MET and CSI improved the strength, pain, and functional status of patients with LE. As a short-term therapeutic option, CSI may be used to reduce pain and return strength. However, MET may be a superior modality in the management of chronic LE. 
References
Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006; 164(11): 1065-1074. [CrossRef] [PubMed]
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Buchbinder R, Green SE, Youd JM, Assendelft WJ, Barnsley L, Smidt N. Shock wave therapy for lateral elbow pain. Cochrane Database Syst Rev. 2005;(4): CD003524.
Buchbinder R, Johnston RV, Barnsley L, Assendelft WJ, Bell SN, Smidt N. Surgery for lateral elbow pain. Cochrane Database Syst Rev. 2011;(3): CD003525. doi:10.1002/14651858.CD003525.pub2.
Brosseau L, Casimiro L, Milne S, et al. Deep transverse friction massage for treating tendinitis. Cochrane Database Syst Rev. 2002;(1): CD003528.