Tennis elbow: get a corticosteroid injection, wait it out, or physical therapy?
Since COVID-19, we’ve seen two things: more people working from home, and more people hitting the tennis courts. The commonality between the two? Tennis elbow.
Tennis elbow, or lateral epicondylitis, characterized by outer elbow pain often associated with repetitive overuse of the wrist extensors, will affect 50% of all tennis players, but accounts for only 5% of all reported cases—meaning tennis elbow can most definitely happen to even those who never pick up a racket (ie. those who use a computer mouse all day).
The study:
A randomized controlled trial study by Bisset et al compared three different approaches to treating tennis elbow. 198 participants were allocated into three different groups:
Group 1: The wait-and-see group, or control group (participants received no treatment);
Group 2: The injection group (participants received a corticosteroid injection);
Group 3: The physical therapy group (participants received eight physical therapy sessions over six weeks)
The results:
By six weeks, the injection group had the greatest improvements in pain levels and pain-free grip force when compared to both the wait-and-see group and physical therapy group.
By six weeks, the physical therapy group, which combined elbow manipulation and exercise, showed greater improvements in pain levels and grip strength when compared to the wait-and-see group.
AFTER six weeks, 72% of participants in the injection group experienced a significant regression of outcomes, with increased pain and weakened grip strength.
After one year, the physical therapy and wait-and-see groups continued to experience improved function and grip strength, with outcomes more successful than the injection group.
What it means:
Physical therapy and corticosteroid injections show improved patient outcomes compared to waiting things out in the short term (within six weeks), but in the long term, injections may be inferior to physical therapy and waiting things out. Caution is advised if choosing to receive a corticosteroid injection, as the study showed 72% of participants experiencing a regression of symptoms.
Short-term winner: corticosteroid injection > physical therapy > wait-and-see
Long-term winner: physical therapy > wait-and-see > corticosteroid injection
Conclusively, the research data suggests that physical therapy is the best-fit treatment option for tennis elbow, since it shows favorable short- and long-term outcomes, as well as being the safer option, when compared to corticosteroid treatment and waiting things out.
Check out our video below to see some examples of mid-stage tennis elbow rehab exercises.
REFERENCES:
Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. Br Med J. 2006;333:939–941. doi: 10.1136/bmj.38961.584653.AE.